Medical and Psychiatric Comorbidities in Autism Spectrum Disorder:

Management and TreatmentOverview

3rd Annual AAAP Symposium, September 13, 2014Ateneo Law School, Makati, Manila

Lirio Sobrevinas Covey, Ph.D.President, AAAP

Professor of Clinical Psychology in PsychiatryColumbia University Medical Center, New York NY

More than one diagnosis, each meeting full criteria, is observable. Not simply an overlap of symptoms.

Each condition is observable, often within the same time period, in the same person.

Comorbidity

Long standing view

- Autism Spectrum Disorder is a neurodevelopmental and behavioral disorder.

- Seen within the boundaries of psychiatry and neurology.

Emerging view –

The core ASD deficits in

communication, social interaction,

restrictive/stereotypic behaviors, are

manifestations of a broader, systemic

and complex disease process.

Beyond neurology and psychiatry.

Many, if not most, PWA experience multiple conditions whose symptoms may and/or may not overlap.

Conditions that are diagnostically, separately identifiable .

Theory: To an extent independent of each other, the comorbid disorders influence the pathophysiology or disease process of several disorders.

For example, gastrointestinal issues can influence higher order behavior and brain function.

CONDITIONS OFTEN SEEN (CO-MORBID)AMONG PERSONS WITH ASD

Attention Deficit Hyperactivity Disorder (ADHD)

Mood disorders – Depression, Anxiety

Epilepsies and Seizures

Gastrointestinal Disorders

Pulmonary Disorders

ADHD ≈ 42%Anxiety ≈ 40%Major Depression ≈ 38%Epilepsy ≈ 8-30%GI Abnormalities ≈ 11.7%,Bipolar Disorder ≈ 6-21%

-

Estimates of comorbidity rates in ASD:

Rates of Comorbid Disorders among Persons with Autism

GI Disor

der

Epile

psy

ADHD

Anxiet

y

Depre

ssio

n

Bipo

lar D

isor

der

05

1015202530354045

%

Managing comorbid illness in the autistic patient carries a multitude of challenges.

Limited ability of PWA to communicate symptoms - pain, lack of a coherent history, and other factors can all contribute to a challenging assessment.

The multiplicity of symptoms when

several conditions are present calls

for a more varied treatment

approach.

The current recommendation, until more definitive answers pertaining to the pathophysiology of autism are available:

ASD clinicians should treat whatever medical illnesses the patient may have, whether they be comorbid, or part of the underlying pathology.

What are those approaches?

Recognizing and treating the presence

of comorbid medical and psychiatric

conditions may result in a substantial

improvement in the quality of life of

persons with autism their parents,

and other family members.

Kohane IS, McMurry A, Weber G, MacFadden D, Rappaport L, et al. (2012) The Co-Morbidity Burden of Children and Young Adults with Autism Spectrum Disorders. PLoS ONE 7(4): 2012. Online

Jina Jang *, Johnny L. Matson, Lindsey W. Williams, Kim Tureck, Rachel L. Goldin, Paige E. Cervantes. Rates of comorbid symptoms in children with ASD, ADHD, and comorbid ASD and ADHD. Research in Developmental Disabilities 34 (2013) 2369-2378.

Janet Wozniak , Carter Petty, Mary Kate Martelon, Ronna Fried , Anela Bolfek, Amelia Kotte, Jonathan Stevens, Stephannie L. Furtak, Michelle Bourgeois, Janet Caruso , Ashley Caron , Joseph Biederman . Population of Adults with Autism Spectrum Disorders:A Comparative Study Gagan Joshi • J Autism Dev Disord (2013) 43:1314–1325 DOI 10.1007/s10803-012-1679-5

Medical Comorbidities in Autism Spectrum DisordersA Primer for Health Care Professionals and Policy Makers Prepared by: Treating Autism l Autism Treatment Trust, March 2013

REFERENCES