Related Conditions

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.

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.  

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