Das psychosoziale Funktionsniveau spätdiagnostizierter Patienten mit Autismus-Spektrum-Störungen – eine retrospektive Untersuchung im Erwachsenenalter

 

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Zusammenfassung

Hintergund: Der hochfunktionale Autismus (HFA) sowie das Asperger-Syndrom (AS) gehören zu den Störungen aus dem Autismus-Spektrum (ASS), die durch seit der frühen Kindheit bestehende sozial-interaktionelle und kommunikative Störungen sowie restriktiv-stereotype Verhaltensweisen charakterisiert sind. In den letzten Jahren werden zunehmend Erstdiagnosen erst nach Erreichen des Erwachsenenalters gestellt (ASS-E). Beschreibungen des psychosozialen Funktionsniveaus dieser differenzialdiagnostisch zunehmend relevanten Gruppe von Betroffenen fehlen für den deutschen Sprachraum bisher weitgehend. Fragestellung: Wie ist das psychosoziale Funktionsniveau (Wohnsituation, Partnerschaften, Berufsausbildung, psychiatrische Vorgeschichte) spätdiagnostizierter ASS-E? Methodik: Aus der Inanspruchnahmepopulation der Kölner Spezialsprechstunde für ASS-E wurden in einer retrospektiven Analyse Angaben zur psychosozialen Situation sowie neuropsychologische und psychopathologische Merkmale von 178 Patienten mit einer zwischen den Jahren 2005 – 2009 erstmals diagnostizierten ASS-E ausgewertet. Ergebnisse: Bei 164 von 178 Patienten wurde ein HFA/AS (92 %) diagnostiziert. Das Verhältnis männlicher zu weiblichen ASS-E lag bei etwa 2:1. Bezüglich der Variablen Alter bei Diagnosestellung (34,1 ± 9,5 Jahre), Intelligenz-Quotient (Gesamt-IQ 115 ± 20) und Autismus-Spektrum-Quotient (AQ 39 ± 6) ließen sich keine Geschlechtsunterschiede erkennen. Über eine psychiatrische oder psychotherapeutische Vorbehandlung berichteten insgesamt 78 % der ASS-E. Ein Viertel der Betroffenen gab an, bereits im Kindes- und Jugendalter erstmals psychotherapeutische oder schulpsychologische Hilfen in Anspruch genommen zu haben. Depressive Symptome in mindestens milder Ausprägung (Beck-Depressions-Inventar [BDI] > 10) fanden sich bei 53 %, in klinisch-relevanter Ausprägung (BDI > 17) bei 30 % der Fälle. In selbstständigen Wohnsituationen oder zusammen mit Partner/Familie lebten 68 % der ASS-E. Über aktuelle oder zurückliegende partnerschaftliche Beziehungen berichteten 58 % der Betroffenen. Zwei Drittel besaßen einen akademischen bzw. beruflichen Abschluss oder befanden sich zum Diagnosezeitpunkt in entsprechenden Ausbildungen. Diskussion: Im Erwachsenenalter werden innerhalb des Autismus-Spektrums ganz überwiegend HFA/AS mit einem vergleichsweise hohen psychosozialen Funktionsniveau hinsichtlich Eigenständigkeit, Berufsausbildung und Fähigkeit zu Partnerschaften diagnostiziert. Die häufige Inanspruchnahme psychiatrischer und/oder psychotherapeutischer Behandlungen vor Diagnosestellung deutet darauf hin, dass die Betroffenen einen deutlichen Leidensdruck haben und unterstreicht zudem die Notwendigkeit, das Vorliegen einer ASS-E in die differenzialdiagnostischen Überlegungen mit einzubeziehen.

Abstract

Background: The first time diagnosis of autism spectrum disorder (ASD) after passing childhood and adolescence is still considered a rare event. However, in recent years an increasing demand for diagnostic clarifications with suspected ASD in adulthood challenges this view. There is insufficient knowledge about the neuropsychological characterisation and psychosocial outcome of this adult subgroup in the autistic spectrum. Aim: To determine the psychosocial functioning (living status, partnerships, level of education, psychiatric history) of adult patients with late diagnosed ASD.Methods: In a retrospective study, a chart review was conducted on 178 consecutively diagnosed individuals at a specialised outpatient clinic for adults with ASD. Global ratings of psychosocial functioning, assessment of psychiatric history and neuropsychological and psychopathological investigations were evaluated. Results: The majority of patients (92 %) diagnosed with ASD suffered from high-functioning autism (HFA)/Asperger syndrome (AS) according to the criteria of ICD-10 (F84.5). The gender ratio was 2:1 favouring males. Mean age at diagnosis (34.1 ± 9.5 years), general intelligence (HAWIE-R, global-IQ 115 ± 20) and self-rated autistic symptoms (autism spectrum quotient [AQ] 39 ± 6) were not discriminative to gender. The psychiatric history revealed a lifetime consultation rate of 78 %, most frequently with depression (50 %). The self-report instrument Beck depression inventory (BDI) identified 30 % of individuals presenting with depressive symptoms in clinical relevant intensity (BDI > 17). Achievement of an independent living status was reported by 68 % of individuals, 58 % reported about current or past intimate partnerships and almost two-thirds of the patients had achieved a higher educational status. Discussion: The majority of ASD diagnosed late in lifetime turned out to be HFA/AS, presenting with high psychosocial adjustment with regard to independent living, educational status and partnerships. The high level of global intelligence supports the hypothesis of cognitively compensated autistic disturbances leading to the diagnosis comparably late in lifetime. The lifetime rate of psychiatric consultations is high, reflecting the importance to consider a diagnosis of ASD even late in life.

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Dr. Fritz-Georg Lehnhardt

Klinik für Psychiatrie und Psychotherapie, Universitätsklinik Köln

Kerpenerstr. 62

50937 Köln

Email: Fritz-Georg.Lehnhardt@uk-koeln.de