More than half of people on the spectrum have four or more other conditions. The types of co-occurring conditions and how they manifest varies from one autistic person to the next and are termed comorbidities.
The conditions that accompany ASD generally can be divided into 4 categories:
- Medical Problems – for e.g. Epilepsy, Gastrointestinal issues such as gluten free/ casein free, Sleep Disorders…
- Developmental delays – for e.g. Intellectual Disability, Language Delay, Dyslexia
- Mental Health Conditions – for e.g. ADHD, OCD, Anxiety, Depression
- Genetic Conditions – Fragile X Syndrome
Nearly all conditions that accompany autism can have a serious effect on wellbeing and some have more severe consequences than autism does.
Below are some of the common comorbid conditions that might be diagnosed in children/adults with ASD.
Anxiety is common among children with ASD. About 40-60% of children with ASD also have anxiety. Social anxiety is one of the most common anxiety disorders. Social anxiety probably happens because people with ASD often have social difficulties that can make them feel stressed and anxious.
Anxiety is treated by medication, behaviour therapy, cognitive behaviour therapy and relaxation techniques can all be used to treat anxiety.
Obsessive Compulsive Disorder (OCD) Obsessive compulsive disorder (OCD) is a type of anxiety disorder.
People with OCD have thoughts that they don’t want but can’t get out of their heads. They behave in repetitive and compulsive ways to deal with these thoughts. For example, they might wash their hands over and over again, or arrange or count objects in patterns, as a way of cancelling out bad thoughts with good thoughts. It’s hard to know how common OCD is among children with autism spectrum disorder (ASD) because these children also tend to have repetitive thoughts and behaviour. Because restricted and repetitive behaviour is more common in younger children with ASD, OCD seems to be more common at younger ages.
OCD can be treated with behaviour therapy, cognitive therapy, medications or any combination of the three.
Attention Deficit Hyperactivity Disorder
Many children have trouble with thinking before they act, sitting still and focusing. But in children with attention deficit hyperactivity disorder (ADHD), these behaviours can be extreme and have a big impact on their daily life. The behaviours usually happen together, although some children can be mainly inattentive.
Autism spectrum disorder (ASD) and ADHD share some common characteristics like not seeming to listen when people speak, interrupting, or intruding on other people’s personal space. Many children with ASD have behaviour that’s very similar to ADHD. There’s no cure, but children and teenagers can manage ADHD using behaviour strategies, medication, or a combination of the two.
Symptoms of depression include low mood, poor sleep and appetite, irritability and a loss of motivation. In children depression symptoms can also be cranky moods rather than just sadness and low moods. Depression can be common in children with autism spectrum disorder (ASD), especially among higher-functioning children who know they have social difficulties.
People with ASD might be more likely to have symptoms of depression if they also have more severe characteristics of ASD, are older and have higher verbal IQ. Health professionals often use a combination of medication and psychotherapy, like cognitive behaviour therapy (CBT), to treat depression.
CBT is a talking therapy. This means it can’t be used successfully with children and teenagers who don’t or can’t use language to communicate.
The most common gastrointestinal symptoms for people with autism spectrum disorder (ASD) are chronic constipation, abdominal pain, diarrhoea and faecal incontinence.
Gastrointestinal symptoms have been linked with more severe ASD and behaviour problems. It’s not clear why children with ASD have relatively high rates of gastrointestinal symptoms, but it might be because of altered gut bacteria, increased gut permeability, longer food transit time through the gut, or low fibre intake. Because there are many reasons why a child might have gastrointestinal symptoms, the child will need a thorough medical examination before starting any treatment. There’s no evidence to support the general use of a gluten-free or casein-free diet. But like some typically developing children, children with ASD might have gluten intolerance, or other food sensitivities, allergies or intolerances. If this is the case, specific diets can help.
Intellectual Disability and Developmental Delays
Intellectual disability can be diagnosed when a child who is six years or older has an IQ below 70 as well as difficulties with daily tasks. In children under six years, the term developmental delay is used when children have significant cognitive and language delays.
Intellectual disability varies from person to person. Children with autism spectrum disorder (ASD) and intellectual disability might have uneven skills, so there might be some things that they’re quite good at and others they find hard.
In most cases, children with ASD have more trouble with verbal skills – like talking, listening and understanding – than with non-verbal skills like doing puzzles or drawing. In the past, it was thought that 50-60% of children with ASD had intellectual disability or developmental delays. But it’s now thought to be 30-40%, with another 20-25% having borderline intellectual disability with an IQ of 71-85.
There’s no cure for intellectual disability, but it can be managed so that many people can live a reasonably normal life. Early intervention and education can support people with intellectual disability and their families.
Seizures and Epilepsy
Epilepsy is the name for a range of brain conditions where a child has or is at risk of having repeated and unpredictable seizures because of abnormal electrical activity in the brain.
The abnormal electrical activity in the brain causes odd sensations and abnormal movement or behaviour. These are called convulsions or seizures. When a child has a seizure, there’s usually a temporary period of unconsciousness, a body convulsion, unusual movements or staring spells.
It can be hard to spot epilepsy in children with autism spectrum disorder (ASD) because some seizure symptoms can be similar to some ASD characteristics, like failing to respond to your name or doing repetitive, tic-like behaviour. Epilepsy is quite common, and 20-30% of people with ASD also have epilepsy. Seizures are most common in children under five years and in teenagers.
Treatment usually involves anti-epileptic medication. Making sure your child takes medication on time, gets enough good-quality sleep and avoids situations that cause stress can alleviate symptoms.