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IN THE CROSSFIRE
CO-OCCURRING MEDICAL PROBLEMS
Merlin L. Taylor, Ph.D., CCC-SLP, BCBA-D
Speech-Language Pathologist
Behavior Analyst
Aspie
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Co-Occurring Medical Problem = Comorbid Condition
“existing simultaneously with and usually independently of another medical condition”
http://www.merriam-webster.com/dictionary/comorbid
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Some Conditions That Can Be Comorbid With Autism Spectrum Disorder (ASD)
Diabetes
Epilepsy
Irritable Bowel Syndrome (IBS)
Iatrogenesis
Post-Traumatic Stress Disorder (PTSD)
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Signs
aggression
agitation
clinging
cramping
crying
flatulence
disorientation
hyperventilation
laughing
screaming
sluggishness
spasms
sweating
tremor
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Problems of Comorbidity
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Avoidance BehaviorActively evading circumstances or activities wherein symptoms might be elicited.
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DenialRefusal to acknowledge a disorder by way of verbalization, altered behavior, or any other means.(May even take the form of feigning symptoms of another disorder.)
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MisdiagnosisMisdirected Treatment
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Symptom SynergyCombined effects of autism and co-occurring conditions.
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Three Dimensions of Disorder
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Deteriorating Course of Illness
Progressive worsening of symptoms
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Neurobiological/Neuropsychological
NEUROBIOLOGICAL orNEUROPSYCHOLOGICAL
PSYCHOEMOTIONALPSYCHOSOCIAL
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Psychoemotional
NEUROBIOLOGICAL orNEUROPSYCHOLOGICAL
PSYCHOEMOTIONALPSYCHOSOCIAL
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Psychosocial
NEUROBIOLOGICAL orNEUROPSYCHOLOGICAL
PSYCHOEMOTIONALPSYCHOSOCIAL
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Three Dimensions of Disorder
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Diabetes
NEUROBIOLOGICAL orNEUROPSYCHOLOGICAL
PSYCHOEMOTIONALPSYCHOSOCIAL
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Signs
aggression
agitation
clinging
cramping
crying
flatulence
disorientation
hyperventilation
laughing
screaming
sluggishness
spasms
sweating
tremor
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Signs
aggression
agitation
clinging
cramping
crying
flatulence
disorientation
hyperventilation
laughing
screaming
sluggishness
spasms
sweating
tremor
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Signs
aggression
agitation
clinging
cramping
crying
flatulence
disorientation
hyperventilation
laughing
screaming
sluggishness
spasms
sweating
tremor
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Diabetes: Correlation with ASD
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Complications of Comorbidity—Diabetes Avoidance behaviors
Denial
Misdiagnosis
Misdirected treatment
Symptom synergy
Deteriorating course of illness
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Epilepsy
NEUROBIOLOGICAL orNEUROPSYCHOLOGICAL
PSYCHOEMOTIONALPSYCHOSOCIAL
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Signs
aggression
agitation
clinging
cramping
crying
flatulence
disorientation
hyperventilation
laughing
screaming
sluggishness
spasms
sweating
tremor
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Signs
aggression
agitation
clinging
cramping
crying
flatulence
disorientation
hyperventilation
laughing
screaming
sluggishness
spasms
sweating
tremor
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Signs
aggression
agitation
clinging
cramping
crying
flatulence
disorientation
hyperventilation
laughing
screaming
sluggishness
spasms
sweating
tremor
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Complications of Comorbidity—Epilepsy Avoidance behaviors
Denial
Misdiagnosis
Misdirected treatment
Symptom synergy
Deteriorating course of illness
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IBS
NEUROBIOLOGICAL or
NEUROPSYCHOLOGICAL
PSYCHOEMOTIONAL
PSYCHOSOCIAL
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Signs
aggression
agitation
clinging
cramping
crying
flatulence
disorientation
hyperventilation
laughing
screaming
sluggishness
spasms
sweating
tremor
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Signs
aggression
agitation
clinging
cramping
crying
flatulence
disorientation
hyperventilation
laughing
screaming
sluggishness
spasms
sweating
tremor
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Signs
aggression
agitation
clinging
cramping
crying
flatulence
disorientation
hyperventilation
laughing
screaming
sluggishness
spasms
sweating
tremor
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Complications of Comorbidity—IBS Avoidance behaviors
Denial
Misdiagnosis
Misdirected treatment
Symptom synergy
Deteriorating course of illness
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Iatrogenesis
NEUROBIOLOGICAL or
NEUROPSYCHOLOGICAL
PSYCHOEMOTIONAL
PSYCHOSOCIAL
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Signs
aggression
agitation
clinging
cramping
crying
flatulence
disorientation
hyperventilation
laughing
screaming
sluggishness
spasms
sweating
tremor
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Signs
aggression
agitation
clinging
cramping
crying
flatulence
disorientation
hyperventilation
laughing
screaming
sluggishness
spasms
sweating
tremor
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Signs
aggression
agitation
clinging
cramping
crying
flatulence
disorientation
hyperventilation
laughing
screaming
sluggishness
spasms
sweating
tremor
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Complications of Comorbidity—Iatrogenesis Avoidance behaviors
Denial
Misdiagnosis
Misdirected treatment
Symptom synergy
Deteriorating course of illness
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PTSD
NEUROBIOLOGICAL orNEUROPSYCHOLOGICAL
PSYCHOEMOTIONALPSYCHOSOCIAL
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Signs
aggression
agitation
clinging
cramping
crying
flatulence
disorientation
hyperventilation
laughing
screaming
sluggishness
spasms
sweating
tremor
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Signs
aggression
agitation
clinging
cramping
crying
flatulence
disorientation
hyperventilation
laughing
screaming
sluggishness
spasms
sweating
tremor
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Signs
aggression
agitation
clinging
cramping
crying
flatulence
disorientation
hyperventilation
laughing
screaming
sluggishness
spasms
sweating
tremor
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Complications of Comorbidity—PTSD Avoidance behaviors
Denial
Misdiagnosis
Misdirected treatment
Symptom synergy
Deteriorating course of illness
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MOST COMMON SYNERGISTIC SYMPTOM
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ANXIETY
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The Problem of PTSD
In anxiety-prone individuals on the autism spectrum, whose sensory processing difficulties can render mundane sensory experiences terrifying, PTSD may occur on more than one occasion
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The Problem of PTSD
Because of deficits in self-insight and/or verbal ability, this individual incidence of PTSD will largely remain unknown
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The Problem of PTSD
PTSD can, in turn, lead to a number of highly maladaptive behaviors, including (but not limited to)
Aggression
Self-injury
Addictions (especially in higher-functioning individuals)
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The Problem of PTSD
Very ironically, PTSD may be misdiagnosed as physiological due to its outward signs, while frankly physiological conditions may be misattributed to anxiety
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The Paradox of Anxiety
While a common factor exacerbating physiological symptoms anxiety is rarely a cause or a solitary symptom in cases of autism with comorbidity.
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The Problem of PTSD
Misdiagnosis—and consequently misdirected treatment—can become occasion for both iatrogenesis and psychological trauma.
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In Summary: Don’t
assume that any physician can make a psychiatric diagnosis
summon the dead to defend a poor diagnostic decision
expect the health problems of individuals with autism to readily make sense
expect omnisicience of any human being (yourself included)
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In Summary: Do
Listen, observe and reflect
Keep asking questions—if only in your mind
Look out for “zebras”
Perform thorough diagnostics as a clinician—insist upon these as a consumer
Keep trying. Keep trying. KEEP TRYING.
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Thank you!