High-Functioning Autism and Associated (Comorbid) Disorders

“We’re in the process of having our son assessed for high functioning autism. We’ve had numerous problems in the past that have brought us to this point. The doc said he believes our son may have several ‘comorbid’ conditions as well. What other conditions might there be?”

When a youngster has one or more conditions along with the main disorder, it is defined as comorbid and comorbidity. High-Functioning Autism (HFA) – also called Asperger’s (AS) – is listed as an Autism Spectrum Disorder and rarely travels alone. Nearly 100% of the time, the child will have other issues that will need to be addressed.

Here are some of the common comorbid conditions associated with HFA and AS:

1. Attention Deficit Hyperactivity Disorder (ADHD) is a very common comorbid condition of HFA and AS. Here the youngster is unable to concentrate and becomes impulsive to a great degree.

2. Depression and anxiety are the two most common disorders found in a youngster with AS or HFA. Adolescents on the autism spectrum often suffer from depression, which may be caused by (a) being bullied and teased, and (b) coming to the realization that they are different from their “typical” peers. Some of these young people have been known to turn to drugs and alcohol as a way to deal with their plight.

3. Dyspraxia is when a youngster is not able to coordinate or perform certain acts in spite of having the prior plan for it. This disorder is one reason why kids with HFA and AS have always been described as clumsy.

4. Meltdowns are “tantrum-like” behaviors in HFA and AS children. Yelling, hitting, screaming, or a complete shutdown (e.g., covering the face and becoming withdrawn) are common during a meltdown.

5. Obsessive Compulsive Disorder (OCD) is something that is found in most kids on the autism spectrum. The child adheres to strict routines, and she likes to keep every particular object in one particular way – and when changed, she may get very distressed. This is one habit which later on leads to OCD.

6. Oppositional Defiant Disorder (ODD) is a condition in which a youngster displays an ongoing pattern of uncooperative, defiant, hostile, and annoying behavior toward people in authority. The youngster’s behavior often disrupts his normal daily activities within the family and at school.

7. Sensory Processing Disorder (SPD) is common among those that have AS or HFA. In this case, the youngster becomes overly-sensitive to the various sensory stimulations (e.g., forms an intense dislike of loud noises, is easily irritated when dealing with unusual textures, avoids certain foods because they taste bitter, etc.).

8. Tourette’s syndrome is when a youngster exhibits repetitive vocal or motor tics. Most kids diagnosed with Tourette’s also have AS or HFA.

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PARENTS' COMMENTS:

•    Anonymous said… A friend of mines son is 14 with aspergers. He wants to interact but has so much trouble. We were all introduced to him as a wonderful child who has an interesting view on life. Our group of friends are great. The 14yr old likes to shake everyones had when they arrive and then walks off. We are glad that despite the fact that he knows how different he is he trys to make an effort. I hope that I am blessed to still have this group of friends when my 7yr old is that old.
•    Anonymous said… Good luck to all - its just who they are, and we just have to adapt and continually educate others so they can too. I just keep up my own mantra: "it's all good" and smile broadly at the fact that while he may be socially challenged, my son is smart and has a heart of gold, despite the fact that he doesn't verbalize it.
•    Anonymous said… He must be high functioning. Aspergers is on the high functioning side of autism anyway - but some are higher than others. So, "uncommon"? I would say yes.
•    Anonymous said… I do think the gap gets bigger as they get older. My son really gets along better with either younger children or adults because of this. He used to quote star wars too, btw, lol! Now he is constantly talking about Final Fantasy 7, and most kids don't even have a clue what that is since it is an old playstation game. Thankfully my hubby is a huge gamer and can carry a conversation with him. lol
•    Anonymous said… I will add my vote to that of the other commenters. My son is the same way - playing 'next to' not with, or fully directing the game choices, character choices, rules and all else whenever he does attempt to play 'with' someone - and forbid they don't want to play along by his rules, then we have arguments and meltdowns because he can't tolerate "that's not how you play". His poor sister - she feels like she can't win; its all about him!

