If I am autistic, can I be diagnosed with co-occurring conditions?
If someone has been diagnosed as autistic and they have another co-occurring condition and/or intellectual disability, sometimes these additional challenges can all be seen as just part of their autism diagnosis. This shows how important it it is to look at every individual on the Autism Spectrum as just that – an individual, with distinct needs, strengths and challenges.
It is really important that we understand that autistic people can (and very often do) have co-occurring conditions such as Attention Deficit Hyperactive Disorder (ADHD), dyspraxia, dyslexia or co-occurring mental health difficulties such as anxiety disorders, mood disorders or Obsessive Compulsive Disorder (OCD). In fact, someone who is autistic might have as many as three or four other diagnoses!
Sometimes these additional diagnoses can be unhelpful (e.g. a personality disorder), but sometimes they can be very useful in getting the right support (e.g. for dyspraxia). An occupational therapy assessment can be useful for picking up on possible co-occuring conditions.
When an Autistic person is diagnosed with another condition it is vital that the challenges of both conditions are explored and addressed. The manner in which the other condition is explored and addressed may need to be adjusted so that it is suitable for an Autistic individual, but should still be treated as a distinct clinical need of its own. The only case where this may become complicated is in the case of diagnostic overshadowing (see below).
As a society, our understanding of various conditions is improving and therefore, gradually, it is becoming more and more common for people to pick up on these differences and receive multiple diagnoses. In Ireland, unfortunately, it can sometimes be difficult to get the appropriate supports if you are autistic and have a co-occuring mental health difficulties, as our Disability Services and Mental Health Services are separate. This means that you will be sent to different teams to receive your different supports.
Below we will provide a short introduction to some conditions which commonly co-occur with Autism and point you to advocacy organisations with specific expertise in these areas.
ADHD – Attention Deficit Hyperactivity Disorder is a medical/neurobiological condition where the brain’s neurotransmitter chemicals (chiefly noradrenalin and dopamine) do not work properly.
ADHD, without proper identification, treatment and management, can have serious and long-lasting consequences and/or complications for an individual. It may also go unnoticed or confused for behavioral issues in autistic children.
It is a genetic and long-term condition which affects learning and executive functioning right through the school years and in many cases beyond into adulthood.
It is important to note that ADHD is a very treatable condition. If diagnosed and properly addressed, people with ADHD can reach their potential and lead happy and successful lives.
Like Autism, ADHD can have diverse characteristics which vary from person to person. One individual may simply appear as especially prone to daydreaming or easily distracted, while another may be hyperactive (which can often be mistaken for aggression or ‘acting out.’)
For more information on the complex ways ADHD manifests in children and adults, check here.
There is a high occurrence of Autistic people who will also be diagnosed with another developmental condition such as dyslexia, dyspraxia and ADHD. There is also significant cross-over in terms of clinical needs and characteristics between the 4 conditions.
According to the Dyslexia Association of Ireland, Dyslexia is “a specific learning difficulty affecting the acquisition of fluent and accurate reading and spelling skills. This occurs despite access to appropriate learning opportunities. Dyslexia is characterised by cognitive difficulties in (1) phonological processing, (2) working memory, and (3) speed of retrieval of information from long term memory. Dyslexic difficulties occur on a continuum from mild to severe and affect approximately 10% of the population. People with dyslexia may experience greater stress and frustration as they endeavour to learn, resulting in heightened anxiety, particularly in relation to literacy acquisition. People with dyslexia may also have accompanying learning strengths.”
To find out more about Dyslexia, visit the Dyslexia Association of Ireland website here.
According to the Dyspraxia Association of Ireland, Dyspraxia or Developmental Coordination Disorder (DCD) is a common disorder affecting fine and/or gross motor coordination in children and adults. It is a chronic neurological disorder beginning in childhood that can affect planning of movements and co-ordination as a result of brain messages not being accurately transmitted to the body
To find out more visit the Dyspraxia Association of Ireland’s website here.
According to Epilepsy Ireland, the word ‘epilepsy’ is derived from the Greek word meaning ‘to be seized, to be overwhelmed by surprise’. To have epilepsy is to have a tendency to have recurring seizures. Anyone can have a seizure, if the brain is exposed to a strong enough stimulus. We know that about 1 in every 20 people will have a single seizure at some time during their lives. Official figures received by Epilepsy Ireland support its estimation that there are over 37,000 people with epilepsy in Ireland.
