There are a number of conditions often co-morbid to Autism Spectrum Disorder. Epilepsy, Seizure Disorders, ADHD, Bipolar disorder, Bowel disease, Developmental Coordination Disorder, Fragile X Syndrome, Intellectual Disability, Obsessive-Compulsive Disorder (OCD), Tourette Syndrome, Immune Disorders and Non-Verbal Learning Disorder – and no doubt a few more I have perhaps overlooked. http://en.wikipedia.org/wiki/Conditions_comorbid_to_autism_spectrum_disorders
As a parent of a child with Autism the issue of co-morbid conditions can be an issue that is really difficult to navigate your way around. There are those specialists who do not believe in giving children multiple labels stating that conditions such as ADHD, Anxiety and OCD are really just part of having a diagnosis of Autism.
Donna Williams, an Australian writer, musician, artist, and professional speaker with Autism herself describes Autism as being like a “fruit salad”. I love this analogy. Donna believes that “whilst we can talk of Autism Spectrum Disorders (ASDs) THERE IS NO ONE TYPE OF AUTISM because autism is like a fruit salad. For each person diagnosed with autism the pieces in that fruit salad can be many or few, big or small, exotic or common” http://www.donnawilliams.net/definition.0.html.
There are some schools of thought that acknowledge the value of recognising and naming co-morbid conditions. For example, the Diagnostic Statistical Manual used to diagnose conditions such as those mentioned above, previously (in the DSM-IV) disallowed an official diagnosis of both ASD and ADHD. The recently updated manual DSM-V now allows both conditions to be recognised and diagnosed.
So what do I think about all this?
Initially, I railed against the idea of having my children labelled with a variety of different terms. As time has gone by though and as I’ve gone through the diagnostic process with my husband, my thoughts have changed. I think you really do need to name the elephant in the room. Until the elephant is named, acknowledged and recognised, you can’t direct the most appropriate intervention or treatment at it.
My boys both have significant issues with Anxiety and ADHD. Tom is clinically ADHD and ASD. James is clinically ASD, ADHD and also has Anxiety Disorder. Both boys appear to have dysgraphia. “Dysgraphia is a deficiency in the ability to write, primarily in terms of handwriting, but also in terms of coherence. Dysgraphia is a transcription disability, meaning that it is a writing disorder associated with impaired handwriting, orthographic coding (orthography, the storing process of written words and processing the letters in those words), and finger sequencing (the movement of muscles required to write).” http://en.wikipedia.org/wiki/Dysgraphia A significant number of individuals on the Autism Spectrum will suffer from dysgraphia. Both boys have been assessed by an Occupational Therapist and have received a number of interventions and strategies that have made their lives at school much easier. Naming the elephant in the room has reduced writing stress for my boys; it has allowed them better access to interactive technologies to assist with writing; and it has helped their teachers provide better support or them in the classroom!
Both boys have also suffered with tics. This is where it gets tricky. Both boys chew their lips and cheeks repetitively which is worse at some times than others. Tom has had eye blinking, finger flicking, mouth/lip chewing, random vocalisations and these have become unmanageable on specific kinds of stimulant medication used to control his ADHD. James has suffered the breath holding, the repetitive speech/words, compulsive whistling, and random vocalisations. I suspect that both boys have Tourette Syndrome but have never pursued a formal diagnosis. Some doctors will no doubt say that this repetitive behaviour is part of their ASD – that it is repetitive, compulsive and/or stimulatory behaviour. I note however that when they have been on medications designed to help control the symptoms of Tourette’s that these behaviours noticeably decrease. I feel this elephant will need to be named shortly in able to best assist them with the behaviours and also help their teachers (and us too) to understand the constant noise and movement they both generate.
From Donna Williams – “Tourette’s can occur from the age of 2. Around 30% of folks on the autie spectrum are thought to have Tourette’s or Obsessive Compulsive Disorder. For some, vocal tics (involuntary and compulsive repeated words/phrases/sounds) are so severe it takes over their communication to the point it becomes utterly dysfunctional and they may lose faith in pursuing communication at all (there is a prevailing myth that these are always swear words, in fact only a small percentage of those with Tourette’s experience the swearing tics). Movement/motor tics can include jumping, flapping, slapping, biting, blinking, grimacing, hand movements, finger movements, tapping, smelling, squeezing, shrugging, hair flicking, etc and of course compulsive breath holding, coughing, sniffing, throat clearing. If severe, these tics can take over and interrupt most interaction.” http://www.donnawilliams.net/tourettesandstims.0.html
There are many conditions that can be comorbid with Autism. In my view, naming the elephant in the room can make all difference in your understanding and particularly in your child’s understanding of their behaviour. It can help you to receive appropriate strategies to help your child and also help with improving others’ understanding of your child and their needs.