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Co-Occuring Conditions

Autism spectrum disorders can have numerous effects on the body and brain. The complexity of the disorder is apparent by observing the co-occurring conditions that are present in some individuals with ASD. According to Autism Society1, these co-occurring conditions include:

1. LOW IQ: Traditionally, standard intelligence quotient (IQ) tests have been unfairly administered to children with developmental disabilities. Physical, verbal, and sensory difficulties often attributed to children with autism achieving low IQ tests when administered the traditional WISC-IV test. Research suggests that children with autism who undergo the Raven’s Progressive Matrices exam attain higher IQ scores compared to traditionally administered evaluations.2 The 2012 CDC report on the prevalence of ASDs in America, found that 38% of children within the 8 network sites either had a qualified professional document intellectual disability in the record or scored lower than a 70 on the IQ test, which marks an intellectual disability.3 The report does not specify which test was used to evaluate the IQ of these children. Other prominent nonverbal IQ tests are the Universal Nonverbal Intelligence Test (UNIT) and the Test for Nonverbal Intelligence (TONI).

2. Seizures/Epilepsy: The three types of seizures are generalized as tonic clonic (convulsive) seizure, absence seizure, and partial seizure.4 Infancy and puberty are two peaks of onset for epilepsy in children with autism. According to Dr. Roberto Tuchman, MD, and Michael Rosanoff, MPH, of Autism Speaks’ science team “epilepsy rates among those with autism spectrum disorders (ASD), range from 20 to 40 percent, with the highest rates among those most severely impaired by autism.”5 The brochure entitled Autism, Epilepsy, & Seizures offers a breakdown of the types of seizures, facts and stats about seizures/epilepsy and autism, advice on what to do for an individual experiencing a seizure, and how to provide first aid for seizures in special circumstances.

3. Chronic Constipation and/or Diarrhea: Gastrointestinal problems occur more frequently in children with autism than typically developing individuals. A 2003 study found that 36% of children with autism had moderate to severe constipation vs. 10% for the control group.6 Individuals with gastrointestinal issues and autism most commonly experience diarrhea, while abdominal pain is the second most frequent occurrence, and constipation is reported slightly less.1 Some children with ASD experience bowl impaction, which, if suspected, can only be confirmed by an x-ray.

4. Sleep Problems: According to WebMD, researchers estimate that 40% to as many as 80% of children with autism have sleep related issues.7 The most common sleep related problems include difficulty falling asleep, inconsistent sleep routines, restlessness or poor sleep quality, and waking early. Studies have indicated that melatonin, which normally helps regulate sleep-wake cycles, is not released at the correct times of day for individuals with autism. Another reason sleeps problems occur may be that some individuals with autism can be more sensitive to outside stimuli, such as touch and sound. Anxiety, which is more common in children with autism, can also attribute to sleep difficulties. The National Autistic Society provides comprehensive advice for suppressing sleep problems in autism.

5. Pica: According to the National Autism Center, an estimated 25% to 30% of children with autism develop pica.8 Pica is defined as “an abnormal desire to eat substances (as chalk or ashes) not normally eaten.”9 Children with autism that develop pica will typically consume dirt, rocks, paint chips, plaster, chalk, cigarette butts, coffee grounds, and toothpaste, just to name a few. Clearly ingesting these substances can have detrimental, if not life threatening, consequences, such as poisoning, bowel problems, intestinal obstruction, dental injury, and parasitic infections. Any parents of a child with pica should seek the advice of a medical professional.

6. Low Muscle Tone: Some individuals with autism have hypotonia, or a state of low muscle tone, frequently including decreased muscle strength. Due to low muscle tone some individuals may experience hypermobility, which is the ability to move limbs into awkward positions like splits or back-bending. Low muscle tone can contribute to a lack of fine motor skills in individuals with autism, which can cause difficulties in balance, coordination, manual dexterity (ie. tie shoelaces, eat with utensils), and even handwriting.10 Physical and/or occupational therapists can determine the degree of severity and provide possible strategies for combating low muscle tone.

7. Sensory Processing Disorder: Common across the autism spectrum, sensory processing disorder (SPD), or sensory integration disorder, causes difficulties with processing information from the five senses: vision, auditory, touch, olfaction, and taste.11 Individuals with sensory processing disorder process information in a way that can cause distress, discomfort, and confusion. This hypersensitivity can result in not liking to be touched or the inability to withstand normal lighting. Learn more about Sensory Processing Disorder and Sensory Integration Therapy.

8. Allergies/Immune System: Decades of research links immunological abnormalities to ASD. Allergies were once thought to be more common in individuals with ASD, but recent “properly-controlled research suggests no difference in allergic phenomena between a person with ASD and neurotypical individuals.”12 Immune deficiencies can cause individuals with ASD to become more susceptible to infections and eczema, chronic runny noses, and ear infections are more likely to occur.13 Many families have found success by implementing gluten/casein free diets for their children. Research has also shown that gastrointestinal issues can also benefit from diets heavy in multivitamins and minerals.14

9.Pain: The pain threshold for individuals with autism can vary dramatically. Some individuals have a high tolerance for pain, which can be dangerous because they may not realize they are doing harm to their body.

10. Hearing/Visual Impairments: A dual diagnosis of autism and visual and/or hearing impairments can present overwhelming challenges for families. The challenges in motor movements caused by autism can make speech and signing difficult.15 Children born blind/visually impaired or deaf/hard of hearing are typically identified early and receive intervention to support their communication and interaction with others.1 However, there are instances of “symptoms that may indicate other developmental problems remain[ing] undiagnosed once a child’s services have been tailored to his or her hearing loss.”16 Children who are deaf and children who are diagnosed with autism typically display common impairments in social communication, and language, delays and abnormalities in play development, and restrictions of interest and activity.16 This causes children with hearing impairments on the autism spectrum to be routinely given a later diagnosis than children without hearing impairments. The Spring/Summer 2008 issue of Odyssey is dedicated solely to deafness and autism. For more information and advice on autism and the visually impaired, visit the National Autistic Society’s visual impairment and autism spectrum disorders page.