Yukie Tateno

Adolescents with autism spectrum disorder (ASD) often have various psychiatric comorbidities, particularly depression. In recent years, gaming disorder (GD) and Internet addiction (IA) have been identified as common comorbidities of ASD. We administered three self-administered screening instruments to adolescents with ASD to assess the severity of depression, GD, and IA. The participants were 10–18-year-olds with ASD. They were asked to complete three questionnaires to assess depressive symptoms, GD, and IA: the Patient Health Questionnaire for Adolescents (PHQ-A), Ten-Item Internet Gaming Disorder Test (IGDT-10), and Internet Addiction Test (IAT). The total IGDT-10 score was calculated in two different ways: the original scoring version (IGDT-10-OV) and the modified version (IGDT-10-MV). Of the 74 respondents, 24.3% had moderate or severe depressive symptoms, 8.1% were identified as having possible GD according to the IGDT-10-OV, 39.2% were identified as having possible GD according to the IGDT-10-MV, and 27.0% were positive for IA according to the IAT. Two-group comparisons revealed that depressive symptoms were more strongly associated with IA than with GD. IA was associated with more depressive symptoms than GD. Since adolescents with ASD have difficulties with social communication, they are prone to isolation and feelings of loneliness. Longer screen times due to social isolation may be a risk factor for the development of GD/IA. Adolescents with ASD often exhibit a preference for visual processing but may struggle with verbal communication. Thus, they may find online spaces more comfortable for them to alleviate their feelings of loneliness.

The association between autism spectrum disorder (ASD) and gender dysphoria (GD) has attracted a great deal of interest among child and adolescent psychiatrists in Japan. In clinical settings, it is common to hear complaints or concerns related to GD from adolescents with ASD. In the past few years, several review articles have been published on ASD and GD. The Initial Clinical Guidelines for co-occurring ASD and GD in adolescents were published in 2018, suggesting the increasing need of intervention for these conditions worldwide. Although a large amount of evidence has been accumulated regarding the co-occurrence of ASD and GD, all review articles were based solely on case reports and articles published in English. In this article, we performed a bilingual literature review using English- and Japanese-language literature databases. We found 13 case reports in English and 11 case reports in Japanese. The Japanese literature included articles on gender-related symptoms in ASD, but not limited to ASD with comorbid GD. Wattel and her colleagues proposed 15 theories on the link between ASD and GD. We classified the reported cases into one or more of the fifteen theories proposed by Wattel. These theories seemed useful in understanding the co-occurrence of ASD and GD, especially in AMAB cases. Wattel’s 15 theories are categorized into biological, psychological, and social factors, respectively. With regard to the social factors, we discussed Japanese school culture and psychological burden among gender-dysphoric students. Further studies are awaited.

Internet addiction (IA) is defined as the condition of being addicted to all sorts of activities on the Internet. Individuals with neurodevelopmental disorders, including autism spectrum disorder (ASD), may be susceptible to IA. Early detection and intervention for probable IA are important to prevent severe IA. In this study, we investigated the clinical usefulness of a short version of the Internet Addiction Test (s-IAT) for the screening of IA among autistic adolescents. The subjects were 104 adolescents with a confirmed diagnosis of ASD. They were requested to answer 20 questions from the original Internet Addiction Test (IAT). In the data analysis process, we comparatively calculated the sum of scores to the 12 questions of s-IAT. In total, 14 of the 104 subjects were diagnosed as having IA based on the face-to-face clinical interview that was regarded as the gold standard. Statistical analysis suggested that the optimal cut-off for s-IAT was at 35. When we applied the cut-off of 70 on the IAT, only 2 of 14 subjects (14.3%) with IA were screened positive, whereas 10 (71.4%) of them were screened by using the cut-off point of 35 on s-IAT. The s-IAT might be useful for the screening of IA in adolescents with ASD.