Figuring out what is behind the challenges you see your child facing can feel a bit like a dog chasing its tail. At least that is the way I have felt as a parent, many times.
I remember one conversation with my sister. I was detailing my concerns and expressing my frustration over so many symptoms affecting my kid being common to so many different conditions. She said: “It could be an autism comorbidity.”
I demanded she explain this new word to me, and was surprised at how she dared to suggest my son could “have it”. As she began to explain, I immediately felt better.
In this article I would like to share with you what a comorbid condition is, what the risk factors are for a child with autism, and what we as parents can do to get our children the help they may need.
What does comorbid mean?
According to Webster’s dictionary, the definition of the word comorbid is as follows: “existing simultaneously with and usually independently of another medical condition”.
So, unlike my first fear, which I admit was a little extreme, comorbid does not have anything to do with a death risk. It simply means that, in the case of a child with autism spectrum disorders (ASD), other conditions besides autism may also be present.
This could mean a child requires separate diagnoses and treatment for additional conditions, while also meeting the challenges autism spectrum disorders can bring.
Do people on the autism spectrum have higher risk factors for comorbid conditions?
In an autism research study published in the National Library of medicine titled: Autism Medical Comorbidities, Mohammed Al-beltagi concluded that comorbidities are indeed more common in children with ASD than in the general population.
This study showed: “Some genetic disorders are more common in children with ASD, such as FXS, DS, Duchenne muscular dystrophy, NF- type I, and TSC. Children with autism are more likely than the general population to have several neurological disorders.
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“Sleep disorders are significant problems in individuals with autism, present in about 80% of them. GI problems are significantly more common in children with ASD, occurring in 46% to 84% of autistic children.
“Several categories of inborn errors of metabolism have been observed in some patients with autism including mitochondrial disorders, as well as other disorders. Some children with ASD have evidence of persistent neuroinflammation, altered inflammatory responses, and immune abnormalities.
“Anti-brain antibodies may play an important pathoplastic mechanism in autism. Allergic disorders are significantly more common in ASD and run through all age groups. The physician should rule out any medical concerns before moving on to other interventions or therapies.”
Now that we know a little more about the occurrence of comorbid conditions with ASD, let’s dive into the kinds of comorbidities that could affect many children with autism spectrum disorders.
What kinds of conditions are comorbid with autism spectrum disorders?
The list of possible comorbidities with ASD is a long one. I would like to take a few of the most common, and help identify their symptoms.
This overview should help anyone suspecting a comorbid condition could be at play in their child’s life, to know what steps to take next. Let’s start with a list and go from there.
First of all, I will be breaking the lists into categories. These categories are: developmental disorders, gastrointestinal disorders, sleep disorders, neurological conditions, and psychiatric disorders.
The CDC funded a program called the Autism and Developmental Disabilities Monitoring Network (ADDM Network). Their aim is to collect information regarding the prevalence of ASD and other developmental disabilities and how they compare to each other in different parts of the US.
ADDM Network goals are to:
- Describe the population of children with ASD
- Compare how common ASD is in different areas of the country
- Measure progress in early ASD identification
- Identify changes in ASD occurrence over time
- Understand the impact of ASD and related conditions in US communities
According to the CDC: “Developmental disabilities are a group of conditions due to an impairment in physical, learning, language, or behavior areas. These conditions begin during the developmental period, may impact day-to-day functioning, and usually last throughout a person’s lifetime.”
Developmental challenges include:
- learning disabilities
- language disorders
- vision problems
- intellectual disability
- developmental coordination disorder
It is important to note, some neurological disorders are also developmental issues.
Developmental disorders that exist alongside autism may be the most noticed, and therefore may receive the earliest treatment. For example, children who are late in their speech may be more likely to get help than people with learning disabilities, just because the symptoms are more obvious earlier in life.
One of the easiest ways to diagnose developmental issues is through the observation of how well a child meets certain milestones as they grow. Not meeting developmental milestones is often the first red flag seen by parents and doctors. Milestones observed include:
- responding to sounds
- social engagement
All of these things help parents and professionals determine what developmental issues their child may be facing.
Pervasive developmental disorders (PDD)
According to the National Institute of Neurological Disorders and Stroke, the definition of PDD is “a group of disorders characterized by delays in the development of socialization and communication skills. Parents may note symptoms as early as infancy, although the typical age of onset is before three years of age.
“Symptoms may include problems with using and understanding language; difficulty relating to people, objects, and events; unusual play with toys and other objects; difficulty with changes in routine or familiar surroundings, and repetitive body movements or behavior patterns. Autism (a developmental brain disorder characterized by impaired social interaction and communication skills, and a limited range of activities and interests) is the most characteristic and best studied PDD.
“Other types of PDD include Asperger’s Syndrome, Childhood Disintegrative Disorder, and Rett’s Syndrome. Children with PDD vary widely in abilities, intelligence, and behaviors. Some children do not speak at all, others speak in limited phrases or conversations, and some have relatively normal language development.
“Repetitive play skills and limited social skills are generally evident. Unusual responses to sensory information, such as loud noises and lights, are also common.”
