IN THE CROSSFIRE

IN THE CROSSFIRECO-OCCURRING MEDICAL PROBLEMSMerlin L. Taylor, Ph.D., CCC-SLP, BCBA-DSpeech-Language PathologistBehavior AnalystAspie

Co-Occurring Medical Problem = Comorbid Condition existing simultaneously with and usually independently of another medical conditionhttp://www.merriam-webster.com/dictionary/comorbidSome Conditions That Can Be Comorbid With Autism Spectrum Disorder (ASD)DiabetesEpilepsyIrritable Bowel Syndrome (IBS)IatrogenesisPost-Traumatic Stress Disorder (PTSD)

Signsaggressionagitationclingingcrampingcryingflatulencedisorientation

hyperventilationlaughingscreamingsluggishnessspasmssweatingtremor

Problems of ComorbidityAvoidance 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 TreatmentSymptom SynergyCombined effects of autism and co-occurring conditions.

Three Dimensions of Disorder

Deteriorating Course of IllnessProgressive worsening of symptoms

Neurobiological/NeuropsychologicalPsychoemotionalPsychosocialThree Dimensions of Disorder

DiabetesSignsaggressionagitationclingingcrampingcryingflatulencedisorientation

hyperventilationlaughingscreamingsluggishnessspasmssweatingtremor

Signsaggressionagitationclingingcrampingcryingflatulencedisorientation

hyperventilationlaughingscreamingsluggishnessspasmssweatingtremor

Signsaggressionagitationclingingcrampingcryingflatulencedisorientation

hyperventilationlaughingscreamingsluggishnessspasmssweatingtremor

Diabetes: Correlation with ASD

Complications of ComorbidityDiabetesAvoidance behaviorsDenialMisdiagnosisMisdirected treatmentSymptom synergyDeteriorating course of illness

EpilepsySignsaggressionagitationclingingcrampingcryingflatulencedisorientation

hyperventilationlaughingscreamingsluggishnessspasmssweatingtremor

Signsaggressionagitationclingingcrampingcryingflatulencedisorientation

hyperventilationlaughingscreamingsluggishnessspasmssweatingtremor

Signsaggressionagitationclingingcrampingcryingflatulencedisorientation

hyperventilationlaughingscreamingsluggishnessspasmssweatingtremor

Complications of ComorbidityEpilepsyAvoidance behaviorsDenialMisdiagnosisMisdirected treatmentSymptom synergyDeteriorating course of illness

IBSSignsaggressionagitationclingingcrampingcryingflatulencedisorientation

hyperventilationlaughingscreamingsluggishnessspasmssweatingtremor

Signsaggressionagitationclingingcrampingcryingflatulencedisorientation

hyperventilationlaughingscreamingsluggishnessspasmssweatingtremor

Signsaggressionagitationclingingcrampingcryingflatulencedisorientation

hyperventilationlaughingscreamingsluggishnessspasmssweatingtremor

Complications of ComorbidityIBSAvoidance behaviorsDenialMisdiagnosisMisdirected treatmentSymptom synergyDeteriorating course of illness

IatrogenesisSignsaggressionagitationclingingcrampingcryingflatulencedisorientation

hyperventilationlaughingscreamingsluggishnessspasmssweatingtremor

Signsaggressionagitationclingingcrampingcryingflatulencedisorientation

hyperventilationlaughingscreamingsluggishnessspasmssweatingtremor

Signsaggressionagitationclingingcrampingcryingflatulencedisorientation

hyperventilationlaughingscreamingsluggishnessspasmssweatingtremor

Complications of ComorbidityIatrogenesisAvoidance behaviorsDenialMisdiagnosisMisdirected treatmentSymptom synergyDeteriorating course of illness

PTSDSignsaggressionagitationclingingcrampingcryingflatulencedisorientation

hyperventilationlaughingscreamingsluggishnessspasmssweatingtremor

Signsaggressionagitationclingingcrampingcryingflatulencedisorientation

hyperventilationlaughingscreamingsluggishnessspasmssweatingtremor

Signsaggressionagitationclingingcrampingcryingflatulencedisorientation

hyperventilationlaughingscreamingsluggishnessspasmssweatingtremor

Complications of ComorbidityPTSDAvoidance behaviorsDenialMisdiagnosisMisdirected treatmentSymptom synergyDeteriorating course of illness

MOST COMMON SYNERGISTIC SYMPTOMANXIETYThe 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 occasionThe Problem of PTSDBecause of deficits in self-insight and/or verbal ability, this individual incidence of PTSD will largely remain unknownThe 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 anxietyThe 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 PTSDMisdiagnosisand consequently misdirected treatmentcan become occasion for both iatrogenesis and psychological trauma.In Summary: Dontassume 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: DoListen, observe and reflectKeep asking questionsif only in your mindLook out for zebrasPerform thorough diagnostics as a clinicianinsist upon these as a consumerKeep trying. Keep trying. KEEP TRYING.

Thank you!aspiehd@gmail.com

SUBJECT LINE: PPT