Please use independent judgment and request references when considering any resource associated with diagnosis or treatment of autism or its associated medical conditions. The following information is solely for educational purposes, not medical advice. It is not a substitute for care by trained medical providers. Autism Speaks is not engaged in the practice of health care or the provision of health care advice or services. For specific advice about care and treatment, please consult your physician.
A number of medical and behavioral issues frequently occur with autism spectrum disorder (ASD). These “co-morbid conditions” include anxiety, depression, attention-deficit/hyperactivity disorder (ADHD), gastrointestinal (GI) problems, sleep disturbances and epilepsy.
In addition, the U.S. Centers for Disease Control and Prevention (CDC) reports that children with autism or other developmental disorders have higher than expected rates of an even broader range of medical conditions. Specifically, these children are:
* 1.8 times more likely than children without developmental disabilities to have asthma,
* 1.6 times more likely to have eczema or skin allergies,
* 1.8 times more likely to have food allergies,
* 2.2 times more likely to have chronic severe headaches, and
* 3.5 times more likely to have chronic diarrhea or colitis (inflammation of the colon).
Autism Speaks continues to fund studies on the causes and treatments of autism’s associated medical and behavioral conditions. (You can explore these studies here.) Our Autism Treatment Network (ATN) brings together specialists interested in providing the highest standard coordinated care. In the following sections, you’ll find more information on behavioral therapies and medicines that researchers and clinicians have found helpful in addressing the disorders most commonly associated with autism.
ASD and Gastrointestinal (GI) Disorders
Gastrointestinal (GI) disorders are among the most common medical conditions associated with autism. These issues range from chronic constipation or diarrhea to inflammatory bowel conditions. They can affect persons of any age. But in the context of autism, they have been most studied in children. For more information, please see our Autism and GI Disorders page.
ASD and Sleep Disorders
Many persons affected by ASD have difficulty falling asleep and staying asleep through the night. This has been most studied in children with ASD, with research suggesting that chronic sleep problems affect as many as four out of five. The most common sleep problems involve difficulty falling asleep and repeated wakening during the night. Some children have prolonged nighttime awakenings or awaken extremely early in the morning.
We know that disrupted and insufficient sleep can result in daytime sleepiness, learning problems and behavioral issues such as hyperactivity, inattentiveness and aggression. Recent research in children with ASD demonstrates that poor sleepers exhibit more problematic behavior than good sleepers. And of course, a child’s sleeping difficulties can disrupt the sleep of other family members.
Many potential reasons exist for poor sleep in children with ASD, including neurological, behavioral and medical issues. Some early studies suggested abnormalities in brain systems that regulate sleep. Autism Speaks is current funding a number of studies evaluating sleep disturbance associated with autism. Some are looking at levels of hormones such as melatonin, which is known to affect sleep.
Sometimes sleep problems result from the need to establish a regular sleep routine. How a parent responds to nighttime wakenings can likewise affect a child’s ability to fall back asleep independently. Medical issues that tend to co-occur with autism can likewise contribute to sleep problems. These include epilepsy and gastroesophageal reflux disease (GERD). Medication side effects can be yet another contributor to sleep difficulties – as can anxiety, which is frequently associated with ASD. (See “ASD and Anxiety” below.)
Fostering Better Sleep
Autism Speaks ATN clinicians have been studying how to help children with autism sleep better. The result is the ATN’s Sleep Strategies Guide. Although the guide was written with children in mind, many of the sleep strategies in this tool kit are equally applicable to adults affected by ASD. You can download the guide free here. Recent research on melatonin, funded by Autism Speaks, provides more support for the careful use of this sleep aid. For more information, see our news story, here.
Helping Teens and Adults Sleep
Like young children, teens and adults need adequate exercise and sunlight and consistent waking and bed times. However, adolescence brings hormonal changes that can delay the onset of sleepiness until later at night. Unfortunately, many classes and jobs start early! It’s important to adopt good sleep habits, including a regular bedtime that allows for 7 to 8 hours of sleep each night. Helpful steps include finishing homework and other activities and turning off computers the computer and TVs at least 30 minutes before bed. Keep lights low. A light snack before bed can help growing teens sleep through the night. In addition, it may help to remove computers, TVs and other electronic communication devices from the bedroom entirely. Importantly, teens and adults who drive need to know to NEVER drive when sleepy.
ASD and Anxiety
Without question, anxiety is a real and serious problem for many people on the autism spectrum. We hear this from parents, teachers and doctors, as well as from adolescents and adults with ASD. Research suggests that at least 30 percent of those affected by ASD also have an anxiety disorder. These disorders include social phobia, separation anxiety, excessive worry, obsessive compulsive disorder and extreme fears – for instance, of spiders or loud noise. In addition, individuals with autism can have difficulties controlling anxiety responses once they are triggered – even if they do not suffer from a specific anxiety disorder.
