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Understanding the Medical Comorbidities of Autism

By: Sheri A. Marino, MA, CCC-SLP

Focus For Health Foundation

Disclaimer

1.  I am a Speech Pathologist.

2.  This should be a full day presentation.

3.  I am from NJ

Course Objectives

1.  To engage you in dialogue about autism outside of the DSM, considering a paradigm shift to a medical model.

2.  To help your recognize the early medical warning signs that may express themselves long before the developmental warning signs.

3.  To help you recognize the underlying medical conditions that could be impacting educational and therapeutic outcomes.

4.  To get you collaborating, talking to each other, to parents, professionals, and doctors.

5.  To help you prevent anymore unnecessary suffering that children with autism often experience because of unrecognized medical conditions.

My Evolution in Autism

S  Douglass Developmental Disabilities Center

S  Milestones Early Intervention and Expansion Team

S  Private Practice S  NJ/NY/London

S  Rocking Horse Rehab

S  Autism Think Tank

S  Focus For Health Foundation

History of Autism

S  1908- “Autism” was used to describe Schizophrenic patients

S  1943- Leo Kanner, MD coined the term “early infantile autism”

S  1944- Scientist, Hans Asperger describes milder symptoms as “Asperger’s Syndrome

S  1967- Psychologist Bruno Bettelheim describes “refrigerator mothers”

S  1977- Research shows a genetics and biological differences in brain development

S  1980- Pervasive Developmental Disorder is listed in the Diagnostic Statistical Manual of Mental Health Disorders (DSM III)

S  1987- DSM replaces “infantile autism” with a broader definition of “autistic disorder” and PDD-NOS

DSM IV vs. DSM V

DSM IV

S  Pervasive Developmental Disorder:

S  Autism

S  Asperger disorder

S  Rett syndrome

S  Childhood disintegrative disorder

S  PDD-NOS

DSM V

S  Autistic Spectrum Disorder:

Removes:

S  Rett syndrome

S  Child disintegrative disorder

Merges:

S  PDD-NOS

S  Asperger syndrome

S  Autism

Getting Closer in the DSM V

S  One diagnosis with variable and descriptive factors

S  Severity of ASD symptoms

S  Verbal abilities

S  Cognitive abilities

S  Inclusion of specifiers such as “Associated with Known Medical or Genetic Condition or Environmental Factor”

Common Symptoms

S  Delayed or lack of speech

S  Poor eye-contact

S  Obsessive desire for sameness/rituals

S  Lacks social skills/emotional reciprocity

S  Mal-adaptive behaviors

S  Echolalia

S  Sensory Processing Disorder

S  Self-stimulatory behaviors i.e. hand flapping

S  Picky eater

Common Medical Symptoms

Case Study 1

Case Study 2

Case Study 3

All Systems Impact

Neurology

Sensory Motor

S  Genetics

S  Seizures

S  PANDAS

S  PICA

S  Mitochondrial Disorders

S  Metabolic Disorders

Medical

S  Tactile

S  Visual

S  Auditory

S  Self-regulation

S  Vestibular

S  Proprioceptive

Sensory Processing Disorder

Sensory Processing Disorder

Tactile

Visual

Auditory

Auditory Processing

Difficulties

Vision

Problems Aversions to or Seeks Textures

Self-Regulation

Poor Sleeper Poor Sensory

Modulation

Inability to

Self-Soothe

Vestibular

Proprioceptive

Low Tone Poor Motor Planning

SPD Signs and Symptoms

Sensitivity to sounds

Covers ears

Increased behaviors

Headaches

Language processing difficulties

Poor eye contact

Poor eye/hand coordination

Sensitivity to light

Poor spatial awareness

Looks at objects peripherally

Refusal to wear certain clothing

Irritated by clothing tags

Refusal to walk on sand/grass

Picky eater

Seeks certain objects

Difficulty falling asleep

Difficulty staying asleep

Irritability

Attention and learning affected

Hypo/hyper activity

Self-Stimulatory Behaviors

Difficulty establishing attention

Difficulty maintaining attention

Risky behavior bolting and elopement

Inactivity- weight gain

“Colicky” baby

Needs the “Mommy Dance” or a

car ride to calm

Difficulty with transitions

Feels floppy

Loose in joints

Not necessarily weak

Trips/falls

Steps on toys

Spills

Difficulty using utensils

Genetics

DNA Genomes

Micro-array

Recent studies

Pharmacogenetics

Seizures

Symptoms •  Body convulsions

•  Body part tremors

•  Eye-gaze/staring

•  Aura

•  Decrease in Muscle Tone

•  Lip smacking

PANDAS Pediatric Autoimmune Neuropsychiatric Disorders Associated with Strep Infection

Symptoms: Sudden onset of;

OCD

Motor or vocal tics Separation Anxiety

Generalized anxiety Motoric hyperactivity/restlessness

Abnormal movements

Concentrations difficulties Sensory abnormalities/food restrictiveness

Developmental regressions Food intolerances

Irritability Frequency of urination and bedwetting

Behavioral changes/tantrums Sleep disturbances

Handwriting deterioration

PICA

Symptoms

S  PICA is an appetite for primarily non-nutritive substances such as chalk, paper, dirt etc. as well as some food substances such as starch and flour.