Autistic people, and individuals with other developmental conditions, are significantly more likely to have epilepsy than the neurotypical population. It can also be difficult, at times, to separate seizures from autistic characteristics such as staring into space, stimming, repetitive behaviours, poor responsiveness or self-injurious behaviour. This can be especially true of people with Autism who have intellectual disabilities or communication difficulties.
To find out more about Epilepsy visit the Epilepsy Ireland website here.
Intellectual/Learning Disabilities
Between 30-40% of Autistic individuals also have an intellectual or learning disability. It is important that both needs are addressed and explored fully to ensure the person is able to reach their own personal potential. It is also important that the person’s education, workplace and community is accessible and accommodating to them as an individual, bearing in mind the additional needs from both diagnoses.
To find out more about Intellectual Disabilities visit Inclusion Ireland’s website here.
According to Down Syndrome Ireland, Down syndrome is a chromosomal anomaly caused by an error in cell division that results in the presence of an additional third chromosome 21 or “trisomy 21.” This extra genetic material results in the physical and learning characteristics associated with Down syndrome. Down syndrome is one of the most common known causes of intellectual disability.
Down Syndrome is a lifelong condition but with the right support, those with the condition can be supported to live happy and independent lives.
To find out more about Down Syndrome visit Down Syndrome Ireland’s website here.
Research has indicated that quite a high percentage of individuals diagnosed with an eating disorder might also be autistic. In Ireland we do not yet have a team that would be dedicated to supporting individuals who are both autistic and suffering with an eating disorder as both areas are highly specialised areas. Currently, there is a lack of professional awareness for the co-occurrence of autism and eating disorders and this is an area that needs to be further investigated. In neurotypicals eating disorders are generally an expression of anxiety and it is possible autistic people may similarly be affected. Unfortunately, the repetitive and restrictive nature that sometimes comes with being autistic can mean that an eating disorder can be more difficult to treat or even identify. With further research and increased awareness it is hoped that the supports for autistic people suffering with eating disorders will improve. For more information on autism and eating disorders you can read more on the Bodywise website here. or on the UK National Autistic Society here. PEACE www.peacepathway.org in the UK (while being a service that does not provide clinical supports in Ireland) has information on its website specifically in this area.
What is Pathological Demand Avoidance?
Pathological Demand Avoidance or PDA is a new proposed subset of Autism, which is not in the official diagnostic manuals. As a result, some have labelled it as a distinct condition in the same way Asperger’s was once used. Pathological Demand Avoidance is also often used as a term to describe how an individual will experience an overwhelming need to avoid or resist demands (i.e. an anxiety based demand avoidcance).
It is really important to understand that when a child is avoiding demands, it is because of anxiety, even if it doesn’t look like anxiety. This is very important to keep in mind, because parents can often respond with more demands which then increases the anxiety further. Sometimes autistic children will avoid demands with challenging behaviours, but the underlying cause is still anxiety. This means that the most important thing to do is to search for the cause of the anxiety and support that. Your child might be screaming or kicking or biting and running away but it is important to remember that although this might not look like ‘typical anxiety’ this is something that is causing your child distress and anxiety and something they need to be supported with.
For more information, see this study by DCU describing experiences with PDA
What can I do to support my child through Pathological Demand Avoidance?
While using visual schedules is a helpful autism resource, for children experiencing anxiety based demand avoidance, this can actually increase their anxiety. Children with anxiety based demand avoidance see visual schedules as another demand, seeing the visual schedule as another thing they have to do. Alternatively, the best way to support your child with PDA is to learn to reduce those demands for your child. First identify what demand it is that affects your child. Then slowly and gradually introduce that particular activity but in a “sideways” way rather than a demand. For example, if homework causes your child to become avoidant, sit at the kitchen table with them drinking hot chocolate. Then, casually have one of their books beside you both on the table. Start a casual conversation about something in the book, gradually have a pencil beside them, etc. It might be a slow, long process but gradually introducing the activity that needs to be done in a non-pressurised way will allow your child to manage their anxiety a little easier.
What is diagnostic overshadowing?
Diagnostic overshadowing describes how when an individual has one diagnosis, any difficulties or challenges they experience is said to be caused by that diagnosis. Diagnostic overshadowing means that an individual might be experiencing a difficulty caused by another condition but will not receive that diagnosis and therefore not receive the support they require for that diagnosis.
