Autism’s Co-Occurring Conditions: Time to Act

March 29, 2018

The evidence is piling up on the severe burden of health problems that accompany autism spectrum disorder (ASD). These problems are often unrecognized and not addressed. According to a new study from scientists with the U.S. Centers for Disease Control & Prevention (CDC), “the high prevalence and diversity of co-occurring conditions/symptoms in ASD suggest the need for a comprehensive system of care for these children.”

The investigators found an average of 4.9 conditions among the eight year-olds studied and 3.8 for four year-olds. About a quarter of the eight year-olds had at least seven conditions. The conditions or symptoms examined and their prevalence among eight year-olds is shown below. They include such debilitating conditions as seizure disorder, aggression, self-injurious behavior, anxiety, ADHD, and sleep abnormalities. Nearly all children with autism–98 percent of the 8 year-olds and 96  percent of the four yeaar-olds–had at least one of these co-occurring conditions.

Conditions/Symptoms Studied Percent of 8 Year Olds
with the Condition
Mood disorder 74.80
Abnormalities in eating, drinking 56.74
Temper tantrums 55.27
Aggression 54.26
Sleep abnormalities 37.12
Language disorder 34.83
Developmental disability-motor 26.86
ADHD 26.05
Self-injurious behaviors 25.02
Developmental disability-adaptive 20.81
Developmental regression 19.34
Developmental disability-cognitive 14.57
Congenital conditions 13.30
Anxiety 11.18
Sensory integration disorder 8.70
Oppositional deviant disorder 4.03
Epilepsy/seizure disorder 3.02
Genetic conditions 0.64

The number of co-occurring conditions/symptoms observed is likely an underestimation, as many conditions found to be elevated in autism from other studies were not included in this investigation, such as immune and metabolic problems, gastrointestinal disease, suicidality, cardiac abnormalities, and wandering/elopement. The study also relied on medical and educational records, rather than formal, in-person assessments, so many conditions may have been missed.

Still, this study adds to the growing body of research demonstrating the magnitude of co-morbidities on the person with autism. These other disabilities or disorders “often contribute to a higher level of impairment [and] increased need for services … impacting the quality of life of children with ASD and their families.” These various conditions also contribute to the frightening rate of earlier deaths (increased mortality) reported for people with autism in other research.

The study authors found that the presence of a given condition may delay a diagnosis of autism in some instances. For example, a child diagnosed with ADHD might not receive an autism diagnosis until later in age because the ADHD symptoms might mask or alter the recognition of autism features. This delay may prevent the most appropriate interventions to be instituted for that child.

The study investigators suggest that “clinicians may use these data to support screening for co-occurring conditions/symptoms and provide specific interventions.” The implications are to screen children with ASD for co-occurring conditions and to treat them accordingly, as well as to screen children with these other conditions for the presence of autism so that early intervention for autism can begin as soon as possible.

This is sound advice, even if couched in “research-ese” language that doesn’t reflect the urgency commensurate with problem. Parents with a child already diagnosed with autism could take this study to their health care providers and ask that their child be screened for other conditions. Likewise, parents with a child presenting with other issues should ask their health care provider to rule in or rule out autism. Once a diagnosis is made, parents should be firm in advocating for treatments targeted for each condition present.

This study is another wake-up call fpr health care professionals to take action on these other problems when developing treatment plans for their patients with developmental disorders. Multidisciplinary teams of experts should be put in place.

Policymakers and the media should understand the full medical burden of the person with autism. A diagnosis of autism goes far beyond social deficits and restricted interests. Autism, with all its accompanying features, is on its way to costing the U.S. one trillion dollars. Ignoring the toll of autism’s complete presentation–which seems to be the prevailing response of policymakers and the mainstream media–will not make the problem go away.


New Study

Prevalence of Co-occurring Medical and Behavioral Conditions/Symptoms Among 4- and 8-Year-Old Children with Autism Spectrum Disorder in Selected Areas of the United States in 2010. G. N. Soke, M. J. Maenner, D. Christensen, M. Kurzius-Spencer, L. A. Schieve. Journal of Autism and Developmental Disorders. 09 March 2018

Growing Body of Research

Autism. 2015 Oct;19(7):814-23. Epub 2015 Apr 24.

The health status of adults on the autism spectrum. Croen LA1, Zerbo O2, Qian Y2, Massolo ML2, Rich S3, Sidney S2, Kripke C4. Autism. 2016 Jul;20(5):551-61. doi: 10.1177/1362361315594798. Epub 2015 Jul 10.

A description of medical conditions in adults with autism spectrum disorder: A follow-up of the 1980s Utah/UCLA Autism Epidemiologic Study. Jones KB, Cottle K, Bakian A, Farley M, Bilder D, Coon H, McMahon WM. Res Dev Disabil. 2012 Mar-Apr;33(2):467-76. doi: 10.1016/j.ridd.2011.10.008.

Concurrent medical conditions and health care use and needs among children with learning and behavioral developmental disabilities, National Health Interview Survey, 2006-2010. Schieve LA, Gonzalez V, Boulet SL, Visser SN, Rice CE, Van Naarden Braun K, Boyle CA. Res Dev Disabil. 2012 Mar-Apr;33(2):467-76


Excess mortality and causes of death in autism spectrum disorders: a follow up of the 1980s Utah/UCLA autism epidemiologic study. Bilder D1, Botts EL, Smith KR, Pimentel R, Farley M, Viskochil J, McMahon WM, Block H, Ritvo E, Ritvo RA, Coon H.  J Autism Dev Disord. 2013 May;43(5):1196-204. doi: 10.1007/s10803-012-1664-z.

Large Swedish study ties autism to early death by Ann Griswold. Spectrum News. December 11, 2015.

One trillion dollars

Autism costs estimated to reach nearly $500 billion, potentially $1 trillion, by 2025. UC Davis Health Newsroom. July 28, 2015

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