That’s right, autism itself is a developmental disorder, and other developmental issues can be comorbid with autism. Are you starting to get the “dog chasing its tail” vibe?
There is a wonderful article on PDD and how to tell the difference between that and autism I will link below in the resources section. Check it out, I think it could really help.
Gastrointestinal (GI) disorders and problems are a common comorbidity with autism spectrum disorder. These could exist alongside autism coincidentally or be caused by the effects of the challenges children with autism can face. They might include:
- Irritable bowel syndrome
- Chronic constipation
- abdominal pain with or without diarrhea
An increase in the severity of autistic symptoms can also be a result of GI disorders.
Depending on the circumstances, these gastrointestinal symptoms could be part of a vicious circle that often starts young. If the need isn’t met in early childhood, symptoms can worsen, and even result in developing other illnesses.
Children with autism are especially vulnerable to sleep disorders and their effects on the ability to function throughout the day. An increased risk of developing sleep disorders has been shown in people with autism spectrum disorder. Some sleep problems comorbid with autism are insomnia, and sleep disturbances such as:
- night terrors
These symptoms and more can not only affect sleep, but can contribute to other conditions as well. Sleep problems affect concentration, academic performance, behavioral performance, mental health, and worsening of other sleep problems such as sleep paralysis.
As we covered above, neurological deficits can affect children with autism often. Below is a list of neurological disorders that have been known to be comorbid with autism spectrum disorder.
- seizure disorder, such as epilepsy
- intellectual disability, or inherited intellectual disability
- cerebral palsy
- sensory processing disorder (SPD)
- attention deficit hyperactivity disorder (ADHD)
- obsessive compulsive disorder (OCD)
While this list is obviously not exhaustive, these are some of the most common conditions comorbid with autism spectrum disorder. There seems to be some evidence to suggest that some neurological conditions can also be classified as psychiatric disorders as well.
One example is OCD. Though it is considered psychiatric in nature, it can alter the brain’s make-up, thus it’s also defined as neurological.
Psychiatric comorbidities are also common to autistic spectrum disorders. Examples include:
- anxiety disorders
- eating disorders
- mood disorders
- bipolar disorder
- post traumatic stress syndrome (PTSD)
Mental disorders are not always spontaneously comorbid with autism spectrum disorder. In fact, they can develop as a result of the challenges (i.e. social) that can exist in a person with autism.
This means, people with autism spectrum disorder are at an increased risk of suffering from major depression, anxiety disorders, sleep disturbance, and gastrointestinal symptoms, just because their mental health has been affected.
The symptoms of psychiatric disorders can include:
- unexplained sadness
- loss of interest in things they enjoy
- behaviors that can be considered violent
- feeling worthless
- refusing to eat, or eating too much
- dramatic fluctuations in highs and lows
- anxiety related to specific circumstances
Once again, this list is not comprehensive. If your child exhibits new or worsening symptoms, that could indicate they are suffering from a comorbid psychiatric disorder, talk to their doctor and get some help.
For this section I would like to pull out three of the most common autism comorbidities, and discuss their signs, symptoms, and what kind of professionals can be involved in the diagnosis and treatment plans to help.
Seizure disorders can be some of the scariest disorders there are. The threat of falling and being injured is just one of the most concerning possibilities.
Symptoms of seizures are some of the most confusing. When I think of seizures I think of losing consciousness and violently jerking uncontrollable movements.
The truth is, those kinds of symptoms are way more rare than most people think. Let’s find out some other symptoms.
Signs and symptoms
- falling down
- staring into space (absence seizures)
- Cognitive or emotional symptoms, such as fear, anxiety or deja vu
- involuntary movements such as facial drooping
- sudden confusion
Types of seizures
According to the Mayo Clinic, here are some types of seizures and their characteristics
- Absence seizures. Absence seizures, previously known as petit mal seizures, often occur in children and are characterized by staring into space or by subtle body movements, such as eye blinking or lip smacking. They usually last for five to 10 seconds but may happen up to hundreds of times per day. These seizures may occur in clusters and cause a brief loss of awareness.
- Tonic seizures. Tonic seizures cause stiffening of your muscles. These seizures usually affect muscles in your back, arms and legs and may cause you to lose consciousness and fall to the ground.
- Atonic seizures. Atonic seizures, also known as drop seizures, cause a loss of muscle control, which may cause you to suddenly collapse, fall down or drop your head.
- Clonic seizures. Clonic seizures are associated with repeated or rhythmic, jerking muscle movements. These seizures usually affect the neck, face and arms on both sides of the body.
- Myoclonic seizures. Myoclonic seizures usually appear as sudden brief jerks or twitches of your arms and legs. There is often no loss of consciousness.
- Tonic-clonic seizures. Tonic-clonic seizures, previously known as grand mal seizures, are the most dramatic type of epileptic seizure and can cause an abrupt loss of consciousness, body stiffening and shaking, and sometimes loss of bladder control or biting your tongue. They may last for several minutes.
Speaking to your child’s pediatrician and inquiring about a pediatric neurologist is a great start. Any other professionals can be recommended as the process of diagnosis progresses.