•    Anonymous said… My 7 year old is high function Aspergers. He is overly social but has no boundaries. He hugs and has no personal space. We are often told that there is no way he could have Aspergers but they don't realise that this behavour is only one aspect of Him. When he meltdowns over getting dressed or getting in the car I have no doubt. At the end of the day you are his parent and see Him for who he is and everything he does trust yourself.
•    Anonymous said… My aspie is very social in that he loves being around other kids, but he isn't popular. He highly lacks in social skills despite his "socialness". It's like he wants friends but making friends is hard and he doesn't realize whenever someone is being mean.
•    Anonymous said… My son is almost 8 and the "social rules" have gotten a lot more complicated from when he was 5.
•    Anonymous said… My son is is the same as far as boundaries, when he plays with other kids we have to remind him to back up because he will talk (very loudly) into their face instead of to it. @ Jessica, you're absolutely right, what is accepted at 5 won't be at 8. I know my son also won't understand when someone is being mean to him. You guys gave me lots of food for thought and I really appreciate your input :).
•    Anonymous said… My son loves being with other children but just doesn't seem to know how to play WITH them. He orders them around and expects to play all games his own way. Every year seems to get harder as the social gap between the kids getts wider. In his defense he is starting to learn more and more social ideas though doesn't seem to understand why we do them.
•    Anonymous said… Ryan was diagnosed HFA/Asperger's and he is how you guys describe. He loves people, but has no social "skills" -- he can't tell when people don't want to play with him or talk to him. He tries to hug on perfect strangers in stores and such. He is bossy with HOW games are played (everyone has to follow his rules or they can't play anywhere near him). I don't think that this type of social behavior is uncommon at all for Aspies. Many areas of documentation explain this as fairly typical Asperger's behavior... it's one of the determining factors that separates it from other areas on the spectrum. They generally WANT friends, they just don't know HOW to make them, where other auties are more or less oblivious to everyone else around them. What seems to happen as the children get older and the social gap becomes larger and your Aspie son is still quoting comic books and Star Wars characters when all the other boys are chasing girls, they become less social. They learn that the other kids don't want to do the things they want to do, and then they begin to focus less on the social interaction.
•    Anonymous said… This summer we sent them to "social skills camp" for the summer (so they could both learn), where the whole focus was on learning those skills - they are teaching the "how to" very systematically. Rome wasn't built in a day, but after 6 weeks we've seen improvement. 
*    Anonymous said... My 5 year old Aspie has all the tell tale signs of Asperger's syndome, to the point where it seems like everything I've ever read was written with him in mind. Except for one key difference...my son is extremely social. He is very popular among other kids, they almost fight for his attention. They love the fact that he can recite comic books word for word, and remembers the names of even the most obscure Star Wars characters, and because he is a people pleaser he will share anything he has to maintain the friendship. He worries very much about how other kids see him and trys obsessively to fit in. I know all children with Asperger's syndrome are different, but my question is, is this very uncommon in Asperger's? I feel people "don't believe" he is on the spectrum because of his social skills.
 
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Why Teens on the Autism Spectrum Can Suffer from Depression

“I’m concerned that my son is depressed (17 y.o.). Is this something that happens along with high functioning autism? If so, why? How can I know for sure if he is really struggling with depression? He has made some off-handed comments about wanting to kill himself. How seriously do I need to be taking these comments?”

Depression seems to be common among teens and young adults with High-Functioning Autism (HFA) and Asperger’s (AS). Many of the same deficits that produce anxiety often unite to produce depression.

The relationship between serotonin functioning and depression has been explored in detail in this population. There is good evidence that serotonin functions may be impaired in kids and teens on the autism spectrum, which suggests that depression is a common comorbid condition.

In addition to impaired serotonin functioning, (a) deficits in social relationships and (b) poor coping-strategies that allow the teenager to compensate for disappointment and frustration may fuel a vulnerability to depression. (As a side note, there is some genetic evidence suggesting that depression and social-anxiety are more common among first-degree relatives of autistic kids, even when accounting for the subsequent effects of anxiety.)

Because some features of depression and autism spectrum disorders overlap, it is important to track that the changes in mood are a departure from baseline functioning. Therefore, the presence of social withdrawal in a teen with the disorder should not be considered a symptom of depression unless there is an acute decline from his or her baseline level of functioning.

Another important point is that the core symptoms of depression should arise together. Therefore, the simultaneous appearance of symptoms would point to depression (e.g., decreased energy, further withdrawal from interactions, irritability, loss of pleasure in activities, sadness, self-deprecating statements, sleep and appetite changes).

An additional point is that teens who display “affective” (i.e., relating to moods and feelings) and “vocal monotony” (i.e., a droning, unchanging tone) are at higher risk for having their remarks minimized by peers, which often gives the HFA or AS teen the impression that he “doesn’t matter” – which in turn can fuel depression.

Some teens on the autism spectrum can make suicidal statements in a manner that suggests an off-hand remark, without emotional impact. When comments are made this way, parents may underestimate them. The content of such comments may be more crucial than the emotional emphasis with which they are delivered. Thus, comments around “wanting to die” should be taken very seriously.

Medications that are useful for treatment of depression in kids and teens on the spectrum are serotonin reuptake inhibitors, although no medications have been shown to be particularly more beneficial for depressive symptoms in people with the disorder. Therefore, the decision as to which medications to use is determined by side-effect profiles, previous experience, and responses to these medications in other family members.

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