It’s important to remember that anxiety can range from fluctuating, mild and completely understandable to unremitting, severe and irrational. Most people experience some form of anxiety on a regular basis. Mild anxiety can actually be a positive, motivating force to increase one’s level of effort and attention when working or socializing. However, research suggests that high levels of anxiety interfere with success in school, work and social situations.
Research also suggests that adolescents with autism may be particularly prone to anxiety disorders, while the rate among younger children on the spectrum may not differ from that of their same-age peers. Some studies likewise suggest that high-functioning individuals on the spectrum experience higher rates of anxiety disorders.
Behavioral Treatments for Anxiety
A recent review of studies found that behavioral interventions help many children and adolescents with autism and anxiety. Some studies suggest that cognitive behavioral therapy (CBT) can be particularly helpful for high-functioning adolescents and adults with autism and anxiety.
Several types of cognitive behavioral therapy have been developed to address anxiety in children and teens with ASD, with promising results from several clinical research centers. Techniques include challenging negative thoughts with logic, role-playing, modeling courageous behavior and incremental (step-by-step) exposure to feared situations. Many of these programs are modified from therapies originally developed for typically developing young people. Programs for children often incorporate special interests to encourage participation. For example, the therapist may use a child’s favorite cartoon characters to model coping skills, or intersperse conversations about a child’s special passion throughout the treatment session to promote motivation and engagement.
Depending on the program, weekly treatment sessions usually last 60 to 90 minutes and continue for 6 to 16 weeks. Most treatment plans depend on parent involvement and weekly homework assignments. Results from a randomized clinical trial, case studies and related reports indicate that most children with ASD who complete such programs experience significant improvements in anxiety as well as some improvement in social communication and other daily living skills.
Autism Speaks continues to support research on these and related behavioral interventions for relieving anxiety. At present these intensive and scientifically studied treatment programs are available primarily at a small number of autism treatment centers. With donor support, we are committed to making programs with proven benefits more accessible to all families.
Medications for Anxiety
At Autism Speaks, we are actively supporting research into anxiety disorders and other medical conditions frequently associated with autism. This includes both basic research on the underlying biology of autism and anxiety and the safe development of medicines that can relieve disabling symptoms and improve quality of life. You can explore these funded studies here.
To date, the Food and Drug Administration (FDA) has not approved any medication expressly for the treatment of anxiety in persons with autism. However some classes of drugs commonly prescribed for anxiety disorders in the general population likewise help many of those on the autism spectrum. These include selective serotonin reuptake inhibitors (SSRIs) such as Prozac and other SSRIs.
For those with autism, anxiety medicine is best used in combination with behavioral interventions. Among high-functioning individuals, medicine may be particularly effective when combined with cognitive behavioral therapy (see above). Some studies have found that anti-anxiety medications, while helpful for some people with ASD, are less effective overall in those with autism than with others. It is possible that the biological root of autism-associated anxiety may differ that of anxiety in the general population. If this proves to be true, individuals with autism may respond best to tailored treatments.
If you are considering anti-anxiety medication for a child with autism, our ATN Medication Decision Aid can help you work with your physician to sort through the pros and cons in the context of your family’s values and goals. You can learn more about the medication tool kit and download a free copy here.
Read more about ASD and Anxiety on our Treatment for Associated Psychiatric Conditions page.
ASD and Attention Deficit and Hyperactivity Disorder
Parents and researchers have long known that attention-deficit/hyperactivity disorder (ADHD) often accompanies autism. Recent studies have helped deepen our understanding of why this is so and how it affects quality of life. One important study looked at gene changes in individuals with ADHD or autism. Another looked at how frequently parents see the symptoms of ADHD in their children and how seriously these symptoms affect their children’s daily functioning and quality of life.
The upshot of the first study is that the genetic changes seen in persons with ADHD often involve the same genes that are associated with autism. This finding may help explain why many of those on the autism spectrum also struggle with ADHD symptoms. In other words, if these disorders share a genetic risk factor, it’s logical that they often occur together. These insights may improve how we diagnose and treat these issues.
The second study helped clarify how commonly children on the autism spectrum are affected by ADHD symptoms and documented how this affects their daily function and quality of life. Perhaps the most notable observation was that, while ADHD symptoms clearly worsened daily function and quality of life for children with autism, only about 1 in 10 were receiving medication to relieve symptoms.
Studies have long shown that ADHD medications improve quality of life for many people. However, we need more research on how well these medications work for persons who are also affected by autism.
Medicines used to ease ADHD include stimulants such as methylphenidate (Ritalin, Metadate, Concerta, Methylin, Focalin, Daytrana), mixed amphetamine salts (Adderall), dextroamphetamine (Dexedrine) and lisdexamfetamine (Vyvanse). Other available options include so-called alpha agonists such as guanfacine (Tenex, Intuniv) and clonidine (Catapres, Catapres TTS, Kapvay).
