Comorbidity, PDD, and Managing Multiple Challenges

The Most Common Comorbid Conditions

For children and adults with PDD, having an additional comorbid condition is not set in stone or in any way guaranteed. However, there are certain disorders and medical conditions that those with PDD seem more susceptible to having. Comorbidity, PDD, and any additional challenges or treatments your child or loved one requires are conversation topics best discussed with their treatment team. Nevertheless, knowing common conditions to watch for is beneficial to your peace of mind as well as your loved one’s treatment.

Common conditions and things to consider in terms of comorbidity, PDD, and treatment plans are listed below. Naturally, you should address specific symptoms or areas of concern with the patient’s primary care provider, as this list is intended to be illustrative rather than comprehensive.

• Patients with PDD have increased risk of anxiety and/or depression-related disorders.
• Sensory issues and Sensory Integration Dysfunction are common in those with PDD.
• Mental health disorders such as OCD and Bipolar disorderr are not uncommon.
• Organic (physical) medical conditions such as gastrointestinal disorders, seizures, and epilepsy show significantly higher instances in patients with PDD.
• Patients with PDD often struggle with impulse control and may exhibit signs of ADHD.

Managing Multiple Challenges

In terms of comorbidity, PDD, and meeting day-to-day challenges, specific strategies depend on the severity of symptoms, behaviors, and other factors. Just as the Charlson Index helps physicians determine which comorbid medical conditions or symptoms take precedence, a PDD patient’s treatment team must determine which behaviors, physical symptoms, and developmental delays take precedence over others. Prioritizing treatment plans to help the child or adult manage or overcome challenges often means treating auxiliary symptoms, rather than the diagnosis itself.

Example of Comorbidity, PDD, and Prioritizing

Josh is a nine year old child diagnosed with PDD-NOS. Josh has difficulty articulating his needs, often struggling to keep his frustration from bubbling over into poor behavioral choices. He often throws toys, screams, and stomps his feet. In novel situations like a new classroom, his behavior often escalates further. After careful evaluation by a multi-disciplinary team including speech pathologists, occupational therapists, psychiatrists, psychologists, and his developmental pediatrician, the team adds Sensory Integration Dysfunction and Generalized Anxiety Disorder to his list of diagnoses.

In devising a treatment plan to address Josh’s low frustration tolerance, angry outbursts, anxiety, and poor articulation, his treatment team makes certain determinations. The team believes his frustration stems primarily from severe anxiety, with both sensory overload and poor communication skills also playing a role. However, rather than focusing on treating his anxiety, the team first seeks to address his sensory and communication challenges. The goal is to reduce these challenges, thereby also reducing additional strain during anxious situations.

The team and Josh’s family spend several weeks or months focusing on speech and occupational therapy. As they reduce his sensitivity to sounds while improving his communication skills, Josh’s family notices a reduction in his anxiety during transitions and novel situations. His anxiety may still benefit from the addition of medication. However, by helping Josh to alleviate or address auxiliary challenges that create additional anxiety, the strain is reduced, even if only marginally.

Keep Comorbidity in Perspective

Parents and caregivers face a difficult challenge in terms of comorbid conditions. While it is natural to want a name, a label for the challenges their children face, focusing solely on diagnostic labels does both the parent and patient a great disservice. One thing parents and caregivers often struggle with is the overwhelming conditions, diagnoses, and therapies their loved one requires. It can sometimes feel like managing an alphabet soup of disorders, challenges, and diagnostic acronyms.

To a parent or caregiver feeling overwhelmed by their child’s PDD, GAD, SID…, keeping things in perspective is difficult. Rather than focusing on specific disorders or how many are listed in the patient’s medical chart, the best defense is a solid treatment plan. Plans should focus on addressing specific challenges, rather than their origins or how many disorders the patient acquires on paper. This does not mean diagnosis is not important, however it does mean that focusing on strategies to address the patient’s challenges are more important than labels.

References and Resources

Autism-help.org https://www.autism-help.org/comorbid-disorders-autistic-spectrum.htm

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

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