1. IN THE CROSSFIRE CO-OCCURRING MEDICAL PROBLEMS Merlin L. Taylor, Ph.D., CCC-SLP, BCBA-D Speech-Language Pathologist Behavior Analyst Aspie

2. Co-Occurring Medical Problem = Comorbid Condition “existing simultaneously with and usually independently of another medical condition” • http://www.merriam-webster.com/dictionary/comorbid

3. Some Conditions That Can Be Comorbid With Autism Spectrum Disorder (ASD) • Diabetes • Epilepsy • Irritable Bowel Syndrome (IBS) • Iatrogenesis • Post-Traumatic Stress Disorder (PTSD)

4. Signs • aggression • agitation • clinging • cramping • crying • flatulence • disorientation • hyperventilation • laughing • screaming • sluggishness • spasms • sweating • tremor

5. Problems of Comorbidity

6. Avoidance Behavior Actively evading circumstances or activities wherein symptoms might be elicited.

7. Denial Refusal 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.)

8. MisdiagnosisMisdirected Treatment

9. Symptom Synergy Combined effects of autism and co-occurring conditions.

10. Three Dimensions of Disorder

11. Deteriorating Course of Illness Progressive worsening of symptoms

12. Neurobiological/Neuropsychological

13. Psychoemotional

14. Psychosocial

15. Three Dimensions of Disorder

16. Diabetes

17. Signs • aggression • agitation • clinging • cramping • crying • flatulence • disorientation • hyperventilation • laughing • screaming • sluggishness • spasms • sweating • tremor

18. Signs • aggression • agitation • clinging • cramping • crying • flatulence • disorientation • hyperventilation • laughing • screaming • sluggishness • spasms • sweating • tremor

19. Signs • aggression • agitation • clinging • cramping • crying • flatulence • disorientation • hyperventilation • laughing • screaming • sluggishness • spasms • sweating • tremor

20. Diabetes: Correlation with ASD

21. Complications of Comorbidity—Diabetes • Avoidance behaviors • Denial • Misdiagnosis • Misdirected treatment • Symptom synergy • Deteriorating course of illness

22. Epilepsy

23. Signs • aggression • agitation • clinging • cramping • crying • flatulence • disorientation • hyperventilation • laughing • screaming • sluggishness • spasms • sweating • tremor

24. Signs • aggression • agitation • clinging • cramping • crying • flatulence • disorientation • hyperventilation • laughing • screaming • sluggishness • spasms • sweating • tremor

25. Signs • aggression • agitation • clinging • cramping • crying • flatulence • disorientation • hyperventilation • laughing • screaming • sluggishness • spasms • sweating • tremor

26. Complications of Comorbidity—Epilepsy • Avoidance behaviors • Denial • Misdiagnosis • Misdirected treatment • Symptom synergy • Deteriorating course of illness

27. IBS

28. Signs • aggression • agitation • clinging • cramping • crying • flatulence • disorientation • hyperventilation • laughing • screaming • sluggishness • spasms • sweating • tremor

29. Signs • aggression • agitation • clinging • cramping • crying • flatulence • disorientation • hyperventilation • laughing • screaming • sluggishness • spasms • sweating • tremor

30. Signs • aggression • agitation • clinging • cramping • crying • flatulence • disorientation • hyperventilation • laughing • screaming • sluggishness • spasms • sweating • tremor

31. Complications of Comorbidity—IBS • Avoidance behaviors • Denial • Misdiagnosis • Misdirected treatment • Symptom synergy • Deteriorating course of illness

32. Iatrogenesis

33. Signs • aggression • agitation • clinging • cramping • crying • flatulence • disorientation • hyperventilation • laughing • screaming • sluggishness • spasms • sweating • tremor

34. Signs • aggression • agitation • clinging • cramping • crying • flatulence • disorientation • hyperventilation • laughing • screaming • sluggishness • spasms • sweating • tremor

35. Signs • aggression • agitation • clinging • cramping • crying • flatulence • disorientation • hyperventilation • laughing • screaming • sluggishness • spasms • sweating • tremor

36. Complications of Comorbidity—Iatrogenesis • Avoidance behaviors • Denial • Misdiagnosis • Misdirected treatment • Symptom synergy • Deteriorating course of illness

37. PTSD

38. Signs • aggression • agitation • clinging • cramping • crying • flatulence • disorientation • hyperventilation • laughing • screaming • sluggishness • spasms • sweating • tremor

39. Signs • aggression • agitation • clinging • cramping • crying • flatulence • disorientation • hyperventilation • laughing • screaming • sluggishness • spasms • sweating • tremor

40. Signs • aggression • agitation • clinging • cramping • crying • flatulence • disorientation • hyperventilation • laughing • screaming • sluggishness • spasms • sweating • tremor

41. Complications of Comorbidity—PTSD • Avoidance behaviors • Denial • Misdiagnosis • Misdirected treatment • Symptom synergy • Deteriorating course of illness

42. MOST COMMON SYNERGISTIC SYMPTOM

43. ANXIETY

44. 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

45. The Problem of PTSD Because of deficits in self-insight and/or verbal ability, this individual incidence of PTSD will largely remain unknown

46. 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)

47. 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

48. 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.

49. The Problem of PTSD Misdiagnosis—and consequently misdirected treatment—can become occasion for both iatrogenesis and psychological trauma.

50. 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)