Autism Essentials: An Examination of Frequent Comorbid Conditions

We all have our own cross to bear in a strict manner of speaking. For some, this manifests itself in the form of a mental health condition. It is approximated that nearly one-fourth of the general populace struggles with one of the known mental health illnesses as presented in the DSM-V. Of these, 1 and 36 individuals suffer from the neurological disorder that is autism spectrum disorder. Bearing all this in mind, there are those among us whose burden — their cross to bear- is a little heavier for them to carry. Having any mental health condition in and of itself is difficult enough as it is. But try and envisage the trials and tribulations of having more than one diagnosis at the same time: for instance, having a working diagnosis of ASD with Schizophrenia or something of the likes. This is what we find in individuals that have what is known as comorbid conditions, or synonymously, co-concurring conditions; a comorbid condition being characteristically defined as a person having more than one disease or condition which are often chronic or long-term conditions. It is crucial to understand the presence of comorbid conditions when working with an autistic individual in any capacity, whether they are a loved one, or a clinical patient. This didactic article will underline and examine how comorbid conditions are frequently found in the demographic of the populace that has autism. Not only that, but it will expand on those ailments that are more commonly found in those living on the autistic spectrum. It is the overarching goal of this article that through awareness of the insights raised in the article, that those on the spectrum can find the therapies and treatments that not only lead to a better quality of life, but that consider the presence of these comorbid conditions adequately.

Even for a doctor that specializes in comorbid conditions it can be challenging work to make an accurate diagnosis seeing as to how they must consider all the overlapping symptoms of the conditions. For instance, the repetitive behaviors of autism can look very much like what we can expect to find in OCD; just as both schizophrenia and autism share poor eye contact, social withdrawal, and communication impairments. On that point, it is interesting to note the way that these ailments express themselves differently at different periods of time, almost in the same capacity as people express themselves. At one time interval, the symptoms of schizophrenia may express themselves more than the symptoms of autism and vice versa, which can make finding an adequate and accurate diagnosis even more difficult. What makes this tricky task even more trying is that common autistic comorbid conditions are not only just mental; combined there is a wide spectrum of other conditions that are frequently found in those with ASD which are also more physical in nature. The result of this is that even an entire treatment team can make mistakes in treating a co-concurring condition. One clear cut exemplification of this is found in the way gut problems normally accompany an autistic diagnosis. Thankfully, it has been discovered that there are generally a handful of common conditions that exist at the same time as autism that encompass mental, physical, neurological, and physiological health. For all intents and purposes, this article will first begin with a look at those mental ailments that are generally found alongside ASD.

Psychological Comorbidities

ADD/ADHD- Both ADD and ADHD seem almost to be an intrinsic part of the history of someone that has ASD. All three of these conditions share several common symptoms. The result of this is found in the way that children with autism are often misdiagnosed with ADD or ADHD in their vibrant youth, or similar that they have a comorbid condition with both conditions being present. What is interesting is that for those living with autism, that autism can seem like the opposite of both ADD or ADHD. While those with either ADD or ADHD have challenges in maintaining attention or focusing on a task, those on the spectrum can have an almost laser like focus on their intensified interests and repetitive behaviors. In either case, what is found in the demographic of individuals living with ASD is that the statistics show that around 30–50 percent of this population have both Autism and ADD or ADHD.

Anxiety- Anxiety is a symptom that is typical with those affected by ASD. What can be found is that those living on the spectrum generally struggle with a sense of generalized anxiety, to the extent that they almost seem to be over catastrophizing everything around them to extremes of the worse kind. In the case of this generalized anxiety, we find just one demonstration of where symptomology can overlap between conditions as this type of anxiety is also present in the case of OCD, schizophrenia, and bipolar disorder all respectively. So, it can be difficult making heads or tails of which disorder this symptom falls under. With all this being kept into consideration, it has been found that, statistically speaking, that around 30 percent of the autistic population is affected by anxiety disorders in one capacity or another, as compared to just 10 percent in the general population.

Depression — Those that have ASD are at high risk for self-harm and suicidal tendencies. This highlights the way that this group of people suffer from a sort of crippling depression, accompanied by terrific lows. Once again, we see an example of a mental health condition or symptom that imbricates one or several other mental health conditions. For example, depression of this extent can also be found in clinical depression as well as bipolar disorder. In the case of those with ASD and depression, it is estimated that nearly 26 percent of autistics struggle with depression as compared to 10 percent of the general population.

