PHYSICAL AND MEDICAL ISSUES THAT MIGHT ACCOMPANY AUTISM
A range of physical and mental health conditions frequently accompany autism. It is helpful to learn more about these issues so that you can learn to read the signs. Oftentimes, caregivers and professionals might automatically attribute certain challenges to the autism diagnosis, when the child or adult may actually have another treatable condition that is causing the difficulties. It is also important to remember that though these issues are more common among autistic people, not all children and adults diagnosed with ASD will have another diagnosis.
These issues, often called comorbid conditions, include, but are not limited to:
Seizure disorder, also called epilepsy, occurs in as many as a third of individuals with autism. Epilepsy is a brain disorder marked by recurring seizures or convulsions. Experts propose that some of the brain abnormalities that are associated with autism may contribute to seizures. These abnormalities can cause changes in brain activity by disrupting neurons in the brain. Neurons are cells in the brain that process and transmit information and send signals to the rest of the body. Overloads or disturbances in the activity of these neurons can result in imbalances that cause seizures. Epilepsy is more common in children who have cognitive deficits. Some researchers have suggested that seizure disorder is more common when the child has shown a regression or loss of skills. There are different types and subtypes of seizures, and a child with autism may have more than one type. The easiest to recognize are large grand mal (or tonic-clonic) seizures. People with these seizures have stiffening and spasming of muscles and typically lose consciousness. Others include petit mal (or absence) seizures, which may look like a vacant stare, typically for up to 15 seconds. Subclinical seizures are so subtle that they may only show up in an electroencephalogram (EEG). It is not clear whether subclinical seizures have effects on language, understanding and behavior.
Seizures associated with autism usually start early in childhood, or during adolescence, but they may occur at any time. If you are concerned that your child may be having seizures, tell your child’s health care provider. They may order tests that may include an EEG, a Magnetic Resonance Imaging (MRI) scan, Computed Axial Tomography (CAT) scan and a Complete Blood Count (CBC). Children and adults with epilepsy are often treated with anticonvulsants or seizure medicines to reduce or eliminate seizures. If your child has epilepsy, work closely with a neurologist to find the medicine or combination of medicines that works best for your child with the fewest side effects. You can also learn the best ways to ensure your child’s safety during a seizure.
Many parents report gastrointestinal (GI) problems in their children with autism. Surveys have suggested that between 46 and 85 percent of children with autism have problems such as chronic constipation or diarrhea. One study found 70 percent of children with autism had a history of gastrointestinal symptoms, such as:
- Abnormal pattern of bowel movements
- Frequent constipation
- Frequent vomiting
- Frequent abdominal pain
The exact prevalence of GI problems, such as gastritis, chronic constipation, colitis and esophagitis, in people with autism is unknown. If your child has GI symptoms, talk with their health care provider. They may want to consult a gastroenterologist, ideally one who works with people with autism.
Pain caused by GI issues is sometimes recognized because of a change in a child’s behavior, such as an increase in self-soothing behaviors like rocking or outbursts of aggression or self-injury. Bear in mind that your child may not have the language skills to communicate the pain caused by GI issues. Treating GI problems and relieving that discomfort may reduce the frequency or intensity of behavioral challenges.
Some evidence suggests that children may be helped by dietary intervention for GI issues, including the elimination of dairy- and gluten-containing foods. Ask your child’s health care provider to develop a comprehensive treatment plan for your child. In January 2010, Autism Speaks initiated a campaign to inform pediatricians about the diagnosis and treatment of GI problems associated with autism.
Some children with autism have an identifiable genetic condition that affects brain development. These genetic disorders include:
- Fragile X syndrome
- Angelman syndrome
- Tuberous sclerosis
- Chromosome-15 duplication syndrome
- Other single-gene and chromosomal disorders
While further study is needed, single-gene disorders appear to affect 15 to 20 percent of those with ASD. Some of these syndromes have characteristic features or family histories. Experts recommend that all people with an autism diagnosis get genetic testing to find these genetic changes. It may prompt your doctor to refer your child to a geneticist or neurologist for further testing. The results can help guide treatment, awareness of associated medical issues and life planning.
