Autism and Co-Occurring Diagnoses
It’s very common for children diagnosed with autism to experience other medical or mental health challenges and conditions. Data shows that having a co-occurring condition is much more prevalent in children with autism than in the general population, so it’s important to recognize these conditions, as they could stimulate or exacerbate symptoms and may also complicate interventions. To get some insight into co-occurring conditions, we sat down with Dr. Hitha Amin, neurodevelopmental neurologist at Children’s Hospital of Orange County (CHOC) Thompson Autism Center, and Dr. Emily Haranin, child and adolescent psychologist at Children’s Hospital Los Angeles and clinical assistant professor of pediatrics at Keck School of Medicine at USC.
Note to our readers: A recent article on the use of language in autism research documents a preference among some people with autism for language that refers to autism as a condition rather than a disorder — and, therefore, to refer to other conditions using the term “co-occurring” instead of “co-morbidity.” As Dr. Amin notes, autism is an umbrella term that describes individuals in many different circumstances; to adopt the most inclusive language, we use the term ”co-occurring.”
What are some common co-occurring conditions with autism?
Do co-occurring conditions present differently in girls with autism?
Autism and ADHD
Both ADHD and autism are neurodevelopmental disorders that present in childhood. Studies show that ADHD is one of the most common co-occurring conditions of autism, with 40-70% of autistic people having significant ADHD symptoms. The coexistence of ADHD and autism can also complicate diagnosis, since ADHD traits may mask those of autism.
Dr. Haranin tells us that when approaching ADHD treatment, it’s important to first make sure the child is ”receiving high-quality intervention to support any challenges that are associated with that autism diagnosis,” and then seeing which co-occurring condition is causing the biggest concern, specifically when it comes to behavior, and making sure there is treatment and support in place for it.
Treatment may include medication (for ADHD), but psychological and environmental interventions are also highly recommended, such as psychoeducation, behavioral parent training and support, behavioral and environmental interventions specific to the child’s needs, and therapy. Treatment may also combine medication and behavioral therapy, but the aim is to make sure the treatment is as effective as possible.
Dr. Amin explains that if a child’s attention span makes behavioral therapy less effective for them, and a clinician finds that medication to treat ADHD symptoms is appropriate, “then we may use that approach where we try to combine treatment modalities, like a behavioral and medication approach to best address the symptoms. Again, this would always be tailored to a particular child and their family. So it may be hard to generalize, but we do see that children with ADHD and autism as a co-occurring condition may be more likely to be on medication.”
She adds that it can be extremely helpful for a child who has co-occurring autism and ADHD to work with a healthcare professional who has experience treating both conditions. “As we manage these co-occurring conditions better, we may see a better involvement in therapies as well,” Dr. Amin says.
To learn more about ADHD, read our article ADHD 101.
Autism and anxiety
How should parents manage autism as a secondary diagnosis?
Can co-occurring conditions be a misdiagnosis?
How to approach autism diagnosis and treatment
When it comes to treatment, Dr. Haranin recommends focusing on the biggest concerns: “Whenever we’re approaching treatment for coexisting conditions, we want to see which condition is causing the biggest concerns at the time. What are those specific behavioral concerns? Let’s make sure treatment is in place for that, and a child is receiving support for that.”
She also highlights the importance of creating a partnership between the family and a child’s providers. “This is another reason why it’s really valuable to have a team involved,” she says. “Talking about any language delays or alternative communication or other aspects — it’s important that we take all of that into consideration and not treat children like they're in little boxes. We want to treat the whole child and not just the diagnosis. And so when we’re talking about treatment, it really has to be more fluid.”