Coexisting Conditions

Individuals affected by autism are at an increased risk of experiencing additional cognitive, emotional, or behavioral disorders. It is very common for individuals on the autism spectrum to be dealing with other challenges and coexisting conditions.

Sometimes these co-existing conditions are noticed and diagnosed before the diagnosis of autism and sometimes they are noticed and diagnosed afterward. There may even be simultaneous diagnoses. Asking “is it Autism?” or “is it X, Y, Z?” provides real challenges to individuals and families but often to physicians and care providers too.

As autism is diagnosed on a spectrum, no two individuals on the autism spectrum present the same.

Overlapping signs and symptoms can make it difficult to get an accurate diagnosis. This adds to the complexity of determining appropriate and effective treatment and educational intervention. Accurate diagnosis by a skilled clinician is important. The clinician must discern whether a sign or symptom belongs to autism, to another condition or disorder, or to both simultaneously. Be sure to ask your clinician about the possibility of coexisting conditions.

Although there aren’t any exact statistics, most children and adults on the Autism Spectrum have at least one other co-existing condition or form of neurodivergence. 

To help you on your journey of understanding, here’s a glimpse into some common forms of neurodivergence and learning disabilities, along with links to resources that can offer extended definitions, guidance, and support. Many may overlap with autism and may be diagnosed separately or first, however since autism is on a spectrum and not a one-size-fits-all condition, your experiences will vary.

Attention-Deficit/Hyperactivity Disorder (ADHD) is characterized by challenges with focus, impulsivity, and hyperactivity. People with ADHD may find it challenging to focus on tasks, follow instructions, or sit still for extended periods. However, they often demonstrate remarkable creativity, energy, and enthusiasm.

Resource: CHADD is the nation’s leading nonprofit organization serving people affected by ADHD: https://chadd.org/

Auditory Processing Disorder (APD) affects the ability to process and make sense of auditory information. Children with APD may have difficulty following verbal instructions, discriminating between similar sounds, or understanding speech in noisy environments.

Resource: American Speech-Language-Hearing Association (ASHA) offers information on APD and resources to find a speech-language pathologist. https://www.asha.org/

Dyscalculia is a learning disability related to difficulties with mathematical concepts. Children with dyscalculia may struggle with basic arithmetic concepts, such as counting, number sense, and understanding mathematical symbols. Nevertheless, they can excel in other areas, such as problem-solving and critical thinking.

Resource: Dyscalculia.org has been online over 28 years. https://www.Dyscalculia.org

Dysgraphia involves difficulties with handwriting and fine motor skills. Children with dysgraphia may experience frustration when forming letters and struggle with the physical act of writing. Despite these challenges, they often exhibit strong verbal and creative skills.

Resource: National Center for Learning Disabilities (NCLD) is a trusted source of information and support for individuals with learning disabilities, including dysgraphia. https://www.ncld.org/

Dyslexia is a specific learning disability that primarily affects reading and language processing. Individuals with dyslexia may struggle with decoding words, recognizing sight words, and spelling. Despite these challenges, dyslexic individuals often possess exceptional problem-solving skills, creativity, and outside-the-box thinking.

Resource: International Dyslexia Association: https://dyslexiaida.org/

Dyspraxia also known as Developmental Coordination Disorder (DCD), is a condition that affects motor coordination and planning. People with dyspraxia may have difficulty with tasks that require fine and gross motor skills, such as writing, tying shoelaces, or participating in sports. 

Resource: Dyspraxia Foundation USA: https://dyspraxiausa.org/

Executive Function Disorder: Executive functioning challenges involve difficulties with organization, planning, time management, and task initiation. Individuals with executive function difficulties may appear disorganized but often possess exceptional problem-solving and creative thinking abilities. 

• Resource: Understood is an online nonprofit that providers educational resources and support so people who learn and think differently can thrive — in school, at work, and throughout life.  https://www.understood.org/

Giftedness and Twice-Exceptionality: Some neurodivergent individuals may be gifted and talented, and face the unique challenge of twice-exceptionality, where they excel in certain areas but may also have learning differences. 

