Children with autism spectrum disorder have higher rates of certain medical and mental health conditions. Medical co-morbidities of autism include seizures, gastrointestinal disorders or distress, eating or feeding problems, and sleep disturbances. Mental health co-morbidities of autism include anxiety, depression, attention deficit and hyperactivity disorder (ADHD), schizophrenia and bipolar disorder.
Although seizures can begin at any age, research has identified two times in which there is a higher chance of seizures starting in children with autism. These two peaks occur in the preschool years and during adolescence or puberty. Research has indicated that as many as 33% of children with autism experience seizures (as compared to 1-2% of the general population).
Autism speaks (2017) lists the following symptoms that are characteristics of possible seizures:
- Unexplained staring spells
- Stiffening of muscles
- Involuntary jerking of limbs
In addition, Autism Speaks lists “Other less-specific symptoms” as:
- Sleepiness or sleep disturbances
- Marked and unexplained irritability or aggressiveness
- Regression in normal development
If parents suspect possible seizures in their child, they should consult with their child’s pediatrician and/or a neurologist.
Gastrointestinal Disorders or Distress
Research indicates that children with autism are eight times more likely to experience gastrointestinal (GI) disorders or distress. GI problems are considered the most common medical condition associated with autism.
Research lists the following symptoms that are characteristics of possible GI distress:
- Abdominal pain
- Chronic diarrhea
- Chronic constipation
- Painful stooling
Parent many want to consider an evaluation with a gastroenterologist if child presents with:
- Unexplained distress or behavioral regression
- Chronic loose stools or constipation
- Frequent or recurrent vomiting
- Gastroesophageal reflux
- Frequent abdominal pain
- Inadequate weight gain
If parents suspect possible GI distress in their child, they should consult with their child’s pediatrician and/or a gastroenterologist.
Eating or Feeding Problems
Young children exhibit feeding disorders when they are unable or refuse to maintain an adequate oral intake of food. Sources estimate that as many as 70% percent of children with ASD experience some type of feeding difficulties during infancy or early childhood; with as many as 36% classifying the problems as severe (Romero 2016). Children who develop feeding disorders are at risk for weight loss, malnutrition, lethargic behaviors, impaired intellectual and social-emotional development, and growth retardation.
A parent might consider a consultation with dietician, nutritionist or psychologist trained in treating feeding problems if:
- Child has a need for sameness with their food that significantly influences their dietary choices which may then affect their GI motility.
- Child has less than 10 foods in their diet
- Child has a heightened sensory awareness on foods such as textures of foods and flavor choices, which may affect GI motility
- Child presents with refusal behaviors of new foods, and they have limited food preferences
- Overconsumption of high-calorie, low-nutrient foods which is related to the high incidence of obesity in adolescents on the autism spectrum
At the Knapp Center, we utilize ABA strategies (behavioral techniques) to address:
- Need for sameness with dietary choices
- Heightened sensory awareness with dietary texture and flavor choices
- Increasing food intake and food preferences
- Working through refusal behaviors of new foods
- Improving nutritional choices of food
Research has indicated that as many as 80-90% of children with autism experience disruptive sleep or sleep disturbances, as opposed to 25-30% of typical developing children (Williams, Sears, & Allard, 2004).
Research lists the following symptoms that are common sleep disturbances in children with ASD:
- Difficulty Falling Asleep
- Bedtime resistance
- Inability to fall asleep on own
- Inconsistent sleep routines
- Restless sleep (or poor quality sleep)
- Shortened night sleep
- Frequent night awakenings
- Extremely early rising
Sleep problems can lead to significant difficulties related to:
- Daytime moodiness
- Lack of focus in class or treatment
- Sleepiness during the day
- Behavioral problems
- Learning problems
- Memory Problems
- Physical Health Problems
- Family stress
If parents suspect sleep disturbance in their child, they should consult with their child’s pediatrician, sleep specialist or psychologist for behavior treatment.
At the Knapp Center, when there is not an identifiable medical cause for sleep disturbance or when the problem is related to insomnia, difficulty falling asleep or difficulty staying asleep throughout the night, we utilize behavioral interventions as an important role in improving sleep. A treatment plan may include:
- Restriction of daytime sleep or naps to ensure child is more tired when going down for the evening
- Environmental modifications such as heavy drapes on windows to block out light, a night light so there are no shadows in the room, types of clothing child sleeps in, blankets that are used, etc.
- Positive bedtime routines, such as one hour before bed dedicated to preparing for sleep – this may include low stimulating activities (no tv or running around), taking a bath, massage, story time, etc.
- Extinction procedures, which includes changing the parent’s behavior, to allow the child to learn to fall asleep on their own without their parent. This may include a gradual extinction process.
Of note, there is some evidence of abnormality of melatonin regulation in children with ASDs, melatonin may be effective for improving sleep onset in children with ASDs. Interested parents should consult with their pediatrician regarding use of any medications, including over the counter medications, prior to use.
Mental Health Conditions
As reported by Autism Speaks “epidemiological studies suggest that between 54 and 70 percent of people with autism also have one or more other mental health conditions (Simonoff 2008, Hofvander 2009, Croen 2015, Romero 2016).” Mental health co-morbidities of autism include anxiety, depression, attention deficit and hyperactivity disorder (ADHD), schizophrenia and bipolar disorder.
Anxiety can affect as many as 40% of children on the autism spectrum. Symptoms of anxiety in children on the autism spectrum can include, but is not limited to (1) worrying thoughts; difficulty controlling worry; (2), extreme fear of new people, crowds and social situations; (3) dislike of going to new places or trying new things; (4) fear of specific stimuli, and (5) physiological symptoms of racing heart, muscle tightness and stomachache.
Depression can affect as many as 25% of individuals on the autism spectrum. Symptoms of depression can include, but is not limited to (1) chronic feelings of sadness, hopelessness, worthlessness, and/or irritability; (2) sudden weight gain or loss; (3) poor sleep; (4) social isolation; (5) moving or talking slowly, and (6) trouble sitting still or concentrating. At the more intensive level, depression can include frequent thoughts about death and/or suicide.
ADHD can affect as many as 60% of individuals on the autism spectrum. Autism speaks reports that “Symptoms of ADHD include a persistent pattern of inattention, hyperactivity and/or impulsivity that interferes with daily life, social development and learning. People with ADHD often fail to pay close attention to details and make careless mistakes at school or work. Often, they don’t appear to listen when spoken to, have trouble organizing tasks and fail to follow through on instructions and assignments, especially those that require sustained attention. (DSM-5 2013)”
Schizophrenia is generally considered an adult disorder; although there can be early onset in childhood. Research has indicated that as many as 35% of adults on the autism spectrum also have schizophrenia. This is a very difficult co-morbid diagnosis to make as both those with autism and schizophrenia have difficulty with processing language and perspective taking of other people’s thoughts and feelings. Schizophrenia is differentiated from autism in that those with schizophrenia present with psychosis, such as hallucinations. If the adult is nonverbal or limited language, it may be hard to determine if hallucinations are being experienced.
Bipolar Disorder affects as many of 27% of individuals on the autism spectrum, as compared to only 4% of the general population (Kessler 1994). Symptoms can include but is not limited to periods of intense energy and social intrusion, with periods of flat affect and irritability.
All mental health conditions include a cluster of symptoms, not just one symptom. Thus, because your child may experience one symptom, it is not necessarily equated to having the mental health condition. If parents are concerned their child may have a co-morbid mental health condition, it may be time to speak with a psychologist, psychiatrist, or specialist in diagnosing co-morbid mental health conditions in those on the autism spectrum.