Co-Occurring Disorders in Autism How many of your children carry multiple diagnoses? In addition to anxiety disorder and depression, ADHD, OCD, ODD, seizure and bipolar disorders are common co-exiting disorders diagnosed in autism. All these co-exiting disorders have common elements with autism. For example, children with autism have executive functioning problems (attention difficulties, poor organizational skills, impulse control problems, etc.) which they share in common with ADD. Also, it is also common for them to have under-aroused nervous systems that can cause hyperactivity, which is common for ADHD. In addition, many children on the spectrum have very rigid/inflexible thinking (rigid adherence to rules, rituals, and routines) which is commonly seen as OCD. With the rigid/inflexible thinking comes strong anxiety to control all activity around them, leading to strong oppositional behavior common in Oppositional Defiant Disorder (ODD) Finally, frequent anxiety, irritability, hyperactivity, meltdowns, and other emotional regulation difficulties are commonly seen with bipolar disorders. Usually children with bipolar disorder will exhibit cycles of extreme irritability and mood swings, racing thoughts, inability to concentrate, very rapid, pressured speech, uncontrollable rage episodes, and very driven hyper-motor activity. The big difference between bipolar and symptoms of autism is in the intensity and duration of episodes. Usually with bipolar the childs extreme irritability, hyperactivity, rage, and racing thoughts are not specific to any event (trigger). The mood/behavior can last longer and seems for driven. The child obviously appears to have no control over the behavior. These same symptoms can also occur with severe biomedical conditions. As you can see, it often can be difficult to separate out the signs and symptoms of autism from other co-exiting disorders. It is very important that you have a doctor who understands autism well, in order to differentiate between what are symptoms of the autism and what is symptomatic of other co-occurring disorders. Once these labels get fixed it usually means long term use of many different medications. So, how do you tell? Usually with the co-occurring disorders, there is a “generalized” nature to the symptoms; meaning they tend to occur across settings and situations, and not specific to identifiable triggers. Usually for autism, if you look closely, the symptoms (behaviors) can be tied to specific events. Often times you can tie the behavior episode to sensory, informational, or emotional overload, transitions, uncertainty, etc. However, since some of the symptoms can be very constant it is often difficult to tell. Usually, if the symptoms are truly the result of another co-occurring disorder, then medication is warranted. However, at this time there are no medications to treat “autism.” I think often the problem is trying to isolate out what underlies the childs anxiety, OCD, and irritability. Some behaviors are the result of their rigid, inflexible thinking, poor impulse control, sensory issues, and executive functioning difficulties. These can often be misdiagnosed as bipolar disorder and other psychiatric disorders. I have often seen that many children on the spectrum suffer from ongoing anxiety, partly because the difficulties regulating in a world that is overwhelming for them. Others suffer from a mild depressive disorder, which is often masked by the anxiety. These cases seem to respond best to the SSRIs. Another thing to consider is many of these children respond best on low doses of medications, rather than higher doses. This series on “labels, diagnoses, and co-occurring disorders” can be found in the green book, “Autism Discussion Page on Anxiety, Behavior, School and Parenting Strategies.”
Posted on: Tue, 16 Dec 2014 09:30:50 +0000
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