IN THE CROSSFIRE CO-OCCURRING MEDICAL PROBLEMS Merlin L. Taylor, Ph.D., CCC-SLP, BCBA-D...

IN THE CROSSFIRE

CO-OCCURRING MEDICAL PROBLEMS

Merlin L. Taylor, Ph.D., CCC-SLP, BCBA-D

Speech-Language Pathologist

Behavior Analyst

Aspie

Co-Occurring Medical Problem = Comorbid Condition

“existing simultaneously with and usually independently of another medical condition”

http://www.merriam-webster.com/dictionary/comorbid

Some Conditions That Can Be Comorbid With Autism Spectrum Disorder (ASD)

Diabetes

Epilepsy

Irritable Bowel Syndrome (IBS)

Iatrogenesis

Post-Traumatic Stress Disorder (PTSD)

Signs

aggression

agitation

clinging

cramping

crying

flatulence

disorientation

hyperventilation

laughing

screaming

sluggishness

spasms

sweating

tremor

Problems of Comorbidity

Avoidance BehaviorActively evading circumstances or activities wherein symptoms might be elicited.

DenialRefusal to acknowledge a disorder by way of verbalization, altered behavior, or any other means.(May even take the form of feigning symptoms of another disorder.)

MisdiagnosisMisdirected Treatment

Symptom SynergyCombined effects of autism and co-occurring conditions.

Three Dimensions of Disorder

Deteriorating Course of Illness

Progressive worsening of symptoms

Neurobiological/Neuropsychological

NEUROBIOLOGICAL orNEUROPSYCHOLOGICAL

PSYCHOEMOTIONALPSYCHOSOCIAL

Psychoemotional



Psychosocial



Three Dimensions of Disorder

Diabetes



Signs

aggression

agitation

clinging

cramping

crying

flatulence

disorientation

hyperventilation

laughing

screaming

sluggishness

spasms

sweating

tremor

Diabetes: Correlation with ASD

Complications of Comorbidity—Diabetes Avoidance behaviors

Denial

Misdiagnosis

Misdirected treatment

Symptom synergy

Deteriorating course of illness

Epilepsy



Signs

aggression

agitation

clinging

cramping

crying

flatulence

disorientation

hyperventilation

laughing

screaming

sluggishness

spasms

sweating

tremor

Complications of Comorbidity—Epilepsy Avoidance behaviors

Denial

Misdiagnosis


Symptom synergy


IBS

NEUROBIOLOGICAL or

NEUROPSYCHOLOGICAL

PSYCHOEMOTIONAL

PSYCHOSOCIAL

Signs

aggression

agitation

clinging

cramping

crying

flatulence

disorientation

hyperventilation

laughing

screaming

sluggishness

spasms

sweating

tremor

Complications of Comorbidity—IBS Avoidance behaviors

Denial

Misdiagnosis


Symptom synergy


Iatrogenesis

NEUROBIOLOGICAL or

NEUROPSYCHOLOGICAL

PSYCHOEMOTIONAL

PSYCHOSOCIAL

Signs

aggression

agitation

clinging

cramping

crying

flatulence

disorientation

hyperventilation

laughing

screaming

sluggishness

spasms

sweating

tremor

Complications of Comorbidity—Iatrogenesis Avoidance behaviors

Denial

Misdiagnosis


Symptom synergy


PTSD



Signs

aggression

agitation

clinging

cramping

crying

flatulence

disorientation

hyperventilation

laughing

screaming

sluggishness

spasms

sweating

tremor

Complications of Comorbidity—PTSD Avoidance behaviors

Denial

Misdiagnosis


Symptom synergy


MOST COMMON SYNERGISTIC SYMPTOM

ANXIETY

The Problem of PTSD

In anxiety-prone individuals on the autism spectrum, whose sensory processing difficulties can render mundane sensory experiences terrifying, PTSD may occur on more than one occasion

The Problem of PTSD

Because of deficits in self-insight and/or verbal ability, this individual incidence of PTSD will largely remain unknown

The Problem of PTSD

PTSD can, in turn, lead to a number of highly maladaptive behaviors, including (but not limited to)

Aggression

Self-injury

Addictions (especially in higher-functioning individuals)

The Problem of PTSD

Very ironically, PTSD may be misdiagnosed as physiological due to its outward signs, while frankly physiological conditions may be misattributed to anxiety

The Paradox of Anxiety

While a common factor exacerbating physiological symptoms anxiety is rarely a cause or a solitary symptom in cases of autism with comorbidity.

The Problem of PTSD

Misdiagnosis—and consequently misdirected treatment—can become occasion for both iatrogenesis and psychological trauma.

In Summary: Don’t

assume that any physician can make a psychiatric diagnosis

summon the dead to defend a poor diagnostic decision

expect the health problems of individuals with autism to readily make sense

expect omnisicience of any human being (yourself included)

In Summary: Do

Listen, observe and reflect

Keep asking questions—if only in your mind

Look out for “zebras”

Perform thorough diagnostics as a clinician—insist upon these as a consumer

Keep trying. Keep trying. KEEP TRYING.

Thank you!

[email protected]

SUBJECT LINE: PPT

mailto:[email protected]

IN THE CROSSFIRE CO-OCCURRING MEDICAL PROBLEMS Merlin L. Taylor, Ph.D., CCC-SLP, BCBA-D...

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