Researcher Discusses Autism in Young Adults

Our understanding of autism has changed significantly in recent years. Previously viewed as a rare childhood disorder with a focus on deficits and pathology, autism is now recognized as a common, lifelong, and heterogeneous condition characterized by a broad spectrum of strengths and challenges. With the increasing number of autistic adults, and especially women, a better understanding of autism in young adulthood for autistic women and men is warranted.

In her dissertation, Miriam Martini, a PhD student at the Department of Medical Epidemiology and Biostatistics at Karolinska Institutet, aimed to better understand the factors that contribute to autism persisting into adulthood. She also wanted to identify what mental and physical health problems autistic women and men may face around the timing of autism diagnosis and during the challenging transition to adulthood, and how mental and physical health problems influence each other. By comparing autistic individuals to non-autistic individuals and investigating how autistic women and men differ from each other, the dissertation aimed to better support the needs of the autistic community.

In this interview she discusses her findings.

What are the main results of your thesis?

We see that genetic factors can be important in development. Autism is highly heritable from childhood to adulthood, with genetic factors contributing to its stability over time. Interestingly, while some genetic influences remain stable over time, new ones can emerge as individuals age. Importantly, the thesis highlights complex health issues in autistic individuals, particularly in relation to mental health issues, as they transition into adulthood.

As a group, autistic individuals are at increased risk of being diagnosed with or hospitalized for psychiatric problems compared to non-autistic individuals between the ages of 16 and 25. We also show associations between childhood medical conditions and psychiatric conditions between the ages of 16 and 25, as well as associations between childhood psychiatric conditions and adult medical conditions in autistic individuals. In terms of sex differences, we found that autistic females are at particular risk. Compared to autistic males, they show higher rates of psychiatric diagnoses prior to autism diagnosis that appear more persistent and are associated with increased risk for psychiatric diagnoses and hospitalizations in young adulthood.

Why did you become interested in this subject?

My interest in this topic stems from my background in psychology and an internship in autism research during my studies, where I became particularly interested in autism after childhood and its strong association with mental health. As I learned more about the gender health data gap, I recognized the unique opportunity that large register data in Sweden provide for epidemiological research, particularly in investigating sex differences.

I am very passionate about improving mental health, particularly for people who face significant challenges in this area. I hope that my work contributes to better mental health care and support for autistic people, and in particular autistic women, who are often overlooked or excluded from services for a variety of reasons.

What do you think should be done in research in the future?

There is an urgent need to expand mental health care for autistic individuals, particularly during the transition to adulthood. Furthermore, care should be tailored to the specific needs of both autistic women and men, ultimately improving their long-term health and quality of life.

To achieve this, healthcare providers need to provide more education about autism and neurodevelopmental disorders so that they can better recognize the unique manifestations of mental and physical health problems in autistic individuals. This will improve the differential diagnosis and treatment of these co-occurring conditions.

Collaboration with the autistic community, carers and healthcare professionals is essential to ensure that research is translated into practical, person-centred care strategies that meet the complex needs of autistic individuals across their lives.