Autism and Medical & Psychiatric Conditions

Autism Spectrum Disorder (ASD) often concurrently presents with other psychiatric disorders and medical conditions (this is referred to as comorbidity). Although estimations vary, 10% of children and young adults with ASD are estimated to present with at least one medical condition such as seizures, gastrointestinal issues, and auditory disorders and related infections (Kohane, 2012). Studies have also supported high rates of comorbidity with mental health conditions (e.g., ADHD/ADD, Intellectual Disabilities, Anxiety Disorders, and Obsessive Compulsive Disorders) (Croen, 2015). It is important to identify co-occurring conditions because targeted, multidisciplinary treatment interventions can offer the most benefits. We will discuss ASD and other medical and psychological conditions among children, teens, and adults.

Medical Conditions and Autism

Gastrointestinal Disorders

Gastrointestinal disorders (like chronic constipation, bowel inflammation) occur at higher rates among individuals with ASD relative to the general population. GI disorders are estimated to occur among 9 to 70% of individuals with ASD (Tye et al., 2019). GI Disorders may have a bidirectional relationship with food restrictions, a common restricted or repetitive behavior (RRB) among individuals with ASD (Autism Speaks, 2017). Various theories (e.g., immune dysfunction as one of the etiologies) have been suggested to explain the link between Autism Spectrum Disorder and GI Disorders (Tye et al., 2019). Additional research is needed to provider further evidence of causal factors. If ongoing GI symptoms (e.g., chronic diarrhea, stomach pains) are suspected, these can be signs of a more chronic GI issue among individuals with ASD.

Epilepsy and Seizures

Seizure disorders are estimated to occur in as high as one out of three individuals with ASD (Tye et al., 2019). Different types of seizures (e.g., partial, complex partial) have been correlated with ASD but with varying prevalence estimations. Notably, specific genetic disorders (e.g., Angelman Syndrome) associated with epilepsy occur at higher rates among individuals with ASD as well. Although associated with one another, scientific evidence does not support a directional link between epilepsy and Autism (Tye et al., 2019.) Symptoms of epilepsy to be aware of include changes in cognition, unexplained staring, involuntary motor changes, and headaches (Autism Speaks, 2017).

Mental Health Conditions and Autism

Attention Deficit Hyperactivity Disorder

Some research has estimated the prevalence rate of ADHD with ASD to be between 30 to 50% (Leitner, 2014). It can be difficult to fully differentiate ADHD symptoms from ASD, and this usually requires a trained psychologist and standardized testing in both areas to identify co-occurrence. When compared to just a single diagnosis of ADHD or ASD, both ASD and ADHD have been associated with greater impairments in functioning (social, physical, emotional) (Leitner, 2014). Signs and symptoms of both ASD and ADHD may include greater difficulties with activities of daily living, aggression, self-injury, and difficulties concentrating even when not interacting socially.

Anxiety and Depressive Disorders

It is estimated that between 11 and 42% of individuals with Autism also exhibit Anxiety Disorder symptoms. Anxiety Disorders include Separation Anxiety Disorder, Social Anxiety Disorder, Panic Disorder, and Specific Phobias. Depressive Disorders are estimated to impact 7% of children and 26% of adults with Autism (Autism Speaks, 2017).

It can be difficult to assess Anxiety and Depressive Disorders among individuals with Autism due to verbal communication deficits and a lack of identification of internal states. Therefore, an accurate mood and anxiety disorder assessment should include measures consistent with the individual’s intellectual and verbal/nonverbal communication abilities. Parents or caretakers should also be involved in the assessment of symptoms, with the client’s granted permission if they/she/he is an adult, when possible.

Signs of Anxiety Disorders may include active avoidance of specific situations (e.g., social situations); more than typical self-stimulation in specific situations; and increased distress (e.g., tantrums, changes in mood) in specific situations. Signs of Depressive Disorder symptoms include increased withdrawal, greater fatigue, and less interest in previously enjoyed activities.

Summary

Autism Spectrum Disorder is a complex neurodevelopmental condition that can present with additional medical (seizures, GI disorders) and psychological conditions (ADHD, Anxiety, Depression). Although ASD is a lifelong condition, when diagnosed and treated, symptoms and impairments in functioning can improve. For more information on Autism Spectrum Disorder, please visit: https://www.autismspeaks.org/what-autism

Para información sobre Autismo en español, por favor visite: https://www.autismspeaks.org/que-es-el-autismo-espanol

References

Autism Speaks (2017). Autism and Health: A special report by Autism Speaks: Advances in understanding and treating the health conditions that frequently accompany Autism. https://www.autismspeaks.org/sites/default/files/2018-09/autism-and-health-report.pdf

Kohane, I. S., McMurry, A., Weber, G., MacFadden, D., Rappaport, L., Kunkel, L., Bickel, J., Wattanasin, N., Spence, S., Murphy, S., & Churchill, S. (2012). The co-morbidity burden of children and young adults with autism spectrum disorders. PloS one, 7(4), e33224. https://doi.org/10.1371/journal.pone.0033224

Leitner Y. (2014). The co-occurrence of autism and attention deficit hyperactivity disorder in children – what do we know?. Frontiers in human neuroscience, 8, 268. https://doi.org/10.3389/fnhum.2014.00268

Tye, C., Runicles, A.K., Whitehouse, A.J.O, & Alvares, G.A. (2019). Characterizing the Interplay Between Autism Spectrum Disorder and Comorbid Medical Conditions: An Integrative Review. Frontiers in Psychiatry, 9, 751. doi: https://doi.org/10.3389/fpsyt.2018.00751

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