"Anxiety and depression in adults with autism spectrum disorder" research reviewed and meta-analysed

I'm only making a fairly brief post today around the paper published by Matthew Hollocks and colleagues [1] titled: "Anxiety and depression in adults with autism spectrum disorder: a systematic review and meta-analysis."

Brief, because their results - "The pooled estimation of current and lifetime prevalence for adults with ASD [autism spectrum disorder] were 27% and 42% for any anxiety disorder, and 23% and 37% for depressive disorder" - were not entirely unexpected (see here and see here for examples) despite the 'gathered together' literature suffering from "a high degree of heterogeneity in study method and an overreliance on clinical samples."

I've said it before and I'll say it again, the [research] conversation now needs to move in a different direction to answer a couple of key questions in this area: (1) why are anxiety and depression so over-represented when it comes to autism? and (2) what are the most effective strategies to combat such issues in the context of a diagnosis of autism?

My opinion? I'm inclined to suggest that anxiety and depression are going to be present for a myriad of different reasons. I know people talk about life experiences as being important to their presentation of such symptoms and I'm not disagreeing at all. I'm inclined however to also suspect that the use of the word 'comorbidity' in respect of anxiety and depression in the context of autism is not altogether accurate. There is ample evidence in the peer-reviewed domain to suggest for example, that some of the core features of autism may actually 'heighten' the risk of depression and anxiety occurring (see here and see here). The nature of any relationship between core symptoms and things like depression and/or anxiety are likely to be complex and probably include aspects such as self-attention and brooding [2] and other related concepts such an intolerance of uncertainty (see here) and perhaps even something more pathological (see here). As unpalatable as this might be to some, the accompanying data from those who 'lost their diagnosis' (see here) supports the need for further investigations into this area...

And whilst on the topic of 'comorbidity', the paper by Eric Rubenstein  & Lauren Bishop‐Fitzpatrick [3] is definitely timely...

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[1] Hollocks MJ. et al. Anxiety and depression in adults with autism spectrum disorder: a systematic review and meta-analysis. Psychol Med. 2018 Sep 4:1-14.

[2] Burns A. et al. Self-Focused Attention and Depressive Symptoms in Adults with Autistic Spectrum Disorder (ASD). J Autism Dev Disord. 2018 Sep 14.

[3] Rubenstein E. & Bishop-Fitzpatrick L. A Matter of Time: The Necessity of Temporal Language in Research on Health Conditions that Present with Autism Spectrum Disorder. Autism Res. 2018 Sep 5.

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