3. The Co-Morbid Conditions of Autism Spectrum Disorders

Report
Cynthia Macluskie
Parent Mentor of Autism Society of
America Greater Phoenix Chapter
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Autism is a complex developmental disability that typically
appears during the first three years of life and is the result of a
neurological disorder that affects the normal functioning of the
brain, impacting development in the areas of social interaction
and communication skills. Both children and adults with autism
typically show difficulties in verbal and non-verbal
communication, social interactions, and leisure or play activities.
One should keep in mind however, that autism is a spectrum
disorder and it affects each individual differently and at varying
degrees - this is why early diagnosis is so crucial. By learning the
signs, a child can begin benefiting from one of the many
specialized intervention programs.
Contrary to what you may hear autism is treatable. It is important
to find effective services, treatments and education for autistic
children as soon as possible. The earlier these children receive
appropriate treatment, the better their prognosis.
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Slow development or lack of physical, social and
learning skills.
Immature rhythms of speech, limited
understanding of ideas and the use of words
without attaching the usual meanings to them.
Abnormal responses to sensations. Sight, hearing,
touch, pain, smell, taste, balance, the way a child
holds his or her body --- any one or a combination
of these responses may be affected.
Abnormal ways of relating to people, objects and
events.
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Some abnormal behaviors of children with
autism are actually caused by medical issues.
Once these medical issues are addressed the
behaviors stop.
It is impossible to learn effectively if you do not
feel well .
Some children actually lose skills or do not
retain skills because of a medical condition.
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Seizure Disorders
Gastrointestinal Disorders
Immune Deficiency and Dysfunction
Hypothyroidism
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According to a study published in Epilepsy
and Behavior 10 to 30 percent of children with
a autism have Epilepsy.
Autism and epilepsy: Cause , consequence, co morbidity or coincidence? By Lidia Gabis, John Pomeroy and Mary R. Androla
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Epilepsy is a well-known co morbidity of
children with autism spectrum disorder (ASD),
with about one third of these children
developing seizures over their lifetime.
Electroencephalogram Abnormalities in Children with Autism Spectrum Disorders
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Seizures do NOT always present exactly the
same way in every individual. They can be
different from a major convulsion on the floor
to minor seizures which look like rapid eye
movement or a period of “zoning out.”
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body shaking or rapid movement of a body party or
convulsions (minor or dramatic shaking can occur with
the entire body, or body parts like the legs or arms.)
a slight body or body part tremble
someone may loose consciousness or experience a
seizure while “awake”
rapid eye blinking
zoning out or lack of attention for periods of time
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Some autism spectrum individual’s zone out or
lose attention from time to time as part of their
disability.
It is important to rule out a medical issue like a
seizure.
Children having seizures tend to gain and then
lose skills.
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A 24 hour E.E.G. or portable E.E.G. equipment
worn for a period of time are the standard test
for looking for seizure activity. Seizure activity
does not always appear when the tests are
being administered. It is important to test the
child in one or more environments if seizures
are suspected in an individual.
Note: Some doctors will only recommend a 45
minute E.E.G. This is not recommended as it is
not enough time to investigate if a child has a
problem with seizures or not.
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TEST: Every child on the autism spectrum should be evaluated for
seizures with a 24 hour or longer E.E.G. by a pediatric neurologist.
TREAT the seizure disorder: It is extremely important to note that
seizures can be deadly. If your child has registerable seizure
activity it is medically necessary to treat the seizure disorder. Your
neurologist will help guide you on what seizure medication is
most effective for your child’s type of seizure activity.
KNOW THE SIGNS: Parents, friends, therapists, and family
members should know the signs of what a seizure looks like and
possible precursors to a seizure. Work with your doctor on
understanding the signs so you can best work with your child if
and when they occur.
BECOME KNOWLEDGABLE: Reading and getting familiar with
all your options for someone you love with a seizure disorder will
help in providing options for treatments and prevention methods
that could make a difference in their lives.
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According to an article in the Journal of
Medical Microbiology in 2005 “Children with
ASD tend to suffer from severe gastrointestinal
problems. “ It found that “GI problems were
significantly more frequent in ASD patients
than in controls demonstrating a significant
association between GI symptoms and autism.”
According to an article in Pediatrics, How
Common are Gastrointestinal Disorders in
Children with Autism by Thea Kuddo, MD and
Karin B Nelson, MD “reports from pediatric
gastroenterologists have described GI
symptoms in 46% to 84% of autistic children.”