Causes

S  Neurological

S  Biochemical deficiencies

S  Acquired Taste

S  Sensory Seeking

S  Cognitive Deficits

Metabolic Disorders

Energy

Protein

Carbo-hydrates

Sugars

Fats

S  Metabolism is the body’s ability to convert the food we eat into energy sources

S  A metabolic disorder occurs when the body cannot convert these foods and we end up with too much or too little essential nutrients for our body to function

Mitochondrial Disorder Symptoms:

•  Language and social impairment

•  Neuropsychiatric symptoms (ADHD, anxiety, OCD, depression)

•  Seizures

•  Weakness or low tone

•  Fatigue

•  Gastrointestinal issues

•  Plateaus or aggressions

Allergy/Immunology

S  Food Allergies/Sensitivities

S  Eczema

S  Seasonal Allergies/Asthma

S  Ear infections

S  Candida Overgrowth

Food Allergies

Symptoms

•  Tingling or itching in the mouth.

•  Hives, itching or eczema.

•  Swelling of the lips, face, tongue and throat or other parts of the body.

•  Wheezing, nasal congestion or trouble breathing.

•  Abdominal pain, diarrhea, nausea or vomiting.

•  Dizziness, lightheadedness or fainting

Eczema

Symptoms •  Dry, sensitive skin

•  Intense itching •  Red, inflamed skin

•  Recurring rash •  Scaly areas

•  Rough, leathery patches •  Oozing or crusting

•  Areas of swelling

•  Dark colored patches of skin (National Eczema Association)

Seasonal Allergies/ Asthma

Symptoms •  Sneezing

•  Wheezing

•  Itchy watery eyes

•  Asthma

Allergy Testing and Treatment Allergy Testing •  Skin vs. Blood Tests •  IgE and IgG Antibodies

Treatment •  Elimination Diets •  Antihistamines and

Decongestants •  Allergy Shots •  Nasal Spray

Side Effects •  Stimulants can lower seizure threshold

Ear Infections

Symptoms

•  Irritability

•  Poor appetite

•  Sleeplessness

•  Red ears

•  Vomiting

•  Diarrhea

Candida Overgrowth

Behavioral Signs Headaches Inappropriate laughter Sleep disturbances Unexplained intermittent crying Belly aches Constipation Bed wetting Gas pains Fatigue Depression “Fogginess” Inattention Hyperactivity Anger, aggression Increased self-stimulatory behavior

High Pitched Screams Increased sensory defensiveness Climbing/jumping off things Sugar cravings Confusion Lethargy Inability to potty train, or loss of this skill Self-limiting Foods Plateauing in skills

Physical Signs In the mouth, in the form of thrush On the skin such as diaper rash or eczema Red ring around the anus Rash or cracking between the toes or joints

r

Gastroenterology

S  Gastroesophogeal Reflux Disease (GERD)

S  Eosinophilic Gastrointestinal Disorders (EIGD’s)

S  Chronic Constipation

S  Chronic Diarrhea

Gastroesophogeal Reflux Disease (GERD)

Medical Symptoms

S  Burning in the chest or throat

S  Chest pain from esophageal spasms (often mistaken as heart attack)

S  Burping/hiccupping

S  Vomiting

S  In infants reflux is common but it’s important to note that reflux in infants does not have to be “seen” as spit up to be present. Therefore the symptoms can be hidden.

Behavioral Symptoms

S  Tapping/hitting the chin

S  Excessive coughing

S  Applying pressure on the abdomen

S  Chewing of clothes (can also be teething/sensory seeking behavior)

S  Food refusal

S  Excessively chewing food or food refusal (difficulty swallowing due to inflammation or eosinophilic gastroenteritis)

Eosinophilic Gastrointestinal Disorders

S  Eosinophilic Esophagitis

S  Eosinophilic Gastroenteritis

S  Eosinophilic Colitis

Lower GI Disorders

S  Chronic Constipation

S  Chronic Diarrhea

S  Leaky Gut

Psychiatry

S  Anxiety

S  Attention Deficit Disorder

S  Oppositional Defiant Disorder

S  Obsessive Compulsive Disorder

S  Tourette’s /Tic Disorder

S  Adrenergic Rage

Psychopharmacology

•  Paradoxical Drug Reactions

Drug-Drug Interactions

Pain Management

•  Increased sensitivity to pain in the internal organs

•  Chronic pain resulting from damaged, dysfunctional or injured tissue

•  Pain felt in a part of the body other than the originating site of stimulus

What is Autism?

Where do we go from here?

S  Educate the Parents

S  Educate the Doctors

S  Educate the Therapists and Teachers

S  Educate the Behaviorists

S  GET PEOPLE TALKING AND COLLABORATING!

Contact Info

S  Sheri A. Marino, MA, CCC-SLP

S  Executive Director, Autism Think Tank, NJ

S  Autism Advisor, Focus For Health Foundation

S  sheri@autismthinktanknj.com