There are multiple disabilities covered by special education services, including an autism spectrum disorder, developmental delay, cognitive disability, learning disorders, and other health disabilities, to name a few. Receiving a diagnosis of any of these can make accessing their education challenging for students. A dual diagnosis can make education plans even more complicated. A couple weeks ago, we discussed what the goals for autism treatment and therapy are for children. But how do those program goals change when you factor in a second diagnosis?
When someone with autism (or another disorder) is diagnosed with a second condition or illness, the conditions are said to be “comorbid.” Comorbidity with autism is very common—nearly three-quarters of children with autism are diagnosed with a comorbid mental or medical condition. While autism is typically diagnosed by the time a child is two years old, comorbid conditions may appear at any point in a child’s development and some may not appear until well into adolescence or even adulthood.
Common autism comorbid diagnoses include:
- Anxiety and depression
- Bipolar disorder
- Down syndrome
- Fragile X syndrome
- Intellectual disability
- Sleep disorders
While children and adults with autism do have a higher rate of comorbid psychiatric disorders than the general population, autism specialists caution that some healthcare professionals who are less familiar with autism may over-diagnose associated disorders due to the overlap in symptoms. For example, emotional meltdowns are common in children with autism feeling frustrated by communication difficulties, but they can also be a hallmark of bipolar disorder.
What’s Different About Comorbid Treatment?
Interactions between the symptoms of comorbid disorders can exacerbate the course of both conditions. Additionally, symptoms from a comorbid condition might influence how effective treatments and therapeutic interventions for autism are in treating ASD symptoms.
When treating comorbid conditions, it’s important to identify and treat each condition separately, but it’s equally important to understand and address the relationship between the symptoms of each.
Treating Comorbidity of Autism and Mental Illness
The first step in addressing a comorbid diagnosis of autism and another mental disorder is to get an accurate diagnosis. Autism advocacy networks like Autism Speaks develop and publish guidelines for diagnosing and treating psychiatric conditions in children with autism. If possible, seek healthcare professionals who are affiliated with organizations such as the Autism Treatment Network to ensure that your child receives a diagnosis and treatment plan in line with evidence-based best practices.
Goals for Treatment of Comorbid Autism and Anxiety
Anxiety is one of the most common conditions comorbid with autism. Research suggests that the prevalence of comorbid anxiety among children with autism may be as high as 30%. Some studies suggest that high-functioning children on the spectrum may experience a higher rate of anxiety, perhaps due to a heightened awareness of “not fitting in” with their peers.
A challenge that complicates treating comorbid autism and anxiety is that children with autism struggle to control anxiety once it sets in. The internal signals of tension—such as a racing heart, muscle tightness, and stomach ache—can cause an increase in the repetitive and self-soothing behaviors that behavioral therapy for autism seeks to minimize.
Cognitive behavioral therapy is generally an effective treatment for addressing anxiety in children with autism. The primary goal in treating comorbid autism and anxiety is to empower the child with tools and strategies for controlling their anxiety so that it doesn’t interfere with their progress in autism therapy.
Treating Comorbid Autism and Down Syndrome
Both autism and down syndrome come with unique developmental challenges, and when these disorders are combined, the challenges multiply. Researchers believe that approximately 18% of children with down syndrome also have autism spectrum disorder (generous estimates suggest the number could be as high as 39%).
Because a degree of developmental delay and atypical behavior is expected in children with down syndrome, a dual diagnosis of autism often comes much later than in children who do not have down syndrome. While parents usually perceive that something more is amiss, healthcare providers can be reluctant to suggest a dual diagnosis and may even be unaware that the disorders can occur comorbidly. This is unfortunate, because early intervention is so critical to the outcomes of autism treatment. If you suspect your child may have a comorbid diagnosis of down syndrome and autism, seek evaluation.
A formal diagnosis of comorbid autism and down syndrome is often a huge relief for a family. Not only does it explain what may have been mystifying behavioral and developmental patterns, but it enables them to seek the support and treatment their child needs. The primary goal in treating autism comorbid with down syndrome is to address the ASD symptoms early enough to minimize any further impact on the child’s development.
As the examples of anxiety and down syndrome demonstrate, comorbid diagnoses of autism with other conditions can be difficult to identify and complex to treat. That’s why it’s important to seek professional evaluation as soon as you begin to suspect that your child may have comorbid condition, and to place them in an environment capable of supporting their needs — such as a school dedicated helping students of with a range of abilities, like Spero Academy.