Sleep problems are common in children and adolescents with autism. Sleep problems can affect the whole family’s health and well-being. They can also have an impact on the benefits of therapy for your child. Sleep problems may be caused by medical issues, such as obstructive sleep apnea or gastroesophageal reflux. Addressing the medical issues may solve the problem.
When there’s no medical cause, sleep issues may be managed with behavioral interventions. These include sleep-hygiene measures, such as limiting sleep during the day and establishing regular bedtime routines. If sleep habits don’t improve, cognitive behavioral therapy is a type of therapy that can help problem-solve sleep issues. If additional help is needed, a pharmaceutical-grade melatonin supplement has also been shown to be effective and safe in children in the short-term, for up to three months.
Don’t give your child melatonin or other sleep aids without talking to your child’s health care provider. For additional information on sleep issues, visit autismspeaks.org/sleep.
Sensory processing disorder
Many autistic children have unusual responses to sensory stimuli and process sensory input differently than nonautistic people. This means that while information is sensed normally, it may be perceived much differently. Sensory systems that can be affected include:
- Sense of movement (vestibular system)
- Sense of position (proprioception and interoception)
Sensory Processing Disorder (SPD), formerly referred to as Sensory Integration Dysfunction (SID), is when sensations that feel normal to others are experienced as painful, unpleasant or confusing. Although SPD is not currently recognized as a distinct medical diagnosis, it is a term commonly used to describe a set of symptoms that can involve hypersensitivity (a tendency, outside the norm, to react negatively or with alarm to sensory input which is generally considered harmless or nonirritating to others. Also called sensory defensiveness.) or hyposensitivity (lack of a behavioral response, or insufficient intensity of response, to sensory stimuli considered harmful and irritating to others).
An example of hypersensitivity is an inability to tolerate wearing clothing, being touched or being in a room with normal lighting. Hyposensitivity may be apparent in a child’s increased tolerance for pain or a constant need for sensory stimulation. Treatment for SPD is usually addressed with occupational therapy and/or sensory integration therapy. Sensory integration therapy helps people with SPD by exposing them to sensory stimulation in structured, repetitive ways so they can learn to respond in new ways. SI therapy is most often play-based and is provided by an occupational therapist.
Pica is an eating disorder involving eating things that are not food. Children between 18 and 24 months of age often eat non-food items, and this is typically a normal part of development. Some children with autism and other developmental disabilities beyond this age continue to eat non-food items, such as dirt, clay, chalk and paint chips. Children with signs of persistent mouthing of fingers or objects, including toys, should be tested for elevated blood levels of lead, especially if there is a known potential for environmental exposure to lead. If you’re worried about pica, contact your child’s health care provider. They can help you assess if your child needs a behavioral intervention or if it is something you can manage at home. Download the Pica Guide for Parents at autismspeaks.org/tool-kit/atnair-p-pica-guide-parents.
Mental and behavioral health disorders
Some children diagnosed with ASD will receive an additional mental health-related diagnosis, such as attention deficit hyperactivity disorder (ADHD) or anxiety disorder. Studies suggest that 20 percent of autistic children also have ADHD, and 30 percent struggle with an anxiety disorder, including:
- Social phobia (also called social anxiety disorder): characterized by an intense, persistent fear of being watched and judged by others
- Separation anxiety: characterized by an extreme fear of being separated from a specific person, such as a parent or teacher
- Panic disorder: characterized by spontaneous seemingly out-of-the-blue panic attacks, which create a preoccupation with the fear of a recurring attack
- Specific phobias: characterized by excessive and unreasonable fears in the presence of or in anticipation of a specific object, place or situation
Symptoms of ADHD include ongoing problems with:
However, these symptoms also can result from autism. For this reason, evaluation for ADHD and anxiety should be done by someone with expertise in both disorders. One study found that just 1 in 10 children with autism and ADHD were receiving medicine to relieve the ADHD symptoms.
Children with autism express anxiety or nervousness in many of the same ways as typically developing children. But they may have trouble communicating how they feel. Outward signs may be the best clues. In fact, some experts suspect that signs of anxiety, such as sweating and acting out, may be especially prominent among those with ASD. Symptoms can include a racing heart, muscular tension and stomach aches. It is important for your child to be evaluated by a professional who has expertise in both autism and anxiety to provide the best treatment options for your child.