Categories: ASD and DD, Child-focused
Many individuals with autism have also been diagnosed with another disorder. This secondary condition is referred to as a “co-morbid” disorder. Many of these secondary conditions are psychiatric in nature and require attention from parents, teachers, and professionals. The most common co-morbid disorders are attention deficit hyperactive disorder (ADHD), obsessive-compulsive disorder (OCD), and mood disorders, such as depression and bipolar disorder, and anxiety problems.
Diagnosing co-morbid disorders in children and adults with autism can be challenging because these individuals have difficulties with language, self-expression, and social interactions. They may be unable to describe personal, internal feelings. Many do not speak at all, and some need specialized communication systems such as pictures, typing screens, and basic sign language to communicate.
A proper diagnosis of a co-morbid disorder should be done by a qualified professional, such as a pediatrician, psychiatrist, or psychologist. This specialist will be able to differentiate between the various disorders and provide a diagnosis based on direct observations of the individual’s behavior and actions, as well as reports from family members and teachers.
Below are some observable behaviors that might be associated with various co-morbid conditions. Note that many of these behaviors are characteristic of autism and do not necessarily indicate the presence of a psychiatric condition.
ADHD: making careless mistakes; appearing not to listen; not following instructions; not finishing tasks; frequently losing items; fidgeting; squirming; difficulty in playing quietly; interrupting others; and not waiting for his or her turn.
OCD: putting all chairs in place at the table; walking the same path at home or school; arranging items; counting items; repeating phrases; and needing to be first in line.
Depression: sadness and excessive crying; little interest in previous favorite items; loss of appetite; and a lack of responsiveness to other people.
Anxiety: increased breathing and heart rate, and strong avoidance of specific situations or items.
An accurate diagnosis is crucial in determining the most effective treatment, especially if medications are to be considered. Treatment for co-morbid disorders must be administered in the context of an individual’s comprehensive program plan. There are three components to this type of approach that are briefly described below.
First, any serious problem behavior – such as tantrums, hitting others, hurting oneself, or destroying property – must be addressed with a plan that includes:
defining the behavior in observable terms;
using rewards for good behavior;
employing a specific consistent response to the behavior, such as ignoring, removing privileges, or directing to a task; and
counting the number of occurrences each day.
Second, the child or adult should be taught ways to cope with situations that might result in problem behaviors. We do this by providing positive reinforcement and rewards, teaching in small steps, and offering assistance when it is needed.
Third, medications can be considered. Many children and adults with autism receive at least one medication for a psychiatric condition. The use of medication should not be seen as a failure, but as an important component of treatment along with a good plan for addressing behavior problems and a thorough program of instruction in skills. Further, the right medication – a stimulant, antidepressant, mood stabilizer, or antipsychotic – can help reduce behaviors such as impulsive or compulsive behaviors that interfere with establishing social skills and friendships.
Obtaining an accurate diagnosis of a co-morbid condition and determining an effective treatment plan based on careful observation and individual consideration will improve the quality of life for children and adults with autism.
By Alan Harchik, Ph.D., BCBA