Intellectual Disabilities — In this instance of comorbidity, we see one of the greatest tribulations that has been found in all the research and studies conducted on individuals living with autism. This is found in the way that no two cases of the neurological disorder are the same. It is a condition that is based on an individual basis, with autism spanning across such a broad spectrum. One can say that autism is accompanied with intellectual deficiencies, and this would certainly be true, with some cases involving patients that are non-verbal and that have difficulties in areas of self-care. However, there are also those that are high functioning, with higher IQs and that are completely capable of academic success, holding jobs, and adapting to change. Again, we can see how difficult it is to measure all that accompanies an autistic diagnosis. It is made even more complicated because individuals with ASD are characteristically known for excelling in certain areas — often those areas that are associated with their intensified interests — and greatly struggling in other areas. So, it can be a struggle adequately measuring their intellectual capacity. Nevertheless, a study was conducted which concluded that nearly 32 percent of the autistic population also had intellectual disabilities.

OCD –Autism, along with is social impairments, is stereotypically known for its rigid and repetitive routines and behaviors. At the same time, OCD is typically defined as a condition that includes experiences of uncontrollable and recurring thoughts that are known as obsessions, in addition to engagement in repetitive behaviors, or both. Here, it becomes obvious how these two overlay one another as is consistent with many of the other ailments. It further reiterates the many complications that come with making an accurate diagnosis of not only autism, but of the conditions that may accompany it. In this instance, it seems the only way of making any distinction between the two is found in the way that the obsessions and intrusive thoughts of OCD are the cause of great anxiety and discomfort, whereas those behaviors of autism are self-soothing and help them to generally cope. Bearing all that in mind, it is not uncommon for these two conditions to exist at the same time. The figures showing the comorbidity of autism and OCD reveal that roughly 17 percent of this population are affected by both.

Schizophrenia — Just like ADD and ADHD, what we find is that autism is often misdiagnosed as schizophrenia as a result of the many overlapping symptoms. A study was conducted out of King’s College that concluded as much. As was discussed earlier in the article, both individual and distinct conditions can include social withdrawal, poor eye contact, communication impairments, as well as thought disorders in addition to paranoia. It is not uncommon that autism accompanies childhood onset schizophrenia. It is of the utmost important to find a clinician that is experienced in both conditions so that none of the characteristics of either condition is missed for the best treatment possible. It is calculated that approximately 7 percent of the autistic community is affected by schizophrenia as opposed to just 0.5 percent in the normal population.

Other: It is not uncommon for individuals with autism to also have a diagnosis of bipolar disorder. Once more, we see how it could be a very tricky task to separate the feelings of depression and anxiety intrinsically found in autism from the same symptoms found in a bipolar disorder diagnosis as it is a mood disorder that usually carries some of the same symptoms. Studies show that around 11 percent of the autistic demographic is affected by bipolar disorder as compared to just 2 percent of the general population. New studies and evidence also suggest that there might very well be a correlation between both the neurological disorders of ASD and dyslexia.

Neurological and Sensory Dysfunction

In this evaluation of comorbid conditions existing alongside an autism diagnosis, it is crucial to understand that the presence of comorbid conditions does not only occur in the area of mental health. It is a far-reaching problem that affects all areas of health, one of these being that of neurological ailments. Extensive research in this matter has revealed that neurological maladies appear more often and in greater abundance in those living on the spectrum than those that find themselves within the general population. Works such as, A Review of Traditional and Novel Treatments for Seizures in Autism Spectrum Disorder: Findings from a Systematic Review and Expert Panel, highlight one such common comorbidity found in ASD. Studies such as this have shown that epilepsy is highly prevalent amongst those living somewhere along the spectrum. When speaking on the topic, it is important to note the ways that the many different types of seizures can be challenging to target and identify; seizures including the likes of subclinical seizures or complex partial seizures which have been linked to behaviors such as staring off into space, engaging in repetitive behaviors, both of which are characteristic of individuals living with autism spectrum disorder. As a matter of fact, the mood stabilizer known as Depakote is not only used in many cases to treat autism and its other comorbid conditions but is also used in treating epilepsy. Be that is it may, it is believed that epilepsy affects approximately 35 percent of the autistic demographic, versus a mere 1 percent in the general population. Figures of this kind have also shown that somewhere around 60 percent of autistics struggle with abnormal electroencephalogram (EEG). Neurological comorbidities that also exist alongside autism include but are not limited to macrocephaly, cerebral palsy, hydrocephalus, autonomic nervous system dysfunction, migraines and headaches, and congenital abnormalities of the nervous system.

