Diagnosis

The Most Common Medical Conditions Comorbid to Autism Spectrum Disorder

If you have a child with autism spectrum disorder (ASD), you’re probably aware that he or she has a high risk of developing comorbidities. Due to a variety of factors, children with ASD are more likely to have medical conditions like gastrointestinal issues, eating disorders, epilepsy, psychiatric issues, and sleep disorders. This guide will help you understand these comorbidities and how to implement positive changes to improve your child’s quality of life.

ASD Comorbidities

ASD comorbidities can present big challenges to parents. By learning more about the conditions in this guide, you can identify symptoms in your child and create an action plan to treat them. 

  • Gastrointestinal Issues
  • Eating Disorders
  • Epilepsy
  • Psychiatric Issues
  • Sleep Disorders

Gastrointestinal Issues

Gastrointestinal (GI) issues like constipation, painful bowel movements, abdominal pain, heartburn, gaseousness, and diarrhea are common conditions in people with ASD. 

Clues that indicate someone may be suffering from GI include gritting teeth, pushing out the jaw, pressing the belly, refusing food, experiencing sleep problems, avoiding lying down, and arching the back. 

While it’s clear that GI issues are more prevalent in people with ASD, it’s not entirely clear what causes each symptom. Many studies attribute issues to restrictive diets and nutritional deficiencies, which are common in people with ASD.

For example, acid reflux in children with ASD tends to flare up when they perform sporadic behaviors like jumping around or crying. Delayed toileting and limited diets are common with children with ASD, and they can result in constipation and further eating disorders. 

Diarrhea in children with ASD can be a result of malabsorption of certain sugars and poor diet. Eosinophilic esophagitis (EoE), an allergic swallowing disorder, can cause children with ASD to feel a gagging sensation and cause behavioral problems. 

The first step to solving these issues is to identify specific symptoms your child is experiencing and what may be causing them. Speaking to a doctor is always a good idea and altering the eating habits of your child can help with GI issues. 

Eating Disorders

Children with ASD are more likely to have eating challenges like eating-related tantrums, ritualistic eating behaviors, and extremely picky food preferences. Underlying factors can be attributed to activity level, social isolation, medication side effects, anxiety, and sensory issues. 

Children with ASD can demonstrate poor behavior at the dinner table. This can include running away from the table, throwing utensils, or refusing to eat. As a result, it’s more difficult to ensure your child is getting the nutrients they need. 

Sensory issues can cause children with ASD to only prefer food that feels a certain way in their mouths. Some children prefer crunchy foods like carrots, chips, and crackers while others prefer soft foods like ice cream, yogurt, and oatmeal. These specific preferences cause significant limitations in a child’s diet. 

Children that prefer softer foods can have undeveloped oral motor musculature. This can make it tiring and burdensome to consume tougher foods like steak, nuts, and vegetables. Because these children lack the muscle development needed to chew tough foods, they tend to avoid them altogether. As a result, they fail to develop their chewing muscle strength. 

Fortunately, there are steps to improve your child’s eating habits and some of their resulting GI issues. 

First, parents need to prioritize which eating behavior they’d like to improve first. Trying to fix all eating habits at once can lead to overwhelm and failure. Start by deciding whether you want your child to eat more food, eat healthier foods, eat more often, or behave more favorably at the dinner table. 

Next, start implementing your plan in small steps. For example, attempting to change a child’s entire diet in one step will most likely backfire. If this is your goal, start by swapping an unhealthy side item with a healthier option. 

It’s best if your child can barely notice the difference. From there, you can assess whether it’s working or not and make small changes over time. If your child is reacting negatively, don’t try to force him or her to eat certain foods. A better option is to simply test another healthy alternative at the next meal. 

If your goal is to have your child finish their entire plate of food, start by asking them to eat a little more than usual. Over the following weeks, allow them to slowly build up to finishing their whole plate of food. 

Set clear goals for your child and reward him or her for completing them. Children can be rewarded through general praise or labeled praise. 

General praise includes encouraging phrases like “Great job!”, “Way to go!”, or “Thank you!”. 

Labeled praise revolves around the specific action that your child performs. This type of praise is preferred as it reinforces the positive behaviors that you’re trying to implement. An example of labeled praise, “Thank you for finishing your entire plate of food. I’m so proud of you for deciding to eat more!”

Epilepsy

There is a proven connection between children with ASD and epilepsy. In fact, around one-third of those with autism also have epilepsy. Epilepsy is a condition that causes recurrent seizures, which are abnormal electrical disturbances in the brain.

Symptoms of a seizure include sudden sleepiness, involuntary jerking of limbs, muscle stiffening, rapid eye movement, frothing at the mouth, teeth clenching, unusual noises, and loss of bladder control. 

Severe cognitive delay, a family history of epilepsy, underlying neurological disorders, and intellectual disabilities can increase the risk of epilepsy in children with ASD. 

Parents should be aware of signs like staring episodes, rhythmic twitching, stiffening, and attention loss in children. If your child experiences a seizure, there are steps you can take to maximize his or her safety. 

