As a parent, Alice had little downtime and loads of stress. James, her 9-year-old son, rarely slept through the night, had numerous food allergies, struggled in school, and battled obsessive-compulsive disorder (OCD). She spent much of her week focused on his treatments, including psychotherapy, to address his OCD symptoms and problem behaviors and occupational therapy to improve his eating behaviors. Alice's experiences are not uncommon because autism spectrum disorder (ASD) rarely exists alone. Like James, a high percentage of children with it have one or more additional health problems.
Affecting one out of every 54 children in the U.S., autism is a spectrum disorder with symptoms that range from mild to severe. The most common autism signs include challenges with verbal and nonverbal communication, social skills, and repetitive and restricted behaviors. Heightened or reduced sensitivity to sensory information is also common.
The impact of autism can touch every area of functioning, including learning, eating, relationships, sleeping, and communicating basic wants and needs. It is the most challenging developmental disability to treat.
The fact that other comorbidities often accompany it compounds the challenges associated with autism.
Autism & Physical Health Conditions
People with autism are far more likely than those in the general population to suffer from various physical health conditions. While the exact reason is unknown, biological factors are suspected.
Few physical health conditions are as closely linked to autism as epilepsy, a neurological disorder marked by seizures, unusual behaviors and sensations, and loss of awareness.
While the rate of epilepsy in the general population is just one percent, a study of nearly 6,000 children with autism found that 12.5 percent have epilepsy. And that rate climbed to 26 percent among children older than 13; other studies report a prevalence as high as 46 percent.
Children on the spectrum are eight times more likely to experience gastrointestinal issues than their developmentally typical peers. Common GI complaints are chronic constipation, abdominal pain, reflux, bowel inflammation, and food allergies. Depending on the study, the number of children with autism and a GI issue might be 85 percent or higher.
Parents of children on the autism spectrum don't need scientists to know that sleep problems are common. Researchers are unsure if disordered sleep is related to hyperactive brain activity, altered circadian rhythms, or other factors. Still, the rate of insomnia is estimated to be between 44 and 88 percent.
On average, people with autism take 11 minutes longer to fall asleep and spend less time in restorative REM sleep. The impact is fatigue, irritability, and an increase in problematic behaviors.
Autism and Intellectual Disabilities
Many children with autism are gifted in one area and struggle in others, making it difficult to assess the actual rate of intellectual disabilities. Studies show that as many as 56 percent have some intellectual impairment, which can impact social functioning, cognitive development, and learning. Another indication is that nearly 30 percent of children with autism score at or below 70 on standardized IQ tests.
Autism & Psychiatric Conditions
There is a strong correlation between mental health conditions and autism spectrum disorder (ASD). While the exact rate is unknown, scientists believe that up to 72 percent of those diagnosed with ASD have at least one psychiatric diagnosis.
The most common include attention deficit hyperactivity disorder (ADHD), anxiety disorders, and depression. Bipolar disorder, schizophrenia, and oppositional defiance disorder are also more commonly found in autism populations.
But the reasons for the connections are unclear. The nature of autism itself may be responsible for declines in mental health. Commonly cited factors include stigmatizing behaviors, bullying, impairments in social functioning, communications, and emotional control.
Attention deficit-hyperactivity disorder, or ADHD, is common in kids with autism. Although it is often difficult to diagnose because of significant overlapping symptoms, scientists estimate that ADHD is present in about one-third to one-half of those with autism.
Characteristics of ADHD include poor focus, limited attention span, impulsivity, sensory-seeking behaviors, and hyperactivity.
The dual diagnosis of autism and ADHD leads to impairments in making decisions, remembering things in sequence, organizing, controlling impulses, staying on task, and adhering to schedules.
Children with autism are more likely to have a close relative with ADHD or other developmental disability, indicating a shared genetic risk between the conditions.
In the general population, the childhood rate of anxiety disorders is around three percent. But for children with autism, the prevalence rises dramatically to 42 percent. Younger children are more likely to develop specific phobia disorder, while teens are more prone to obsessive-compulsive disorder (OCD) and social phobias.
Many children, particularly those who are high functioning, are acutely aware that they are different, increasing their anxiety and feelings of isolation, particularly as they transition from childhood to adolescence.
Obsessive-compulsive disorder (OCD) is one of the most frequently cited anxiety disorders among those with autism. While OCD afflicts one percent of the general population, up to 17 percent of those with autism suffer from the often-debilitating condition.
OCD is characterized by unwanted and intrusive thoughts called obsessions and the behaviors or compulsions to alleviate the distress caused by them.
But OCD is often hard to diagnosis in those with autism because of similar symptoms.
Repetitive behaviors and restricted interests associated with autism are often difficult to distinguish from compulsions and obsessions associated with OCD.
But the reasons behind the behaviors differ. For those with OCD alone, the actions are an attempt to reduce anxiety, worry, or fears from the obsessive thoughts. For those with autism, the behaviors are more likely to self-stimulate, soothe, or calm.
Children with OCD exclusively tend to perform cleaning, checking, and counting rituals. Kids with OCD and autism, however, are more likely to engage in hoarding, ordering, and self-injurious behaviors (SIBs).
Specific phobias tend to develop in childhood across all populations. But for those with autism or other developmental disabilities, fears tend to be more intense and centered around peculiar things like choking, wind, vacuums, and elevators. Research published in Autism Spectrum Disorders found that over 40 percent of children with autism had unusual fears.
Scientists believe that sensory processing abnormalities may be a significant source of these fears.
Generalized anxiety disorder (GAD) is among the most common autism comorbid mental health conditions. Excessive and pervasive worry about everyday situations without specific reasons are common characteristics.
This catastrophic thinking often leads to restlessness, irritability, tension, and hyperactivity, which can impair social performance and academic achievement. Even worse, GAD can contribute to the development of additional psychiatric conditions if left untreated.
Children with autism are often intolerant to change and experience extreme stress when things diverge from their expectations. Scientists believe that this pervasive and intense need for sameness creates a fertile breeding ground for anxiety.
Social anxiety is also common among those with autism, particularly in older children. Deficits in social performance—lack of eye contact, misreading social cues, poor negotiating skills, and mental inflexibility—are frequently seen in children on the spectrum.
These impairments often trigger anxiety in social settings with excessive fears over performance and scrutiny from peers, particularly among children on the high functioning end of the spectrum.
Autism and Symptoms of Depression
People with autism are four times more likely to develop depression in their lifetime than neurologically normal populations. Depression can limit the ability to live independently, develop relationships, cope with daily stress, and interact effectively with others. A small portion of people with both autism and depression experience suicidal thoughts.
Of course, feelings of sadness, hopelessness, and low self-esteem are common for anyone who suffers from depression. But for those with autism, these emotions are often hard to express, which can make efforts to treat it more difficult.
Treatment for autism and the conditions that commonly exist with it requires a multimodal approach.
Cognitive-behavioral therapy and applied behavior analysis are two widely used psychotherapies to treat the maladaptive behaviors associated with autism and mental health conditions like anxiety and depression.
Other commonly utilized therapies for children with autism include occupational, physical, and speech therapies.
Doctors may prescribe prescription medications to control fears, reduce sadness and anxiousness, improve sleep and minimize physical discomforts.
Autism spectrum disorder is a multidimensional, complex disorder, made even more challenging by physical and mental health problems that often accompany it.
It is not easy for families to coordinate therapies and work to meet the child's wide-ranging needs, but it is possible. Early intervention delivers significant improvements in behaviors, cognitive development, social skills, emotional health and well-being.
Does your child have autism or showing signs of autism? Alliance ABA can help. Call to schedule a consultation today.