Medical Comorbidities in Autism: Challenges to Diagnosis and Treatment

Bauman, Margaret L.

doi:10.1016/j.nurt.2010.06.001

Cited by 308 publications

(217 citation statements)

References 35 publications

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“…We recognize that in addition to comprehensive early intervention programs, the management and treatment of young children with ASD often involves speech and language and occupational and physical therapies, as well as management of comorbid conditions such as associated medical disorders (eg, sleep, gastrointestinal), 12 anxiety, and challenging and maladaptive behaviors. However, a review of these targeted interventions was beyond the scope of the current initiative.…”

Section: Methodsmentioning

confidence: 99%

Early Intervention for Children With Autism Spectrum Disorder Under 3 Years of Age: Recommendations for Practice and Research

et al. 2015

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This article reviews current evidence for autism spectrum disorder (ASD) interventions for children aged ,3 years, based on peerreviewed articles published up to December 2013. Several groups have adapted treatments initially designed for older, preschool-aged children with ASD, integrating best practice in behavioral teaching methods into a developmental framework based on current scientific understanding of how infants and toddlers learn. The central role of parents has been emphasized, and interventions are designed to incorporate learning opportunities into everyday activities, capitalize on "teachable moments," and facilitate the generalization of skills beyond the familiar home setting. Our review identified several comprehensive and targeted treatment models with evidence of clear benefits. Although some trials were limited to 8-to 12-week outcome data, enhanced outcomes associated with some interventions were evaluated over periods as long as 2 years. Based on this review, recommendations are proposed for clinical practice and future research. Pediatrics 2015;136:S60-S81

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Section: Methodsmentioning

confidence: 99%

Early Intervention for Children With Autism Spectrum Disorder Under 3 Years of Age: Recommendations for Practice and Research

et al. 2015

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“…[1][2][3][4][5] With the prevalence of autism near 1%, 6 understanding this comorbidity burden is especially important (not least because of the clinical resources this burden entails). Understanding the co-occurrence patterns among comorbidities in ASD is the first step for uncovering the underlying etiologies associated with ASD and stratifying the risk of various conditions across individuals with ASD.…”

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confidence: 99%

Comorbidity Clusters in Autism Spectrum Disorders: An Electronic Health Record Time-Series Analysis

2014

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WHAT'S KNOWN ON THIS SUBJECT: Individuals with autism spectrum disorders have a higher comorbidity burden than the general pediatric population, including higher rates of seizures, psychiatric illness, and gastrointestinal disorders. WHAT THIS STUDY ADDS:Comorbidities do not occur evenly. Our clustering analysis reveals subgroups characterized by seizure, psychiatric disorders, and complex multisystem disorders including auditory and gastrointestinal disorders. Correlations between seizure, psychiatric disorders, and gastrointestinal disorders are validated on a sample from a second hospital. abstract OBJECTIVE: The distinct trajectories of patients with autism spectrum disorders (ASDs) have not been extensively studied, particularly regarding clinical manifestations beyond the neurobehavioral criteria from the Diagnostic and Statistical Manual of Mental Disorders. The objective of this study was to investigate the patterns of cooccurrence of medical comorbidities in ASDs.METHODS: International Classification of Diseases, Ninth Revision codes from patients aged at least 15 years and a diagnosis of ASD were obtained from electronic medical records. These codes were aggregated by using phenotype-wide association studies categories and processed into 1350-dimensional vectors describing the counts of the most common categories in 6-month blocks between the ages of 0 to 15. Hierarchical clustering was used to identify subgroups with distinct courses.RESULTS: Four subgroups were identified. The first was characterized by seizures (n = 120, subgroup prevalence 77.5%). The second (n = 197) was characterized by multisystem disorders including gastrointestinal disorders (prevalence 24.3%) and auditory disorders and infections (prevalence 87.8%), and the third was characterized by psychiatric disorders (n = 212, prevalence 33.0%). The last group (n = 4316) could not be further resolved. The prevalence of psychiatric disorders was uncorrelated with seizure activity (P = .17), but a significant correlation existed between gastrointestinal disorders and seizures (P , .001). The correlation results were replicated by using a second sample of 496 individuals from a different geographic region.CONCLUSIONS: Three distinct patterns of medical trajectories were identified by unsupervised clustering of electronic health record diagnoses. These may point to distinct etiologies with different genetic and environmental contributions. Additional clinical and molecular characterizations will be required to further delineate these subgroups.

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“…[1][2][3] Similarly, co-occurring behavioral or mental health symptoms occur in the majority of children who have ASD, 4 with individual children often showing symptoms of $2 comorbid disorders. [5][6][7] Recent systematic analyses of comorbidity in ASD indicate that behavioral or mental health conditions increase the need for multiple resources, extra assistance in schools, and therapeutic interventions.…”

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confidence: 99%

Clinical Practice Pathways for Evaluation and Medication Choice for Attention-Deficit/Hyperactivity Disorder Symptoms in Autism Spectrum Disorders

et al. 2012

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BACKGROUND AND OBJECTIVE: Hyperactivity, impulsivity, and inattention (referred to as "ADHD [attention-deficit/hyperactivity disorder] symptoms") occur in 41% to 78% of children with autism spectrum disorders (ASDs). These symptoms often affect quality of life, interfering with learning or interventions that target primary ASD symptoms. This practice pathway describes the guidelines for evaluation and treatment of children and adolescents with ASD and comorbid ADHD symptoms.METHODS: Current research in this area is limited, and, therefore, these recommendations are based on a systematic literature review and expert consensus in the Autism Speaks Autism Treatment Network Psychopharmacology Committee. RESULTS:The recommended practice pathway includes the Symptom Evaluation Pathway for systematic assessment of ADHD symptoms across settings; examination for comorbid sleep, medical, or psychiatric comorbidities that may contribute to symptoms; and evaluation of behavioral interventions that may ameliorate these symptoms. For children for whom medication is being considered to target the ADHD symptoms, the medication choice pathway provides guidance on the selection of the appropriate agent based on a review of available research, assessment of specific advantages and disadvantages of each agent, and dosing considerations.CONCLUSIONS: These recommendations provide a framework for primary care providers treating children who have ASD and ADHD symptoms. Our systematic review of the current evidence indicates the need for more randomized controlled trials of the medications for ADHD symptoms in ASD. There will also be a need for studies of the effectiveness of these practice pathways in the future. Pediatrics 2012;130: S125-S138

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Medical Comorbidities in Autism: Challenges to Diagnosis and Treatment

Cited by 308 publications

References 35 publications

Early Intervention for Children With Autism Spectrum Disorder Under 3 Years of Age: Recommendations for Practice and Research

Early Intervention for Children With Autism Spectrum Disorder Under 3 Years of Age: Recommendations for Practice and Research

Comorbidity Clusters in Autism Spectrum Disorders: An Electronic Health Record Time-Series Analysis

Clinical Practice Pathways for Evaluation and Medication Choice for Attention-Deficit/Hyperactivity Disorder Symptoms in Autism Spectrum Disorders

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