Co-occurring Conditions

ASD often appears not on its own but alongside other neurodevelopmental, mental health, or medical conditions. Recognizing these "co-occurring conditions" (comorbidities) is critical to building a complete and effective treatment plan. Sometimes treating these conditions can bring an even clearer improvement in a child's overall functioning than treatments aimed at ASD itself.

Intellectual Disability

Some children with ASD (about one-third to one-half, according to current data) also have an intellectual disability. But as we noted, this figure also means that the remaining children may have cognitive abilities that are average or above. The presence and degree of intellectual disability are assessed with standard intelligence tests (see Chapter 18) and directly affect educational planning.

Attention-Deficit/Hyperactivity Disorder (ADHD)

ASD and ADHD often occur together; some studies describe significant attention or hyperactivity symptoms in nearly half of children with ASD. Having both conditions together can lead to added difficulties with attention, impulse control, and organization, and it often means adding behavioral and/or medication treatment for ADHD to the plan (see Chapter 26).

Anxiety Disorders

Anxiety is markedly more common in children and adolescents with ASD than in the general population. It can show up as generalized worry, social anxiety, specific phobias (of certain sounds, textures, or animals), or intense anxiety in the face of change. It can sometimes be hard to tell anxiety apart from ASD's core features (insistence on sameness, sensory sensitivity), and this distinction directly affects the treatment approach.

Epilepsy

The relationship between ASD and epilepsy is especially notable from both a clinical and a neurobiological standpoint. Epilepsy is markedly more common in children with ASD than in the general population, and this rate rises even further in children who also have an intellectual disability. This connection is linked to the theory, discussed in Chapter 1, that the difference in the excitation-inhibition balance may play a role in both conditions. When signs of epilepsy — especially "zoning out," sudden pauses with a change in awareness, or unexplained changes in behavior — are noticed in a child with ASD, an EEG evaluation (see Chapter 19) should be done without delay.

When to Seek Advice

If you notice brief episodes in a child with ASD, such as "zoning out," a sudden freeze in behavior, unexplained falls, or fluttering or drifting of the eyes, don't dismiss them as simple "autism behavior." Report them to a pediatric neurologist; these findings could be epileptic seizures.

Gastrointestinal Problems and Sleep Disorders

Gastrointestinal problems such as constipation, reflux, and abdominal pain, along with difficulty falling and staying asleep, are markedly more common in children with ASD than in the general population. In children who are nonverbal or have limited speech, discomforts like abdominal pain can show up as changes in behavior (restlessness, aggression, an increase in self-injurious behavior). For this reason, an underlying medical cause should always be considered when behavior changes for no clear reason. Sleep problems are covered in detail in Chapter 30.

Did You Know?

The large majority of children with ASD have at least one co-occurring condition; a picture of "just autism" is actually the exception, not the rule.

Treating co-occurring conditions can noticeably improve a child's overall quality of life.

Unexplained changes in behavior should always bring to mind an underlying medical cause (pain, epilepsy, a sleep problem).