Move large objects away from the child to prevent injury. Do not restrain the child, and instead turn the child on his or her side. Finally, make sure there is nothing in the child’s mouth to prevent choking. 

Long-term treatment strategies include anti-epileptic drugs, non-pharmacological therapy, or consulting with a neurologist who’s familiar with autism-friendly electroencephalography (EEG) practices. 

Psychiatric Issues

Children with ASD are at a higher risk of developing mental disorders like depression, anxiety, and attention-deficit hyperactivity disorder (ADHD). 

There are several factors that cause psychiatric problems in children with ASD. Because they have a higher risk of being a victim of bullying, they’re more likely to develop anxiety or depression. 

Resistance to ASD uncertainty, emotional regulation issues, difficulties regulating stress, heightened physiological arousal, sensory sensitivity, social skill deficits, and cognitive rigidity can also be contributing factors. 

Anxiety in children with ASD can take the form of general anxiety, social anxiety, phobias, and obsessive-compulsive disorder (OCD). 

Children with general anxiety are often worried about future events and changes. It’s common for people with general anxiety to ask repetitive questions and look for reassurance about an upcoming event. It’s also common for children with ASD to struggle to communicate what they’re feeling.

Social anxiety tends to be more prevalent in older children with ASD because they’re more aware of their differences. Social anxiety is not caused by a disinterest in interacting with others. Rather, it’s caused by the fear of a negative outcome when interacting with others.

Irrational phobias can develop in children with ASD. Sensory sensitivity can make these children more susceptible to loud noises and strange textures. This can lead to fears of things like elevators, vacuum cleaners, needles, hairdryers, certain types of food, and crowds. 

OCD is a disorder that causes people to have recurring sensations, ideas, or thoughts called obsessions. These obsessions cause them to feel driven to repeat a certain action called a compulsion.

While repetitive behaviors are common in children with ASD, an OCD comorbidity may cause them to do things like stacking up objects perfectly, washing hands excessively, or double checking everything they do. Acting on compulsions can cause children to temporarily reduce anxiety, and they can become irritable if you try to stop them. 

Depression in children with ASD can cause them to have feelings of diminished self-esteem, hopelessness, or sadness. Factors that contribute to a high risk of depression include social rejection, ASD symptoms, teasing from peers, and low self-efficacy. 

Depression in children with ASD can cause them to perform behaviors like decreased self-care, self-injurious behavior, difficulty communicating their feelings, regression of skills, decreased interest in activities, and volatile moods. 

Children with ASD are also more susceptible to ADHD. While some ASD symptoms mimic ADHD, children who demonstrate behaviors like constant fidgeting, excessive talking, inability to focus, interrupting conversations, and acting without thinking may suffer from ADHD too. 

To treat these mental health disorders, consider cognitive behavioral therapy (CBT). CBT is a highly structured practice proven to reduce anxiety in children with ASD. Parents can also consult a professional about medications or try pharmacological therapies. For more information on mental health treatment, visit The American Academy of Children and Adolescent Psychiatry (AACAP) website here.

Sleep Disorders

According to a 2019 study, sleep disorders are twice as common in children with ASD. Sleep disorders not only affect children with ASD, but also their parents. Anxiety, medication, and genetics can play a role in a child’s sleep disorder. 

Common issues include waking up extremely early, excessive and prolonged awakening, and difficulty falling asleep. Sleep disorders not only affect a child during the nighttime, but also negatively affect daytime behaviors and the family’s quality of life.  

To treat sleep disorders, you can improve your child’s general sleep hygiene, learn from a parent-guided sleep improvement program, or have a sleep specialist evaluate your child. 

Conclusion

If your child is struggling with ASD comorbidities, it’s important to identify the medical condition causing their symptoms and learn about treatment options. Gastrointestinal issues can flare up in children with ASD, and they can be treated by altering diet habits and consulting with a doctor. If your child has an eating disorder, take small steps to create positive changes. 

If your child has epilepsy, it’s crucial to know what to do in the event of a seizure. Treatment options for epilepsy include anti-epileptic drugs, non-pharmacological therapy, or consulting with a neurologist. 

Children with psychiatric issues like anxiety, depression, and ADHD can be treated with CBT, pharmacological therapy, and the help of a professional. Sleep disorders are also prevalent, and you can improve them through changes in sleep hygiene, sleep improvement programs, or professional help. 

Whatever condition your child may be suffering from, he or she is not alone. It’s common for children with ASD to have comorbidities, and there are steps you can take to improve your child’s quality of life.

Feel free to leave a comment below or send me an email! I’m here to help!

About the author

Emily Cummings

I am a mom of two crazy, amazing, independent, little feminists. They bring so much light to my life and a lot less sleep. Since becoming a mother and increasingly in the last year, I have witnessed parents struggling to connect with their child's special education team with no success. I have become more aware of the gaps in our public school system and how parents may benefit from empowerment and advocacy tools.

My work experiences range from a juvenile detention center to an autism specialist in the Issaquah School District and a special education teacher in a self-contained program in the Lake Washington School District. My master's in teaching focused on special education and behavioral disorders from Seattle Pacific University. I completed my BCBA coursework from Montana State University.

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