Clinical Profiles and Biological Mechanisms of Older Autistic Adults

2026 Award: $200,000

Although autism spectrum disorder (ASD) is a life-long condition, nearly all ASD research has focused on children, and almost no research has included older autistic adults. Older autistic adults have a far higher risk for parkinsonism that leads to worse psychosocial, physical health, cognitive, and mental health outcomes. However, the biological mechanisms underlying the link between parkinsonism and ASD have not been studied.

Need/Problem: Although autism spectrum disorder (ASD) is a life-long condition, nearly all ASD research has focused on children, and almost no research has included older autistic adults. Thus, there is almost no knowledge of: (1) psychiatric comorbidities in the aging subset of the autistic population, (2) evidence-based psychiatric care for aging autistic individuals; or (3) training needs for service providers of this population. There is therefore a critical need for research on older autistic adults to address an important and prevalent public health issue. Recent data from multiple independent studies indicate that autistic older adults have a far higher risk for parkinsonism that leads to worse psychosocial, physical health, cognitive, and mental health outcomes. These associations have critical implications for clinical care, healthcare policy, and understanding the shared pathogenetic mechanisms underlying ASD and parkinsonism. However, the biological mechanisms underlying the link between parkinsonism and ASD have not been studied.

Grant Summary: Recent data from multiple independent studies indicate that autistic older adults have a significantly higher risk of developing parkinsonism than the general population. This association has critical implications for clinical care, healthcare policy, and understanding the shared pathogenetic mechanisms underlying autism and parkinsonism. This proposal aims to examine clinical profiles and biological mechanisms of older autistic adults with parkinsonism by comparing three groups: older autistic adults with parkinsonism, older autistic adults without parkinsonism, and typically developing control adults. Older autistic adults will be recruited from a unique North Carolina statewide outpatient clinic cohort of autistic adults diagnosed in childhood, beginning in 1960.

Goals & Projected Outcomes: The primary goals are to establish the safety, feasibility, and tolerability of accelerated piTMS and to estimate its preliminary clinical efficacy relative to standardBy addressing critical gaps in understanding autism in older adulthood, this project has the potential to inform interventions, services, workforce training, and public health policy while also elucidating pathogenic mechanisms underlying the co-occurrence of autism and parkinsonism.