On another note, one cannot emphasize enough the trials and tribulations that autistic individuals suffer on account of sensory dysfunction. There is a relatively accurate video on YouTube that attempts to — rather successfully — show what it is like to live with this as a reality to life. The video shows the young Clark Kent struggling to adapt to the sensory stimuli of our earth, concluding with him saying that this world is too large. It is worth watching to see what it must be like for those living on the spectrum. At any rate, our five senses are the portals through which we perceive the world around us. What is found in the case of ASD is that often it is coupled with sensory dysfunction, especially when juxtaposed to the general population. This can manifest itself in being hyper or hypo sensitive to sensory stimuli. Just try and envisage a reality of being constantly bombarded and overwhelmed by the senses. To the autistic world, sensory input is like a constant attack on the individual. They are distracted and discomforted by every little sound; the chirping of birds out of the nearest window, the hustle and bustle of traffic outside, the tapping of a pen by the person in the room next to them, or the screeching of cartwheels at the shopping mart next door, all cascades down across them, and can be difficult for them to cope with. In the same way, everyday lights can shine like neon lights with the luminosity of the sun. In this way, normal everyday experiences are taken in on a completely different level for those on the spectrum. Consequently, what we find is that autistic individuals tend to live in their own little worlds, perhaps wearing headphones to block out the noise, which might very well be a way to help them cope with this problematic area of their life.

Genetic

In a scholarly article entitled, Autism medical comorbidities, as found in the World Journal of Clinical Pediatrics, author Mohammed Al-Betagi details and expands on the more common comorbidities found in autism as the title would suggest. One of the key areas of his research which is consistent with various other related sources is that autism is often accompanied with a cluster of differing genetic disorders. Once again, it can be observed that it is much more typical that these conditions occur with the presence of autism than they do in the general populace. Many of the comorbid conditions presented in this article are also included in Al-Betagi’s article. However, Al-Betagi’s article also lists the genetic disorders that are frequently found alongside ASD. The genetic disorders in question worth mentioning included but are by no means limited to Down syndrome (DS), Fragile X syndrome (FXS), neurofibromatosis, Duchenne muscular dystrophy, as well as that of tuberous scierosis complex (TSC). Of these, FXS is observed to be the most common exemplification of an intellectual disability that can be inherited. It has been observed that FXS in autistic individuals accompanied by atypical neural circuitry, causing for ASD symptoms such as can be found in impediments in everyday communications. The data that documents this relationship between the two disorders show that while 2–3 percent of individuals with autism also have FXS, that somewhere between 25 and 33 percent of those that have FXS also have autism. On the other hand, a kind of astronomical anomaly can be noted in the presence of Down syndrome and autism. This outlier several times removed is one of staggering proportions. Both of these conditions by themselves when they are set apart to stand alone are relatively rare. Autism on the one hand effects 1 and 36. DS is even more uncommon, appearing in only around 1/800 individuals. The surprising fact is that is seems more frequent than one might expect that autism appears in individuals with DS. Studies have shown that up to 40 percent of the individuals living with DS also have ASD to accompany it. What’s more, is that the research into this issue reveals that those who have both of these conditions existing at the same time are at an increased risk of also displaying other comorbidities than those with just one of these underlying ailments.

Gastrointestinal Coupled with Feeding and Eating Challenges

The subject matter of gastrointestinal problems in individuals with autism is one that could take up the space of an entire article onto itself, as it has in many instances. It is a trending topic and a major focus of interest for those working with autism spectrum disorder on any level. This comes at no surprise. The research on the matter is extensive, and the numbers show that gastrointestinal complications affect as much as 85 percent of the autistic community. Despite the many studies that have been conducted on the matter, it is confounding that the results are for the most part inconclusive, seeing as this research does not indicate any known genetic or neurological connections that cause for this, or any other reason for that matter. One of the many possible explanations might be found in the way that many autistic personages have selective diets as a direct consequence of their sensory sensitivities as mentioned above. Another explanation might also be found in the medications they are taking. What is known is that the more frequented gastrointestinal problems found in autism are that of chronic diarrhea, chronic flatulence, chronic constipation, nausea and/or vomiting, colitis, inflammatory bowel disease, ulcers, abdominal discomfort, food intolerance, gastroesophageal reflux, as well as that of failure to thrive. Again, one of the more probable explanations for these complications may very well be associated with the difficulties with feeding and eating. As mentioned above, it is common for people living on the spectrum to have selective eating; for instance, they may choose foods based on a certain texture, or choose to eat the same foods time and time again. Not only that, but obesity is something that is very common in individuals with autism, although this too may also be attributed to the medications leveraged to treat the disorder. It is approximated that over 30 percent of the autistic community is obese as opposed to just 13 percent of the general populace. Additionally, those in the autistic demographic are more likely to develop some kinds of food allergies, as some 25 percent of this group are affected by moderate to severe food allergies.

Sleep Disturbances

Just as it is startling to see the exact number of people living with autism have a type of gastrointestinal comorbidity, the same fact holds true in the case of the sleep disorders that appear next to autism. The same numbers and figures hold true in approximating the number of autistics that have difficulties with sleeping. It is calculated that sleeping complications appear in roughly 50–80 percent of this demographic. This is something that parents of autistic youths are well aware of, as it is one of the more common concerns brought up by parents to their children’s clinicians. For this reason, it is not uncommon for doctors to prescribe a sedating antipsychotic like Seroquel just to combat this problematic matter.

Writting and Research by Aaron M. Weis