Resource: Supporting the Emotional Needs of the Gifted (SENG) is a nonprofit network of people who guide gifted, talented, and twice-exceptional individuals to reach their goals intellectually, physically, emotionally, socially, and spiritually. https://www.sengifted.org/

Non-Verbal Learning Disability (NVLD) is a condition that can impact social and non-verbal communication skills. Individuals with NVLD may excel in verbal communication but struggle with non-verbal cues, visual-spatial abilities, social interactions, and interpreting body language. 

Resource: The NVLD Project offers information, articles, and support for individuals with NVLD. https://nvld.org/

Sensory Processing Disorder (SPD) affects how individuals process sensory information from their environment. Individuals with SPD may have heightened or diminished sensitivities to sensory stimuli, impacting their daily lives.

Resource: The STAR Institute for Sensory Processing offers resources, education, support and a variety of treatment services. https://sensoryhealth.org/

Visual Processing Disorder relates to difficulties in interpreting visual information. Individuals with visual processing issues may struggle with tasks such as recognizing shapes, letters, or patterns. Nevertheless, they may excel in auditory learning and verbal communication.

Resource: The American Foundation for the Blind (AFB) provides resources for individuals with visual processing issues. https://www.afb.org/

In addition to the above, it is not uncommon to see signs of anxiety, depression, PTSD or eating disorders in autistic teenagers or adults.

We’ll go into a little more depth on some of the more common co-conditions below and will also be adding new content regularly throughout the Autism Empowerment website. Please visit our sister website www.SpectrumLife.org to read articles in Spectrum Life Magazine as we have covered a number of these topics in greater depth.

Many children, teenagers and adults with an autism spectrum diagnosis either overreact or underreact to certain sights, sounds, smells, textures, and tastes. This may be correlated with a condition called Sensory Processing Disorder, although a diagnosis of SPD is not necessary for an autistic person to have sensory-related challenges.

For example, some may:

• Dislike or show discomfort from a light touch or the feel of clothes on their skin.
• Experience pain from certain sounds, like a vacuum cleaner, a ringing telephone, or a sudden storm; sometimes they will cover their ears and scream
• Have little to no reaction to intense cold or pain.
• Have difficulty eating, dressing and toilet training
• Crave sensory stimulation and constant motion

Like autism, Sensory Processing Disorder (SPD) or Sensory Integration Disorder is also on a spectrum. Researchers are trying to determine if these unusual reactions are related to differences in integrating multiple types of information from the senses.

Reference: STAR Institute for Sensory Processing Disorder

Autistic children and adults tend to have problems falling asleep or staying asleep, or have other sleep problems. These problems make it harder for them to pay attention, reduce their ability to function, and lead to poor behavior. In addition, parents of children with autism and sleep problems tend to report greater family stress and poorer overall health among themselves.

Sleep problems that start in childhood may continue in the teenage years and even throughout adulthood.

Fortunately, sleep problems can often be treated with changes in behavior, such as following a sleep schedule or creating a bedtime routine. Some children may sleep better using medications such as melatonin, which is a hormone that helps regulate the body’s sleep-wake cycle. Like any medication, melatonin can have unwanted side effects. Always talk to your child’s doctor about possible risks and benefits before giving your child melatonin.

Treating sleep problems in children on the autism spectrum may improve the child’s overall behavior and functioning, as well as relieve family stress.

A helpful article about sleep issues has been written by Aspie and Asperkids founder Jennifer Cook O’Toole at Asperkids:

To Sleep… Perchance To… Oh Who Are We Kidding

Many people on the autism spectrum have some degree of learning challenges or intellectual disability. When tested, some areas of ability may be normal, while others—especially cognitive (thinking) and language abilities—may be relatively weak. For example, a person who is autistic may do well on tasks related to sight (such as putting a puzzle together) but may not do as well on language-based problem-solving tasks.

