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Comorbidity and Asperger's

written by: Sandi Johnson • edited by: Elizabeth Wistrom • updated: 5/18/2011

In terms of comorbidity with Asperger’s Syndrome, neither doctors nor researchers can predict what, if any, additional challenges your child will struggle with beyond Asperger’s. However, there are disorders and conditions, which are commonly, associated with autism spectrum disorders.

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    Asperger's Syndrome, as one of many autism spectrum disorders, has its own challenges and struggles. Here, we will discuss comorbidity with Asperger's, to learn more about common conditions which frequently exist side-by-side with Asperger's Syndrome.

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    What Does Comorbid Mean?

    According to Merriam-Webster’s online dictionary, comorbid is defined as “existing simultaneously with and usually independent of another medical condition." The term first became popular in the medical community in the early 1980’s. Many mental health disorders and medical conditions are known, even if only anecdotally, to commonly accompany another medical condition. Among medical disciplines, however, the term “comorbid" is applied differently.

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    Medical Conditions vs. Mental Health

    To understand comorbid disorders, you must first understand the difference in how the term "comorbid" is used. The Charlson Comorbidity Index is a tool used by doctors that predicts the one-year mortality rate for patients with various medical conditions. Doctors use this index to help determine which of several medical conditions such as heart disease, diabetes, or cancer, warrants treatment first or most aggressively. In this sense, comorbid often literally refers to conditions occurring in the same individual that could each prove fatal if left untreated.

    In mental health, however, comorbid takes on a different meaning. Many disorders or conditions may be diagnosed as comorbid to a primary diagnosis. This is due, in large part, to the inaccuracies associated with diagnosing mental health problems. A single diagnosis often does not encompass all the symptoms a patient presents with, so additional diagnoses are added to help target and treat all symptoms appropriately.

    In the case of comorbidity with Asperger’s Syndrome, the primary diagnosis of Asperger’s indicates that the majority of symptoms stem from this diagnosis. However, additional diagnosis of anxiety disorders, sensory problems, or Bipolar disorder are added for additional symptoms not otherwise covered. These comorbid disorders often change over a patient’s lifespan as symptoms emerge or difficulties subside.

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    Comorbidity and Asperger’s Syndrome

    Most information and studies on common comorbid disorders associated with Asperger’s Syndrome are anecdotal, at best. Research seems to indicate that individuals with Asperger’s Syndrome and other autism spectrum diagnoses stand a higher risk of developing several disorders and conditions. Unfortunately, when all studies are compared, sample sizes and determining factors are not uniform. Some studies even seem to contradict each other.

    In spite of the lack of concrete research information, parents of children with Asperger’s and other autism disorders often find their children have similar struggles to others on the spectrum. For example, when discussing the challenges of comorbidity with Asperger’s Syndrome, many parents find commonalities among their children in regards to anxiety disorders, Sensory Integration Dysfunction, depression, mood disorders, and other conditions. It is not uncommon to have several autistic children in a group who struggle with Generalized Anxiety Disorder and various sensory problems.

    In fact, the nonprofit group, Autism Help, lists several common comorbid conditions for which children on the spectrum, including those with Asperger’s, routinely struggle. According to their fact sheet, children and adults with Asperger’s Syndrome have a higher than average possibility for the following comorbid disorders:

    • Sensory problems (including Sensory Integration Dysfunction)
    • Seizures and epilepsy
    • Attention Deficit Hyperactivity Disorder (ADHD)
    • Obsessive Compulsive Disorder
    • Bipolar and other mood disorders
    • Anxiety (including Generalized Anxiety Disorder)
    • Depression
    • Fragile X Syndrome
    • Other intellectual disabilities
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    The Most Common Comorbid Disorders in Individuals with Asperger’s

    Anxiety is thought to be the most common comorbid condition children and adults with Asperger’s face, although systematic studies have not determined this conclusively. The inability to function at an acceptable level of social aptitude, the need for sameness, and the strict adherence to routines contribute to the anxiety level many patients with Asperger’s feel when placed in novel situations. Some researchers feel that the stereotypical behaviors such as hand flapping associated with Asperger’s are actually a manifestation of anxiety, as these behaviors often increase during stressful or new situations.

    Sensory problems are also commonly associated in terms of comorbidity with Asperger’s. Individuals may have sensitivity to light and sounds, temperature, textures, smell, and/or sense of touch. In fact, Sensory Integration Dysfunction and other delays in SI development are not uncommon for children with developmental disabilities such as Asperger’s. The way the brain interprets sensory input from the environment may either amplify or dull an individual’s perception of their surroundings.

    A diagnosis of Attention Deficit Disorder, either Inattentive Type or Hyperactive Type is also not uncommon in terms of comorbidity with Asperger’s. The primary similarity is often an inability to control impulses or impulsive behavior. A poor understanding of socially accepted norms, such as staying in your seat or waiting your turn to speak often contributes to such a diagnosis. Inability to stay on task or focus on a particular project is also common.

    While these three conditions (anxiety, sensory problems, and ADHD) are common in children and adults with Asperger’s, an Asperger’s diagnosis does not immediately equate to comorbid disorders. In many instances, comorbid conditions are diagnosed when symptoms either do not fit an Asperger’s diagnosis or when such symptoms are considered extreme, even for those with Asperger’s. Other conditions such as digestive difficulties, mood disorders, intellectual disabilities, and learning disorders are not uncommon. However, they are not as predominant as anxiety, ADHD, and sensory challenges.

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    References and Resources

    Emory University Charlson Index: http://www.sph.emory.edu/cms/departments_centers/bios/theses/kieszak.html

    Psychiatric Comorbidity, An Artefact of Current Diagnostic Systems: http://bjp.rcpsych.org/cgi/content/full/186/3/182#REF5

    Autism Help Fact Sheet: http://www.autism-help.org/comorbid-disorders-autistic-spectrum.htm

    Comorbid Psychopathology in Individuals with Austim Spectrum Disorders and Intellectual Disabilities: http://etd.lsu.edu/docs/available/etd-04092009-171942/unrestricted/ThesisFinalForEditorApril92009.pdf

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