Stimulants can produce side effects such as decreased appetite, irritability, emotional outbursts and difficulty falling asleep. Common side effects of alpha agonists include sleepiness and irritability. Importantly, if a person responds adversely to one of these medicines, another may prove less problematic. On a practical level, this can require a trial period of several different medicines – each tried in a judicious manner – before the medicine with the greatest benefit and least side effects is found.
It is important to work with your or your child’s physician and behavioral therapists to tailor treatment to your or your child’s behavioral challenges, needs, goals and values. To this end, the specialists in Autism Speaks Autism Treatment Network have developed a family Medication Decision Aid available for free download here.
Read more about ASD and ADHD on our Treatment for Associated Psychiatric Conditions page.
Seizures are relatively common in children and adults on the autism spectrum. Independently, autism and epilepsy (seizures of unknown cause), each occur in around 1 percent of the general population. But epilepsy rates among persons with autism range from 20 to 40 percent, with the highest rates among those who are the most severely impaired by autism’s core symptoms. Conversely, about 5 percent of children who develop epilepsy in childhood go on to develop autism.
Autism and epilepsy share many similarities. Both exist on a spectrum – that is, the severity varies widely among those affected. In addition, a number of different abnormal genes are associated with increased risk of developing one or both disorders.
Importantly research shows that the combination of autism and epilepsy is often associated with overall poor health and premature death. So development of effective therapies is critically important. This goal begins with increasing our understanding of the shared brain networks, genes and other biological mechanisms that underlie these two conditions. Autism Speaks is currently partnering with the International League Against Epilepsy and Citizens United for Research in Epilepsy (CURE) to further this research. (Explore our related studies here.)
At present the treatment of epilepsy in persons with autism is based on the same principles as treatment of epilepsy in any child. Should parents suspect that their child is suffering seizures, the first step is to work with a pediatric neurologist to obtain a brain study called an electroencephalogram (EEG). An EEG can determine if these events are indeed seizures. Treatment usually involves an antiepileptic drug, which the treating physician chooses based on the type of seizure and the associated EEG patterns – to —to maximize effectiveness and minimize side effects. By themselves, antiepileptic drugs fail to resolve seizures in about one-third of patients. Such difficult-to-control cases sometimes respond to more complicated interventions. These include combinations of several anti-epileptic drugs, a ketogenic diet (high-fat, adequate-protein, and low-carbohydrate) and/or brain surgery.
Clearly, it’s important identify and treat seizures early. Red flags include unexplained staring spells, unusual involuntary movements in the face or limbs, unexplained confusion and severe headaches. Other less-specific signs can include sleepiness or sleep disturbance, behavioral regression and sudden unexplained changes in mood or ability to control emotions. For more information and resources, see our Autism and Epilepsy page.
Neurological Changes with Age
Research shows that children with autism continue to improve, show fewer symptoms and gain more skills as they move through adolescence. However, some children affected by ASD experience neurological changes that result in psychiatric conditions, challenging behaviors and/or general regression. On rare occasion, older children and adults affected by ASD experience the potentially life-threatening condition known as catatonia. Catatonia stems from neurological changes that produce an inability to move normally, if at all. The person may become completely unresponsive and nonverbal despite being awake. In some cases, periods of nonresponsiveness alternate with odd movement patterns or hyperactivity. In some cases, catatonia results from the withdrawal or initiation of an anti-psychotic medication. Typically treatment involves medications called benzodiazepines, which have relaxing, sedating and anticonvulsant properties. In severe cases, electroconvulsive therapy (ECT) can be helpful.
ASD and Wellness
In considering medical conditions in an individual with ASD, it is important to remember the importance of overall wellness. While those affected by an ASD may need specific treatments for core symptoms and associated medical conditions, it’s crucial to integrate these with regular physical check-ups, dentist visits, good nutrition and fitness. Of course, this can prove challenging. For this reason, Autism Speaks continues to invest in resources that help children and adults with ASD build healthy habits and maintain a high quality of life. Please see our Health and Wellness pages for more information.
For still more information and resources, please see our Video Glossary, FAQs and special sections on Symptoms, Learn the Signs, Treatment, Your Child’s Rights, Asperger Syndrome and PDD-NOS. We also offer a number of resource-packed tool kits for free download (here and here). They include our 100 Day Kit for families who have a child recently diagnosed with autism. These resources are made possible through the generous support of our families, volunteers and other donors.
You may also be interested in these related news stories and blog posts:
Autism and Associated Medical Conditions
Autism and ADHD
ADHD Symptoms in Children with Autism Are Common, Problematic and likely Undertreated
More Evidence that Melatonin Eases Autism-Related Insomnia
What behavioral therapies can help someone with autism and severe anxiety?
How common are anxiety disorders in people with autism, and are there effective treatments?
How common are seizures among people with autism, and what can help?