Children or adults with a form of autism phenotype that presents like Asperger syndrome (no longer in the DSM-5 but still commonly used in describing a set of characteristics of some autistic individuals) often have average or above-average language skills and do not show delays in cognitive ability or speech.

One in four children on the autism spectrum has seizures, often starting either in early childhood or during the teen years. Seizures, caused by abnormal electrical activity in the brain, can result in

• A short-term loss of consciousness, or a blackout
• Convulsions, which are uncontrollable shaking of the whole body, or unusual movements
• Staring spells.

Sometimes lack of sleep or a high fever can trigger a seizure. An electroencephalogram (EEG), a nonsurgical test that records electrical activity in the brain, can help confirm whether a child is having seizures. However, some children with an autism diagnosis have abnormal EEGs even if they are not having seizures.

Seizures can be treated with medicines called anticonvulsants. Some seizure medicines affect behavior; changes in behavior should be closely watched in autistic people, particularly children. In most cases, a doctor will use the lowest dose of medicine that works for the child. Anticonvulsants usually reduce the number of seizures but may not prevent all of them.

For more information about medications, see the NIMH online booklet, “Medications”. None of these medications have been approved by the FDA to specifically treat symptoms of ASD.

Fragile X syndrome is a genetic disorder and is the most common form of inherited intellectual disability causing symptoms similar to autism. The name refers to one part of the X chromosome that has a defective piece that appears pinched and fragile when viewed with a microscope. Fragile X syndrome results from a change, called a mutation, on a single gene. This mutation, in effect, turns off the gene. Some people may have only a small mutation and not show any symptoms, while others have a larger mutation and more severe symptoms.

Around 1 in 3 children who have Fragile X syndrome also meet the diagnostic criteria for ASD, and about 1 in 25 children diagnosed with autism have the mutation that causes Fragile X syndrome.

Because this disorder is inherited, children with an autism diagnosis should be checked for Fragile X, especially if the parents want to have more children. Other family members who are planning to have children may also want to be checked for Fragile X syndrome. For more information on Fragile X, see the Eunice Kennedy Shriver National Institute of Child Health and Human Development website.

Some parents of children on the autism spectrum report that their child has frequent gastrointestinal (GI) or digestion problems, including stomach pain, diarrhea, constipation, acid reflux, vomiting, or bloating. Food allergies may also cause problems for autistic children. It’s unclear whether children on the autism spectrum are more likely to have GI problems than typically developing children. If your child has GI problems, a doctor who specializes in GI problems, called a gastroenterologist, can help find the cause and suggest appropriate treatment.

Some studies have reported that children with an autism diagnosis seem to have more GI symptoms, but these findings may not apply to all children on the autism spectrum. For example, a recent study found that autistic children in Minnesota were more likely to have physical and behavioral difficulties related to diet (for example, lactose intolerance or insisting on certain foods), as well as constipation, than children who were not autistic.

The researchers suggested that children on the autism spectrum may not have underlying GI problems, but that their behavior may create GI symptoms—for example, a child who insists on eating only certain foods may not get enough fiber or fluids in his or her diet, which leads to constipation.

Some parents may try to put their child on a special diet to control autism or GI symptoms. While some children may benefit from limiting certain foods, there is no strong evidence that these special diets reduce autism symptoms. If you want to try a special diet, first talk with a doctor or a nutrition expert to make sure your child’s nutritional needs are being met.

Children, teens and adults with an autism spectrum diagnosis can also develop mental health conditions or disorders. More common co-occurring conditions include anxiety disorders, eating disorders, attention deficit hyperactivity disorder (ADHD), bipolar disorder or depression. Research shows that people with autistic neurology are at higher risk for some mental health conditions or disorders than people without autism.

Managing these co-occurring conditions with medications or therapy may reduce symptoms that appear to worsen autism-related symptoms.

References:  https://www.ninds.nih.gov/disorders/autism/autism.htm