Alexander Repetski’s daughter Gwenevere, now age five, had her first seizure at three months old and was diagnosed with intractable epilepsy. Her seizures were eventually brought under control through cannabis therapy, but Gwenevere remained non-verbal. Repetski and his wife noticed she would focus on specific objects and engage in repetitive behaviours. Gwenevere had been diagnosed with global development delay (GDD) as a result of her severe epilepsy, but the family wondered if she could in fact have another co-morbid condition: autism spectrum disorder.
“Because she has GDD, some doctors weren’t willing to look at [the] autism,” says Repetski. He persevered nonetheless, because he felt his daughter would benefit from applied behaviour analysis and other autism therapies. His parental instinct was right: After testing, the new diagnosis was made and Gwenevere was able to get the right treatments to help her thrive.
Parents who are worried that a single diagnosis doesn’t account for some of their kid’s symptoms should catalogue those symptoms and research possible co-morbid conditions. “Doctors will pay attention to someone who comes in and says: ‘This is what’s going on. Here’s the evidence. I need to see these specialists,’” says Repetski.
Common ASD co-morbid conditions In fact, autism has a number of possible co-occurring conditions. The evolving field of gene sequencing reveals that as many as 60 percent of kids on the spectrum also have another identifiable genetic condition, syndrome or chromosome abnormality.
Epilepsy is a prevalent neurological co-morbidity, with up to 50 percent of children with ASD showing some electroencephalogram (EEG) abnormality at some time, says Lewis. This chronic neurological disorder is identified by recurrent seizures that seem to come out of nowhere. The seizures can range in severity from an absence seizure, which looks like a staring spell and lasts for a few seconds, to a convulsive or spastic seizure that lasts for several minutes.
Up to 50 percent of children on the spectrum have gastrointestinal issues, such as chronic diarrhea or gastro-oesophageal reflux disease (GERD). “A large number of families I see say that identifying gastrointestinal issues preceded even recognizing the autism,” says Lewis.
Neurological disorders such as sensory processing disorder (SPD), which impacts up to 60 percent of people with autism, are also common. SPD is a condition in which the brain and nervous system have difficulty integrating or processing external information collected through the body’s five senses. Classic signs include: intolerance of specific clothing fabrics or textures, avoidance of certain foods because of their texture, and an overreaction to or anxiety caused by loud noises, bright lights or crowded environments.
Emotional co-morbidities, such as anxiety and depression, occur in 44 percent of kids with autism, too. An anxiety disorder is marked by excessive worry about everyday problems or social situations, or irrational fear around an object, animal or situation that induces physical symptoms of panic, such as sweaty palms and a racing heart. In kids and teens with higher-functioning autism, anxiety can manifest as a preoccupation with how they are different from their peers and worrying over how they are perceived as a result.
Depression, which is defined as prolonged feelings of sadness, increased fatigue and a loss of interest in relationships and activities, can be hard to detect in kids on the spectrum—particularly because they may lack the communication skills to talk about their feelings. Instead of seeming sad or tired, for kids on the spectrum, depression can surface as new sleep problems, extra difficulty concentrating, emotional outbursts and increased irritation or agitation.
Up to half of kids with autism also have sleep disorders, such as sleep apnea. Other symptoms of a sleep disorder include snoring or irregular breathing during sleep, difficulty falling asleep, restlessness, or a child always seeming tired even after what appeared to be a full night’s sleep.