common medical problems in asd

Common MedicalProblems in AutismSpectrum DisordersA guide by parents for parents and carers

“Care providers should be aware

that problem behaviour in patients

with ASDs may be the primary or

sole symptom of the underlying

medical condition.”

“At this point, I think there is

enough evidence to say that

while autism certainly involves

the brain, it is really a problem

of the whole body, including the

brain, from molecules to cells,

from organs to metabolism, from

immune to digestive systems. Even

for those with autism who show no

obvious medical problems, take a

careful look for hidden issues.”

Consensus Report, Pediatrics, Buie et al., 2010

Martha Herbert, MD, PhD, ‘The AutismRevolution: Whole-body strategies formaking life all it can be’

co-morbid sheet for parents 2_Layout 1 13/11/2013 11:01

People with ASD suffer medicalproblems more commonly than theirpeers. Further to this, their symptoms maybe different from what is normally expected,but, if appropriate treatments are provided,quality of life can improve and symptoms ofASD can diminish, sometimes dramatically.

Recent studies have shown that manymedical conditions are significantly morecommon in people with autismcompared to the typical population,including: eczema, allergies, asthma, earand respiratory infections, gastrointestinalproblems, severe headaches, migraines,and seizures.

It is also a sad fact that mortality issignificantly increased in autism, withdeath rates being more than three timeshigher than the general population.Premature deaths in autism are mostly the

result of co-occurring medical conditionssuch as epilepsy, respiratory,gastrointestinal and cardiovascular disease.Risk of epilepsy and premature deathincreases with the severity of autism.

In spite of their increased health careneeds, many people with ASD are notreceiving appropriate attention andtreatments. There are several factors thatprevent people with ASD from gettingproper health care. Communicationdif!culties are a de!ning characteristic ofASD and more severely affected peoplemay have almost no ability to explain theirsymptoms. As well, people with ASD maynot localise the pain as we would expectand their symptoms may not be the sameas found in the non-ASD population.

However, the most common reasonpreventing people with ASD from

PARENT’S STORY My son had severe gastrointestinal problems from an early age. After his regression, hedeveloped self-injurious behaviour, violent outbursts and prolonged bouts of sobbing and crying. I was notprepared to accept his paediatrician’s opinion that his chronic diarrhoea was ‘just part of his autism’, and pushedfor a referral to a gastroenterologist. An abdominal X-ray revealed impaction of the colon, causing distension ofthe rectum. Despite symptoms suggestive of diarrhoea, my son was actually suffering from severe and chronicconstipation, and the violent and self-injurious behaviours were, in fact, manifestations of pain.

Treatment of his gastrointestinal issues, mostly through diet and supplementation, was key to restoring hisgeneral health and well-being. He is immeasurably healthier and happier than in the dark days of head-banging,hand-biting and inconsolable screaming. Despite his communication difficulties, he has the ability to reach outto people and his personality shines through his autism.

“Treatment of comorbid medical conditions may result in a substantial improvement of quality of life both of the child and their parents. Whatinvestigations should be implemented can vary both within the autismspectrum and individually.” Isaksen et al., 2012 ‘Children with autism spectrum

disorders: The importance of medical investigations.’


receiving appropriate health care isdiagnostic overshadowing. Diagnosticovershadowing is far too common becauseof the widespread but erroneousassumption that a diagnosis of ASD is anexplanation for any and sometimes allbehaviours and symptoms. Many parentshave reported to our charity that medicalprofessionals have dismissed theirconcerns regarding self-harming,aggression, night-waking, change inappetite, severe anxiety, and many more as‘just autism’. None of these behaviours arepart of the ASD diagnostic criteria, andthere is much evidence to show thatbehaviour is often the result of a physicalcause, such as re"ux pain for example.

Treatment for relatively straightforwardmedical issues such as reflux can haveimmediate positive results but diagnosticovershadowing can have incredibly negativeoutcomes: unnecessary pain and suffering,increased violent behaviours, avoidablepsychotropic drugs, diminished abilities andquality of life, even premature death.

