Our understanding of autism has changed significantly in the past years. Previously viewed as a rare childhood disorder with a focus on deficits and pathology, autism is now recognized as a common, lifelong and heterogenous condition characterized by a broad spectrum of strengths and challenges. With increasing numbers of autistic adults and in particular females, a better understanding of autism in young adulthood for autistic females and males is warranted.
In her thesis, Miriam Martini, PhD student at the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, aimed to gain a better understanding of the factors that contribute to autism continuing into adulthood. She also aimed to identify which mental and physical health problems autistic females and males might be struggling with 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 nonautistic individuals and exploring how autistic females and males differ from each other, the thesis aimed to better support the needs of the autistic community.
What are the most important results in your thesis?
"We see that genetic factors might be important across development. Autism is highly heritable from childhood into 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 challenges in autistic individuals, particularly with regards to mental health problems, as they transition to adulthood. As a group, autistic individuals are at a higher risk to be diagnosed with or hospitalized for psychiatric difficulties compared to nonautistic individuals between ages 16 and 25. We also show associations between childhood somatic conditions and psychiatric conditions between 16 and 25, as well as associations between childhood psychiatric conditions and adult somatic conditions in autistic individuals. Regarding sex differences, we found autistic females to be particularly at risk. Compared to autistic males, they show higher rates of psychiatric diagnoses before autism diagnosis that seem more persistent and show an increased risk for psychiatric diagnoses and hospitalizations in young adulthood."
Why did you become interested in this topic?
"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 beyond childhood and its strong association with mental health. As I learned more about the gender health data gap, I recognized the unique opportunity large register data in Sweden provides for epidemiological research, especially in examining sex differences. I am very passionate about improving mental health outcomes, particularly for those who face significant challenges in this area and I hope my work contributes to better mental health care and support for autistic individuals, and particularly autistic females, who are often overlooked or excluded from services because of various reasons. "
What do you think should be done in future research?
"There is a critical need to expand mental health services for autistic individuals, particularly during the transition to adulthood. Additionally, care must be tailored to address the specific needs of both autistic females and males, ultimately improving their long-term health and quality of life. To achieve this, healthcare providers require more education on autism and neurodevelopmental conditions to better recognize the unique manifestations of mental and physical health issues in autistic individuals, which will improve differential diagnosis and treatment of these co-occurring conditions. Collaboration with the autistic community, caregivers, and healthcare professionals is essential to ensure research translates into practical, person-centered care strategies, meeting the complex needs of autistic individuals across their lifespans."
Doctoral thesis
Autism in young adulthood: etiology, health outcomes and sex differences.
Miriam Martini. Karolinska Institutet (2024), ISBN: 978-91-8017-715-3
