Post on 24-Feb-2016
description
IN THE CROSSFIRE
CO-OCCURRING MEDICAL PROBLEMS
Merlin L. Taylor, Ph.D., CCC-SLP, BCBA-D
Speech-Language Pathologist
Behavior Analyst
Aspie
Co-Occurring Medical Problem = Comorbid Condition
“existing simultaneously with and usually independently of another medical condition”
http://www.merriam-webster.com/dictionary/comorbid
Some Conditions That Can Be Comorbid With Autism Spectrum Disorder (ASD)
Diabetes Epilepsy Irritable Bowel Syndrome (IBS) Iatrogenesis Post-Traumatic Stress Disorder (PTSD)
Signs aggression agitation clinging cramping crying flatulence disorientation
hyperventilation laughing screaming sluggishness spasms sweating tremor
Problems of Comorbidity
Avoidance BehaviorActively evading circumstances or activities wherein symptoms might be elicited.
DenialRefusal to acknowledge a disorder by way of verbalization, altered behavior, or any other means.(May even take the form of feigning symptoms of another disorder.)
MisdiagnosisMisdirected Treatment
Symptom SynergyCombined effects of autism and co-occurring conditions.
Three Dimensions of Disorder
Deteriorating Course of Illness
Progressive worsening of symptoms
Neurobiological/Neuropsychological
NEUROBIOLOGICAL orNEUROPSYCHOLOGICAL
PSYCHOEMOTIONALPSYCHOSOCIAL
Psychoemotional
NEUROBIOLOGICAL orNEUROPSYCHOLOGICAL
PSYCHOEMOTIONALPSYCHOSOCIAL
Psychosocial
NEUROBIOLOGICAL orNEUROPSYCHOLOGICAL
PSYCHOEMOTIONALPSYCHOSOCIAL
Three Dimensions of Disorder
Diabetes
NEUROBIOLOGICAL orNEUROPSYCHOLOGICAL
PSYCHOEMOTIONALPSYCHOSOCIAL
Signs aggression agitation clinging cramping crying flatulence disorientation
hyperventilation laughing screaming sluggishness spasms sweating tremor
Signs aggression agitation clinging cramping crying flatulence disorientation
hyperventilation laughing screaming sluggishness spasms sweating tremor
Signs aggression agitation clinging cramping crying flatulence disorientation
hyperventilation laughing screaming sluggishness spasms sweating tremor
Diabetes: Correlation with ASD
Complications of Comorbidity—Diabetes Avoidance behaviors Denial Misdiagnosis Misdirected treatment Symptom synergy Deteriorating course of illness
Epilepsy
NEUROBIOLOGICAL orNEUROPSYCHOLOGICAL
PSYCHOEMOTIONALPSYCHOSOCIAL
Signs aggression agitation clinging cramping crying flatulence disorientation
hyperventilation laughing screaming sluggishness spasms sweating tremor
Signs aggression agitation clinging cramping crying flatulence disorientation
hyperventilation laughing screaming sluggishness spasms sweating tremor
Signs aggression agitation clinging cramping crying flatulence disorientation
hyperventilation laughing screaming sluggishness spasms sweating tremor
Complications of Comorbidity—Epilepsy Avoidance behaviors Denial Misdiagnosis Misdirected treatment Symptom synergy Deteriorating course of illness
IBS
NEUROBIOLOGICAL or
NEUROPSYCHOLOGICAL
PSYCHOEMOTIONAL
PSYCHOSOCIAL
Signs aggression agitation clinging cramping crying flatulence disorientation
hyperventilation laughing screaming sluggishness spasms sweating tremor
Signs aggression agitation clinging cramping crying flatulence disorientation
hyperventilation laughing screaming sluggishness spasms sweating tremor
Signs aggression agitation clinging cramping crying flatulence disorientation
hyperventilation laughing screaming sluggishness spasms sweating tremor
Complications of Comorbidity—IBS Avoidance behaviors Denial Misdiagnosis Misdirected treatment Symptom synergy Deteriorating course of illness
Iatrogenesis
NEUROBIOLOGICAL or
NEUROPSYCHOLOGICAL
PSYCHOEMOTIONAL
PSYCHOSOCIAL
Signs aggression agitation clinging cramping crying flatulence disorientation
hyperventilation laughing screaming sluggishness spasms sweating tremor
Signs aggression agitation clinging cramping crying flatulence disorientation
hyperventilation laughing screaming sluggishness spasms sweating tremor
Signs aggression agitation clinging cramping crying flatulence disorientation
hyperventilation laughing screaming sluggishness spasms sweating tremor
Complications of Comorbidity—Iatrogenesis Avoidance behaviors Denial Misdiagnosis Misdirected treatment Symptom synergy Deteriorating course of illness
PTSD
NEUROBIOLOGICAL orNEUROPSYCHOLOGICAL
PSYCHOEMOTIONALPSYCHOSOCIAL
Signs aggression agitation clinging cramping crying flatulence disorientation
hyperventilation laughing screaming sluggishness spasms sweating tremor
Signs aggression agitation clinging cramping crying flatulence disorientation
hyperventilation laughing screaming sluggishness spasms sweating tremor
Signs aggression agitation clinging cramping crying flatulence disorientation
hyperventilation laughing screaming sluggishness spasms sweating tremor
Complications of Comorbidity—PTSD Avoidance behaviors Denial Misdiagnosis Misdirected treatment Symptom synergy Deteriorating course of illness
MOST COMMON SYNERGISTIC SYMPTOM
ANXIETY
The Problem of PTSDIn anxiety-prone individuals on the autism spectrum, whose sensory processing difficulties can render mundane sensory experiences terrifying, PTSD may occur on more than one occasion
The Problem of PTSDBecause of deficits in self-insight and/or verbal ability, this individual incidence of PTSD will largely remain unknown
The Problem of PTSDPTSD can, in turn, lead to a number of highly maladaptive behaviors, including (but not limited to)
AggressionSelf-injuryAddictions (especially in higher-functioning individuals)
The Problem of PTSDVery ironically, PTSD may be misdiagnosed as physiological due to its outward signs, while frankly physiological conditions may be misattributed to anxiety
The Paradox of AnxietyWhile a common factor exacerbating physiological symptoms anxiety is rarely a cause or a solitary symptom in cases of autism with comorbidity.
The Problem of PTSDMisdiagnosis—and consequently misdirected treatment—can become occasion for both iatrogenesis and psychological trauma.
In Summary: Don’t
assume that any physician can make a psychiatric diagnosissummon the dead to defend a poor diagnostic decisionexpect the health problems of individuals with autism to readily make senseexpect omnisicience of any human being (yourself included)
In Summary: Do
Listen, observe and reflectKeep asking questions—if only in your mindLook out for “zebras”Perform thorough diagnostics as a clinician—insist upon these as a consumerKeep trying. Keep trying. KEEP TRYING.
Thank you!