Why Addressing Comorbidities Should Be the First Step in Autism Spectrum Disorder (ASD) Care

No human being can reach their potential without basic health and wellness.

 

After an autism diagnosis, most families are encouraged to pursue therapy. While there are a range of therapies that can be highly effective, it is important to acknowledge, early on, that autistic people often experience a range of underlying comorbid health conditions. Many of these conditions are not only treatable, but also necessary to address for therapy to have its intended impact and to enhance overall quality of life.

 

The Prevalence of Comorbidities in Autistic Individuals

 

The prevalence of comorbid medical conditions is not only high, but also includes a range of conditions, from subtle to serious. A population-based survey in Sweden highlighted that half of individuals with ASD had four or more coexisting disorders, while only 4% had no additional conditions. Given that ASD affects 1 in every 36 children and is a lifelong condition, understanding comorbidities is crucial for patient-centered healthcare, especially as this population ages.

 

 Common comorbid conditions include:

  • Epilepsy

  • Gastrointestinal (GI) disorders

  • Rare genetic conditions

  • Various psychological disorders

 

Healthcare providers should be vigilant for signs that may indicate comorbidities, such as:

 

  • Unexplained multi-system involvement

  • Regression of skills

  • Lack of response to therapeutic interventions

 

 

Make Health and Wellness a First Step

 

It is important to remember that no human being can reach their potential without basic health and wellness. While behavioral interventions are crucial in supporting individuals with ASD, relying solely on these strategies can lead to the dismissal or misdiagnosis of the numerous underlying medical issues that many autistic individuals face.

 

Addressing comorbidities—the additional medical conditions that often accompany ASD—should be the foundational step in comprehensive autism care. Unfortunately, there are several factors that make identifying and addressing related medical conditions challenging that need to be addressed.

 

Identifying Hidden Health Challenges in ASD

 

Comorbid medical conditions are often overlooked in autistic individuals due to atypical symptom presentations and communication challenges. Approximately 25–50% of individuals with ASD are non-verbal, which complicates the expression of discomfort or symptoms. Additionally, deficits in social communication and restricted, repetitive behaviors can mask underlying health issues.

 

Behavioral changes, including maladaptive behaviors, often emerge at home and school, manifesting as alterations in everyday situations or conflicts in personal relationships. These behavioral shifts can obscure the presence of comorbid medical conditions, making it essential to investigate physiological issues rather than attributing changes solely to behavior.

 

While behavioral interventions are essential, a balanced approach that includes thorough medical investigations is necessary to ensure comprehensive care for autistic individuals. Experts advocate for a cautious approach when encountering unexplained multi-system involvement in ASD patients. Key considerations include:

 

  • Self-injurious and hetero-aggressive behaviors without clear context

  • Regression of skills, especially after three years of age

  • Unexpected responses to therapeutic interventions

  • Frequent visits to the emergency room

  • History of perinatal complications

  • Use of multiple medications, including over-the-counter (OTC) drugs and dietary supplements

 

For patients exhibiting these signs, a structured review of systems is mandatory. Asking detailed questions is a cost-effective and insightful method compared to expensive and time-consuming laboratory tests. Surprisingly, many symptoms go unreported because they are not deemed relevant. When parents do report symptoms, it is crucial to trust their observations, especially when they compare them to their other children.

 

Embracing Individuality: One Size Does Not Fit All

Echoing Dr. Stephen Shore’s insight—"If you have met one person with autism, you have met one person with autism."—it is clear that ASD encompasses a diverse spectrum of experiences and medical profiles. Systematic investigations into comorbidities reveal that ASD is not a single disorder but a spectrum with varied underlying biological processes.

 

To improve outcomes for autistic individuals, healthcare providers must reorient services to better recognize comorbidities and refer patients to appropriate specialists. Addressing the burden of comorbidities in ASD requires a multidisciplinary approach that includes:

 

  • Parents and caregivers

  • Special educators

  • Psychologists

  • Medical professionals

 

Conclusion

Health and wellness are the bedrock upon which every other aspect of life—education, employment, housing and safety—rests. Without addressing the basic medical needs of autistic individuals, it is impossible for them to reach their full potential. By prioritizing the identification and management of comorbidities, we can significantly enhance the quality of life for those with ASD.

 

Join the Movement for Comprehensive Autism Care

Whether you are a parent, clinician, researcher or advocate, supporting a holistic approach to autism care can make a profound difference. Let’s work together to ensure that every autistic individual receives the comprehensive medical attention they deserve, paving the way for a healthier and more fulfilling life.

 

For more information on addressing comorbidities in ASD or to get involved in this initiative, please contact the Thought Leadership and Innovation Foundation here.

Caitlin Oldham