IN THE CROSSFIRE

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



Psychosocial



Three Dimensions of Disorder

Diabetes



Diabetes: Correlation with ASD

Complications of Comorbidity—Diabetes Avoidance behaviors Denial Misdiagnosis Misdirected treatment Symptom synergy Deteriorating course of illness

Epilepsy



Complications of Comorbidity—Epilepsy Avoidance behaviors Denial Misdiagnosis Misdirected treatment Symptom synergy Deteriorating course of illness

IBS

NEUROBIOLOGICAL or

NEUROPSYCHOLOGICAL

PSYCHOEMOTIONAL

PSYCHOSOCIAL

Complications of Comorbidity—IBS Avoidance behaviors Denial Misdiagnosis Misdirected treatment Symptom synergy Deteriorating course of illness

Iatrogenesis

NEUROBIOLOGICAL or

NEUROPSYCHOLOGICAL

PSYCHOEMOTIONAL

PSYCHOSOCIAL

Complications of Comorbidity—Iatrogenesis Avoidance behaviors Denial Misdiagnosis Misdirected treatment Symptom synergy Deteriorating course of illness

PTSD



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!

[email protected]

SUBJECT LINE: PPT

mailto:[email protected]

IN THE CROSSFIRE

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