Experts say detecting health conditions in autistic people with a learning disability should become a ‘clinical priority’ to reduce health inequalities.
The calls come following new research, published in The Lancet Regional Health – Europe, which found that common debilitating health conditions are underdiagnosed in autistic adults with a learning disability.
The research included 15,675 people diagnosed as autistic without a learning disability and 6,437 participants diagnosed as autistic with a learning disability. The data was taken from GP practices across the UK between 2000 and 2019.
The team of researchers then analysed whether autistic people experience similar rates of five common mental health conditions (anxiety, depression, self-harm, harmful alcohol use, and substance use), and three common physical health conditions (migraine, neck/back pain, and gynaecological issues), compared to people without an autism diagnosis.
Previous research has found that autistic adults are significantly more likely to experience more health conditions, but the GP records analysed did not reflect this.
For example, the new research showed that autistic adults with a learning disability were diagnosed much less frequently than the general population with conditions including depressive disorders, harmful alcohol use, migraine, and neck or back pain, yet studies show these conditions are more common in this group compared to the general population.
Additionally, autistic adults without a learning disability were found to be 80-90% more likely to receive a new diagnosis of anxiety or depression compared to the general population, but previous research shows older adults self-reporting autism characteristics in the UK were more than seven times as likely to have anxiety and five times as likely to report self-harm with suicidal intent.
The researchers say the results are likely explained by communication difficulties, as lead author Dr Elizabeth O’Nions explains: “Autistic adults, particularly those with a learning disability, often find it hard to communicate with GPs about how they are feeling. Some people with a learning disability may also not recognise the need to tell someone about a health condition. This means that conditions where signs can’t be readily observed and a person must describe what has been happening to them may go undiagnosed.”
“We can only infer that our results reflect under-diagnosis of common conditions by comparing our results to other studies, which were conducted in different settings. More work is needed to try to actively identify how common these health conditions really are in autistic and non-autistic people to provide more conclusive evidence that they are under-diagnosed,” she added.
The authors acknowledge limitations to their study, including the large proportion of undiagnosed autistic adults in the UK, meaning that the results of this study that focused on those with a diagnosis only may not generalise to all autistic people.
Dr O’Nions says there now needs to be more ‘thorough investigations’ to ensure that autistic people receive access to high quality care.
Corresponding author Professor Josh Stott said: “We believe that improved detection of health problems in autistic people, particularly those with learning disabilities, should be a clinical and policy priority to reduce health inequalities.”
