Join us for a discussion about comorbidities common in autistic children and what treatment looks like, presented by Naomi Replogle, APRN, CPNP-PC, PMHNP-BC.
Treating Comorbidities in Children with Autism
[00:00:00] Hello everyone. I’m Naomi Replogle. I’m a nurse practitioner, board certified in both pediatric primary care and psychiatric mental health. I’m currently pursuing a fellowship in psychiatric functional medicine, and I’m also the mother of two profoundly autistic children. Today I’m going to discuss treating comorbidities in children with autism.
Comorbidities is a term used to describe when an individual has two or more medical conditions occurring simultaneously or at the same time.
Autism spectrum disorder. This is a lifelong complex neurodevelopmental condition. Individuals diagnosed with autism often display repetitive behaviors or movements and have restricted interests. Deficits are present in social communication and social interaction. Symptoms are initially observed in the [00:01:00] stages of early childhood development.
Significant impairment in functional ability is present in social, occupational, and other important areas of functioning in their lives. Symptoms of autism can vary from mild to severe.
According to the May, 2025 report from the Centers for Disease Control and Prevention, prevalence of autism in children aged eight years is 1 in 31, displaying a significant increase from one in 150 children with the diagnosis in 2000. Males are three times more likely to have an autism diagnosis than females.
All socioeconomic, racial and ethnic groups have been found to be affected.
Incidents of comorbidities. [00:02:00] Individuals with autism statistically have a significantly increased risk of co-occurring diseases and or disorders when compared to individuals without autism. One study involving over 26,500 participants found at least one co-occurring developmental disorder to be present in 83% of children and adolescents with autism in the United States.
A co-occurring psychiatric diagnosis was noted in 70% of this study population. Additional study with over 42,000 participants demonstrated 74% of individuals with autism have at least one co-occurring medical condition. There are numerous studies showing similar data with regard to the increased presence of co-occurring medical conditions in individuals with autism.
[00:03:00] On this slide, I have listed some of the most commonly occurring comorbidities based upon research findings in individuals with autism. Psychiatric findings include attention deficit hyperactivity disorder, also known as ADHD, which is by far the most common one, anxiety disorders and phobias, which would include social anxiety, separation anxiety, and generalized anxiety disorders.
Mood disorders, which includes major depressive disorder, bipolar disorder, obsessive compulsive disorder, also known as OCD. Eating disorders, the most prevalent of those tend to be anorexia and bulimia. Schizophrenia, personality disorders, suicidal behaviors. [00:04:00] While all these conditions are important, I want to share recent studies are showing children, adolescents with autism have doubled the risk for suicide attempts when compared to children, adolescents without autism. Adults with autism are approximately 25 times more likely to attempt suicide than adults without autism.
Neurological comorbidities include sleep disorders, seizure disorder or epilepsy, learning disability, intellectual disability, motor delay, social communication disorder, Tourette’s syndrome, and tic disorder.
Statistically, individuals with autism are four times more likely to have at least one gastrointestinal condition when compared to individuals [00:05:00] without autism. Gastrointestinal conditions can include constipation, diarrhea, abdominal pain, feeding disorders, and or food intolerances, gastroesophageal reflux, PICA, which is eating non-food items, vomiting and obesity.
Additional comorbidities associated with autism include: in the metabolic category — mitochondrial disorders, amino acid disorders, neurotransmitter disorders, folate metabolism, and folate transport disorders, cerebral creatine deficiency syndrome and [00:06:00] phenylketouria, also known as PKU. Under genetics, we have fragile X syndrome, Down syndrome, Duchenne Muscular Dystrophy, 22q deletion Syndrome, Angelman Syndrome, CHARGE, Prader Willi Syndrome and Smith-Magenis Syndrome. Under allergic and immune category, we have food allergies, food intolerances, eczema, chronic nasal drainage, immune system dysfunction, and or inflammation.
Diagnostic and treatment challenges.
Diagnosing and treating medical conditions in individuals with autism can be challenging for the following [00:07:00] reasons. Communication for the individual can be difficult. This may be related to speech challenges. Some individuals are nonverbal. There also could be anxiety related to medical visits.
Internal body signals are not always understood and sometimes cannot be communicated completely, if at all. This makes it challenging because sometimes these body signals may be symptoms of an underlying condition, which the medical provider and or the caregiver cannot observe externally.
Completing a physical exam may be difficult and therefore not fully performed. This can be an issue because things can be missed if a full physical exam is not necessarily completed. However, it also can be traumatic for the child to go through the [00:08:00] physical exam. Obtaining lab work, x-rays, and performing simple medical procedures may require restraint and or sedation.
Continuing with diagnostic and treatment challenges, medical providers may not fully understand the challenges of caring for individuals with autism. For example, if you have informed your child’s provider, it is difficult to medicate your child, yet the provider prescribes three different medications which need to be given multiple times a day, the likelihood of your child being treated successfully is not good.
Next, caregiver concerns are often dismissed by medical providers.
Symptoms including [00:09:00] behavioral changes are blamed on the autism diagnosis and not worked up appropriately. This can result in medical conditions being missed and treatment being neglected, unfortunately. And lastly, psychiatric conditions may respond atypically to medication treatment in the presence of autism.
For example, if a child with autism and attention deficit hyperactivity disorder is being treated with the stimulant medication, the medication may not work as well. Or it actually may not work at all. Even though stimulant medication is typically prescribed as a first line treatment for attention deficit hyperactivity disorder.
Sometimes stimulants can increase behavioral difficulties in children with autism. Then this [00:10:00] results in it being necessary for us to weigh risk versus benefit, to continue on the medication and then potentially maybe have to add another medication to treat the behavioral side effects from the first medication.
Pharmacogenetic testing. I wanted to touch on this, because I feel that it is important. Given how often individuals with autism are prescribed medications and especially psychiatric ones, but really this testing can be useful for anyone. So this testing works by analyzing how medications are processed in the body.
Specimen is collected by a cheek swab. Typically, the results are received within less than a week, once the specimen is at the lab for processing. [00:11:00] Cost is covered by many insurance companies and it decreases potential medication interactions and medication side effects. It also reduces multiple failed medication trials because the prescriber has the genetic information needed for the patient before any prescriptions are written, if the testing’s performed. So overall, it improves patient safety, satisfaction, and most importantly, quality of life.
I encourage you to research companies that provide this type of testing. If you are interested in having it done for yourself, your child, family member, whoever. Before you have it performed, because some companies offer more comprehensive results than others do. Key takeaways, individuals [00:12:00] with autism have a significantly increased likelihood to experience co-occurring medical conditions, also known as comorbidities, psychiatric, gastrointestinal, and neurologic conditions are among the most common medical comorbidities, however, it is vital to remember that any type of disease and or disability may occur.
Consider pharmacogenetic testing, especially if multiple medications are being prescribed.
Caregivers are always the best experts and should be a valued member of the care team. Never allow yourself as a caregiver to feel dismissed by any professional. It can be time consuming and challenging to find the best team of professionals to meet medical needs of your [00:13:00] loved one. Do not give up. I promise you they are out there, sometimes it is just seems so difficult to find them, but if you continue to look, you will. And never stop advocating for the best possible care and quality of life for your child. Thank you so much.