Autism spectrum disorder and psychiatric comorbidities in childhood and adolescence: An integrative review

Abstract

Background: Children and adolescents with autism spectrum disorder (ASD) often have additional psychiatric conditions, but the evidence is scattered across designs and disorders. Methods: We conducted an integrative review following the Whittemore and Knafl framework, with PRISMA 2020 items for reporting. PubMed and Consensus were searched on 17 October 2026 for English-language studies published from 2021 to 2026. Of 299 records, 81 studies were included (38 systematic reviews, 41 observational studies, 1 randomized trial, and 1 guideline proposal). Results: Psychiatric comorbidity was common. Pooled estimates from population-based studies were 26.2% for ADHD, 11.1% for anxiety disorders, and 2.7% for depression, and clinical, surveillance, or claims samples gave higher figures. ADHD and anxiety were the conditions most often reported, whereas cohort data showed depressive and psychotic disorders appearing more often toward adolescence. About one in four autistic youth reported suicidal ideation. Cognitive behavioral therapy was the best supported treatment for anxiety, and evidence for ADHD medication was of low certainty. Conclusions: The findings support considering repeated psychiatric screening across development. Priorities are validated measures, tri als for depression, obsessive-compulsive disorder, and psychosis, and data from low- and middle-income countries.