ADHD is one of the most common comorbid issues with autism. Autistic children can be greatly affected by ADHD, and like so many other comorbidities, it can worsen mental health symptoms, affect sleep, and lead to other problems.
The good news is that ADHD and its symptoms have lots of research and treatment options to help.
Signs and symptoms
People with ADHD show a persistent pattern of inattention and/or hyperactivity–impulsivity that interferes with their daily life, growth, and development. Here are a list of symptoms, from the Diagnostic and Statistical Manual fifth edition (DSM-5), that can be observed and used to diagnose ADHD:
- Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or with other activities
- Often has trouble holding attention on tasks or play activities
- Often does not seem to listen when spoken to directly
- Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., loses focus, side-tracked)
- Often has trouble organizing tasks and activities
- Often avoids, dislikes, or is reluctant to do tasks that require mental effort over a long period of time (such as schoolwork or homework)
- Often loses things necessary for tasks and activities (e.g. school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones)
- Is often easily distracted
- Is often forgetful in daily activities.
Hyperactivity and impulsivity:
- Often fidgets with or taps hands or feet, or squirms in their seat
- Often leaves their seat in situations when remaining seated is expected
- Often runs about or climbs in situations where it is not appropriate (adolescents or adults may be limited to feeling restless)
- Often unable to play or take part in leisure activities quietly
- Is often “on the go” acting as if “driven by a motor”
- Often talks excessively
- Often blurts out an answer before a question has been completed
- Often has trouble waiting their turn
- Often interrupts or intrudes on others (e.g., butts into conversations or games)
A combination of professionals is required for a diagnosis of ADHD. These include parents (Yes we are professionals when it comes to our children.), a pediatrician or licensed therapist, and or pediatrician.
Signs and symptoms
- stomach pain
If your child suffers from one or more of the above symptoms frequently, talk to their pediatrician and ask about a referral to a gastroenterologist if needed. These symptoms may also be linked to food allergies, in which case, a dietician or nutritionist may also be able to be added to your team.
What can parents do if they suspect their child with ASD has a comorbid condition?
Parents, you can take the reins on your child’s needs by following the five D’s to collecting and sharing information with the right professionals. The five D’s are:
If you see symptoms, write them down. Starting with the day, time, circumstances, and food consumed that day. Continue with any updates that come in the days after. This will help you see any patterns that may materialize, and help the doctors and other professionals down the line.
Talk about what you are seeing. Share your findings with your child’s pediatrician or therapist. When you tell them, and show them the documentation, they can help you decide what to do with the information.
Once you and the required professional are on the case, soon you will discover the cause of your child’s struggle and symptoms. Tests can be administered, results analyzed, and options provided. Next you can figure out what to do in light of what is found.
Working with your child and the rest of the team, you can decide what the course of action or treatment should be for your child. What is appropriate for one family, isn’t always the best choice for others. Each one is unique, as should the plan moving forward.
When you have the diagnosis, professionals, services, and information your child needs to find help, it’s time to follow through. It may seem simple, but it is often tempting to skip appointments, discontinue medication, or to dispense with the list of daunting tasks you and your child may need to do.
Parents can also see success, and question whether or not their child still requires the services they are providing. It can be time consuming, a financial burden, and a constant struggle. Perseverance and consistency is key.
If something is working, great, keep it up. If something isn’t working, that’s what the team is for– to find a more appropriate solution. We want the best for our children, of course.
Conditions comorbid with autism are common. If your child has autism, it does not automatically mean they will also have a medical comorbidity. However, the risks are higher with children with autism, than children without autism spectrum disorders.
Knowing the signs and symptoms of certain conditions that frequently accompany autism can help. Early intervention is vital to getting your child the help they may need.
I hope this article helps calm the confusion that this subject can bring, and that knowing you are not alone, eases your mind a bit. No matter what, there is help available, and there is no shame in reaching out for it.
Resources for parents
Article on PDD: https://www.autismparentingmagazine.com/pervasive-developmental-disorder/
Mayo Clinic https://www.mayoclinic.org/diseases-conditions/seizure/symptoms-causes/syc-20365711
Al-Beltagi M. (2021). Autism medical comorbidities. World journal of clinical pediatrics, 10(3), 15–28. https://doi.org/10.5409/wjcp.v10.i3.15
George, M. S., Melvin, J. A., & Kellner, C. H. (1992). Obsessive-compulsive symptoms in neurologic disease: a review. Behavioural neurology, 5(1), 3–10. https://doi.org/10.3233/BEN-1992-5101
Penzol, M. J., Salazar de Pablo, G., Llorente, C., Moreno, C., Hernández, P., Dorado, M. L., & Parellada, M. (2019). Functional Gastrointestinal Disease in Autism Spectrum Disorder: A Retrospective Descriptive Study in a Clinical Sample. Frontiers in psychiatry, 10, 179. https://doi.org/10.3389/fpsyt.2019.00179
Liu, X., Hubbard, J. A., Fabes, R. A., & Adam, J. B. (2006). Sleep disturbances and correlates of children with autism spectrum disorders. Child psychiatry and human development, 37(2), 179–191. https://doi.org/10.1007/s10578-006-0028-3