“A history of GI symptoms was elicited in 70%
of children with autism spectrum disorders
compared with 22% of children with typical
development and 42% of children with other
developmental disabilities.” according to a
study by Valicenti-McDermott.
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According to Autism Speaks, “because of their
deficits, many children with autism are not
able to effectively communicate their
symptoms or discomfort to their doctors.”
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Constipation
Diarrhea
Reflux
Vomiting
Abdominal discomfort
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Gastrointestinal pain can cause behaviors that
might be dismissed as a behavior problem
instead of a medical issue.
Posturing
Self Injury
Outbursts without obvious cause
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If you child is having recurrent or chronic
diarrhea, constipation, bloating or abdominal
pain…
If you have a child that wakes up in the night
crying…
If you have a child that hits their throat or
grabs at their neck…
If you have a child that leans their stomach
against furniture…
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See a Pediatric Gastroenterologist
Most parents recommend Dr. Ursea at Phoenix
Children’s Hospital.
You should expect the doctor to take a detailed
history, do a physical exam and lab work
including an intestinal permeability and celiac
test.
The doctor may want to do an endoscopy or
colonoscopy
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Many children with autism do very well on a
gluten free, soy free and dairy free diet.
This diet should not be tried until a celiac test
has been completed.
Autism Society of America Greater Phoenix
Chapter has parent mentors’ who can discuss
dietary intervention with interested parents.
Personally, my child made the greatest gains
once we started this diet and it had been life
changing for our family.
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Approximately 25% of children on the spectrum have
immune deficiency and dysfunction.
Most children with autism do not have symptoms so it
is important to run the lab work to rule this disorder.
Our parents highly recommend Dr. Hellmers as the
immunologist who best understands children with
autism.
Children who have gastrointestinal disorders are very
likely to have immune deficiency.
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Testing for immune deficiency and dysfunction
is very simple and inexpensive. A lab test
including :
 IGG Subclasses
 Total IGG
 Immunoglobulin Quantitative
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The treatment for immune deficiency is IVIG.
IVIG is given as a plasma protein replacement therapy
(IgG) for immune deficient patients who have
decreased or abolished antibody production
capabilities. In these immune deficient patients, IVIG is
administered to maintain adequate antibodies levels to
prevent infections and confers a passive immunity.
Treatment is given every 3-4 weeks.
It is usually covered by insurance.
Some children with autism experience cognitive gains
and improvement in language and social skills.
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About 5-10% of the general population has a
thyroid disorder requiring supplementation,
and that percentage may be higher in autism.
Poor thyroid function due to lack of iodine is
the major cause of mental retardation in the
world, resulting in over 80 million cases of
mental retardation. Poor thyroid function can
be caused by other factors as well.
Dr. Sears recommends that all children
diagnosed with autism have a thyroid panel
run.
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Thyroid disease can be diagnosed with a
simple blood test.
Make sure the range used by the lab is the
proper range for children.
The treatment is a daily medication to
supplement the thyroid.
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Children with autism need a medical home.
According to Dr. Melmed, “a medical home
requires looking at the child from a holistic
perspective, and recognizing the centrality of
families and constructing a comfortable
medical environment. Finding a qualified,
compassionate and responsive physician is a
priority for any family seeking medical services
for their child with autism.”
COMMON SYMPTOMS IN
AUTISM
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Self Injurious behaviors
Self stimulatory
behaviors
Night time waking
Toe walking
Loss of skills
Toilet training issues
ARE POSSIBLE SIGNS OF:
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Ear infections
Esophageal Ulcerations
Acid Reflux
Constipation
Seizures
Chronic
Diarrhea/constipation
COMMON SYMPTOMS IN
AUTISM
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Rectal Digging
Behavior regression
Head banging
Skin rashes
Poor Attention
ARE POSSIBLE SIGNS OF:
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Protozoal infections
Seizures, puberty
Upper respirator
infections
Food sensitivity
Constipation
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When faced with a behavioral issue with a
child with autism rule out medical causes
before seeking a behavioral approach.
Remember what the co-morbid conditions that
affect children with autism and make sure to
rule them out whenever a new issue arises.
Seek medical treatment for your child and do
not let doctors dismiss you with “it’s just
autism.” Often, it is an unresolved medical
issue.

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