Original Post By: Social Motion Skills
In recognition of April as Autism Awareness Month, we’d like to shine a light on a topic that sometimes gets left out of the conversation around autism: the frequent occurrence of comorbid conditions among individuals on the autism spectrum.
What exactly is comorbidity?
“Comorbidity means there are two or more diagnostic issues that are happening at the same time,” says Dr. Kimberly Harrison, a clinical psychologist in Houston specializing in autism spectrum disorders. To understand this better, we spoke with Dr. Harrison by phone and asked her about which conditions present most frequently alongside autism and how parents can best help their children who receive multiple diagnoses, while also nurturing the health of the whole family.
What do you most often see in patients with autism when you recognize there are additional conditions present?
Most persons on the autism spectrum have comorbidity with some type of anxiety — usually generalized, sometimes a panic disorder, and sometimes even an OCD-type presentation. But most have anxiety. The other comorbid issue that is almost always present with autism is an executive function disruption. We typically call that ADHD, although sometimes it looks very different in persons with autism. Secondary to those, but often presenting as more problematic, is depression. The anxiety has been there pretty much throughout the lifespan; the ADHD has been there throughout the lifespan. As problems mount resulting from those issues, individuals can become depressed. Often, the depression is secondary, but the depression may receive the most attention because it’s more dramatically serious when it occurs.
“If you are experiencing minor trauma every time you have a social interaction, you’re going to be anxious.”
Can early intervention can help mitigate long-term consequences?
Yes. When we can discern autism is the foundational cause at an early age, then we can separate and treat related issues. For example, social skills can help with many of the social issues associated with autism. We also can see a direct relationship between social skills and anxiety: if you are experiencing minor trauma every time you have a social interaction, you’re going to be anxious. Thus, if you can develop skills to deal with social situations better, anxiety likely will be lower. And the earlier you can learn to manage anxiety, the better. As one might expect, the earlier there’s intervention for the attention deficit-related issues the better. ADHD-related executive function disruptions can be addressed with a variety of treatments, including medication, organizational and structural therapy, and social skills therapy. Improving ADHD symptoms will help make it easier to perform in school and manage day-to-day activities, such as keeping a hygiene schedule and doing homework. When ADHD symptoms are managed, anxiety is usually lower, and the potential for depression is likely to be less. So, absolutely, early intervention is the most important thing.
“All parents need a team, and those who have a child on the autism spectrum need a team with a variety of perspectives on the child’s behavior and emotional functioning.”
What advice would you give to parents whose child has been diagnosed with autism, but who may not know whether these other issues are going on?
I think parents are experts on their children and teenagers. They truly know them better than anyone else. However, parents look through the lens of a loving heart and not always a clinical eye. Often parents have trouble making sense of their child’s behavior, and they’re just not sure what to do. They might say, “This is a good kid; this is a smart kid; this is a child who’s really working hard, but he’s having meltdowns every day,” or, “She’s not able to function in this environment, but I don’t know what to do.” This is when parents need some extra help. My role as a psychologist is to take a clinical look at the issues and help determine which ones are really causing problems. Sometimes you might think it’s the social part of autism. Quite often, I find, it’s the anxiety.
Having somebody look at it from a different perspective, a clinician trained in identifying the problematic factors, is very helpful. Not only psychologists. There are many types of therapists who work with persons on the spectrum. Occupational therapists, speech therapists, counselors…Most parents find it’s helpful to have a team to address challenges. I think all parents need a team, and those who have a child on the autism spectrum need a team with a variety of perspectives on the child’s behavior and emotional functioning.
“Families need to have a way of functioning and a sense of normalcy that works for everyone.”
How do you see family dynamics affected, especially for parents and siblings, when there’s a child with special needs? How can parents take care of themselves, as well as other children, without diverting all their attention to the child with special needs?
That’s an important question. It’s hard when there’s a child with special needs not to have an imbalance of time and monetary resources. It’s very hard to keep things balanced, and sometimes impossible. The other child, though, requires special attention, too. That doesn’t always mean more attention…Sometimes it’s just simple things, like a weekly date with a parent or being able to pick the dessert at the restaurant for the family to share. We often work with families in family therapy to create balance. Sometimes they need just one or two sessions to generate some ideas. At other times family therapy might need to be ongoing. Regardless of length of time, it can be very helpful to focus on family wellness. Families need to have a way of functioning and a sense of normalcy that works for everyone.
This piece was written and posted by Social Motion Skills, a 501(c)3 non-profit in Houston, TX. Social Motion thanks Dr. Kimberly Harrison for her time and comments shared in this interview.