Beyond relatively straightforward treatmentfor conditions such as re"ux, there arepractitioners and researchers investigatingcomplex health issues often found in ASDsuch as mitochondrial impairment, alteredimmune responses including allergy,gastrointestinal problems, and autonomicdysfunction. Current research into andsuccessful treatment of these dif!culthealth issues are making it clear that ASDis a whole body disorder, with thesymptoms used to diagnose autism beingthe result of complex physical problemsamong many body systems. The barrier totreatment lies in the fact that there are fewresearchers and practitioners taking thiswhole-body approach.

In a 2009 survey of our members, morethan 95% of respondents who hadused biomedical treatments for autismfound those treatments to be beneficialand 24% found those benefits to belife-changing. You can learn more abouthealth problems and ASD and readstories from some of our members at ourwebsite www.treatingautism.co.uk

PARENT’S STORY My son has severe autism and very little speech. When he was eleven, he suddenlybecame very agitated and aggressive. He was charging at people, hair pulling, scratching, kicking, etc, as wellas self-harming several times a day for no obvious reason. We were told by health professionals that pubertywas the reason for this behaviour. I couldn’t believe that puberty would impact so suddenly and so drastically. Indesperation we followed the advice of the professionals and put him on an anti-psychotic drug. This had littleeffect on the outbursts, instead it triggered his first seizure.

During a dental check up, our special needs dentist told us our son’s teeth were badly eroded, it was likelycaused by either fizzy drinks or acid reflux. As he never has fizzy drinks we went back to the paediatrician whoagreed to trial reflux medication. The aggression stopped overnight and I had my old loving, gentle son back. Hemust have been in terrible pain. I eventually weaned him off the medication and have kept the reflux at baythrough diet and the occasional over the counter remedy.

The only times the aggression has returned have been when my son has been ill and in pain. Aggression isnot part of his autism but is a symptom of real and acute pain.


To find more about Treating Autism or to join us as a member visit www.TreatingAutism.co.uk By joining our charity you will receive a free copy of the book The Autism Revolution, by Martha Herbert MD, PhD or another book of your choice. Membership also gives you free access to our library with hundreds of autism books and DVDs as well as discounts at dozens of autism friendlybusinesses and our conferences.

To request papers copies of this document and/or a full length document prepared for professionals, please contact us at [email protected]

FOR PARENTS BY PARENTS

Behaviours which mayindicate an underlyingcomorbid illness include: Sudden change in behaviour Loss of previously acquired

skills Irritability and low mood Tantrums and oppositional

behaviour Frequent night-waking or

general sleep disturbance Teeth grinding Change to appetite or dietary

preferences Heightened anxiety and/or

avoidance behaviours Repetitive rocking or other

new repetitive movement Walking on toes Posturing or seeking

pressure to specific area Extreme sensory sensitivity

(eg covering ears with hands), tactile defensiveness, sensitivity to light

Behaviour around evacuation

Onset of or increase in aggression

Self-injurious behaviour: biting, hits/slaps face, head-banging, unexplained increase in self-injury

Constant eating/drinking (‘grazing’ behavior)

Frequent clearing of throat, swallowing

Mouthing behaviours: chewing on clothes

Facial grimacing, wincing, tics

Tapping behaviour: finger tapping on throat

Sobbing ‘for no reason at all’ Vocal expressions of

moaning, groaning, sighing, whining

Agitation: pacing, jumping up and down

Blinking, sudden screaming, spinning or fixed look

Common sources of painand discomfort include: Headache Earache Toothache Sore Throat Reflux Oesophagitis Gastritis Colitis Soft or hard stool

constipation (underlying cause will be relevant)

Small Intestinal Bacterial Overgrowth

Musculoskeletal injury or disease

Seizure Disorder (including subclinical crisis)

Allergy Disorder

Pain can be acute or chronic, progressive or static.

The table below is designed to help parents and carers betterunderstand symptoms or behaviours they may observe.

Treating Autism is run on a voluntary basis. www.treatingautism.co.uk


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