Common Disorders Associated with Autism

Our autistic children experience life in a different way than typical children. They often have additional diagnosis, disorders, or conditions alongside the autism diagnosis. Below, we talk about some of the things our kiddos may be experiencing. We've provided some information, symptoms, tips, and links concerning the following: - Sensory Processing Disorder (SPD) - Attention Deficit Hyperactivity Disorder (ADHD) - Anxiety - Separation Anxiety - Obsessive Compulsive Disorder (OCD) - Pathological Demand Avoidance (PDA) - Oppositional Defiant Disorder (ODD) Please share your experiences or tips in the comments. ADHD - Attention Deficit Hyperactivity Disorder A chronic condition including attention difficulty, hyperactivity, and impulsiveness. ADHD often begins in childhood and can persist into adulthood. Autism is often diagnosed at a younger age, toddler years; however, ADHD is not typically diagnosed until a bit later (age 6 or older). This is likely because they can look very similar, but ADHD becomes more prevalent as children are in school and required to apply focus and attention on tasks. More than half of all individuals who have been diagnosed with ASD also have signs of ADHD. ADHD is the most common coexisting condition in children with ASD.

Please note: It's important to understand if you think your child has both to address their sensory needs first. Do not just assume their actions are a result of ADHD and inadvertently overlook their autistic needs.

ADHD and autism may look like this: - hyperactivity & impulsivity - being abnormally active and acting without thinking - being unable to sit still or constantly fidgeting - difficulty focusing - having a short attention span - difficulty concentrating Whereas, children with ADHD tend to be relatively boisterous and talkative, and eager rather than apprehensive of interactions with peers or adults, autistic children may be distinguished by their repetitive and less coordinated motor function, difficulty communicating, emotions in sync with their sensory reality more than with their social setting, and uniform behaviors that keep the unpredictable at bay.

Read more about ADHD & Autism: https://chadd.org/abou.../adhd-and-autism-spectrum-disorder/ https://www.webmd.com/add-adhd/childhood-adhd/adhd-or-autism https://embrace-autism.com/autistic-and-adhd-traits/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8918663/ SPD - Sensory Processing Disorder A condition in which the brain has trouble receiving and responding to information that comes in through the senses (stimuli). Sensory processing problems are commonly seen in developmental conditions like autism spectrum disorder. In some countries, SPD can be diagnosed as a stand-alone disorder, not currently in the US.

Sensory issues are usually defined as either (but experiencing both is quite common): Hypersensitivity (over-responsiveness) to sensory stimuli and may look like: - Seems fearful of crowds - Avoids standing in close proximity to others - Doesn’t enjoy a game of tag - Overly fearful of swings and playground equipment - Extremely fearful of climbing or falling, even when there is no real danger - Has poor balance and may fall often - Think clothing feels too scratchy or itchy - Think lights seem too bright. - Think sounds seem too loud

Think soft touches feel too hard - Different food textures make them gag - React poorly to sudden movements, touches, loud noises, or bright lights

Hyposensitivity (under-responsiveness) to sensory stimuli and may look like: - A constant need to touch people or textures, even when it’s inappropriate to do so - Doesn’t understand personal space when peers understand it - Clumsy and uncoordinated movements - Extremely high pain tolerance - Often harms other children and/or pets when playing (i.e. doesn't understand his or her own strength) - May be very fidgety and unable to sit still - Enjoys movement-based play like spinning, jumping, etc. - Seems to be a "thrill seeker" and can be dangerous at times - Chew on things (including their hands and clothing) - Seek visual stimulation (like electronics) - Have problems sleeping - Don’t recognize when their face is dirty or nose is running

Many children with sensory processing disorder start out as fussy babies who become anxious as they grow older. These kids often don't handle change well. They may frequently throw tantrums or have meltdowns. Many children have symptoms like these from time to time. But therapists consider a diagnosis of sensory processing disorder when the symptoms become severe enough to affect normal functioning and disrupt everyday life.

Ways to help: - Sensory Integration Therapy (SI is provided by OT) - Uses fun activities in a controlled environment. With the therapist, your child experiences stimuli without feeling overwhelmed. He or she can develop coping skills. - Occupational Therapy - It can help with fine motor skills, such as handwriting and using scissors. It also can help with gross motor skills, such as climbing stairs and throwing a ball. It can teach everyday skills, such as getting dressed and how to use utensils. - Sensory Diet (provided by OT) - A sensory diet is customized based on your child’s needs. These activities are designed to help your child stay focused and organized during the day. A sensory diet might include: - 10 minute walk once every hour - 10 minutes on a swing twice a day - 10 minutes on a trampoline twice a day - Fidget toys - Sensory bins - While at school, access to headphones so your child can listen to music while working - While at school, access to a desk chair bungee cord or wiggle seat. This gives your child a way to move his or her legs while sitting - Developmental, Individual Difference, Relationship-based (DIR) Therapy (Floor Time) - This method involves multiple sessions of play with the child and parent. The play sessions last about 20 minutes. There are two phases to this method; the first is child led, the second is more parent led using information gathered from the first phase. The sessions are tailored to the child's needs. For instance, if the child tends to under-react to touch and sound, the parent needs to be very energetic during the second phase of the play sessions. If the child tends to overreact to touch and sound, the parent will need to be more soothing.

Read more about SPD & Autism: https://familydoctor.org/.../sensory-processing-disorder.../ https://www.webmd.com/children/sensory-processing-disorder https://www.autismparentingmagazine.com/autism-sensory.../ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4116166/ Anxiety Anxiety can be a big one for our littlies to deal with. It often goes hand in hand with Autism and can manifest in refusal, meltdowns, shutdowns, and aggressive behaviors.

Some strategies for dealing with anxiety in children are: - Having a set routine of activities, having a routine can take the fear of the unknown away and create steps to follow - Creating visual boards of steps to take for daily tasks such as getting ready for the day, bathing, toileting, meal times, etc.. - Creating adequate transition time and warning when tasks are ending or changing - Taking time to adjust to new situations (such as allowing child adequate time to adjust to a new school or neighbourhood where possible) this could look like frequent visits to the school before starting, staggering days so only doing an hour to start with and building from there (where possible)

Read more about anxiety & Autism: https://adaa.org/.../con.../anxiety-autism-spectrum-disorder https://www.autism.org.uk/.../topics/mental-health/anxiety https://www.autism.org/autism-and-anxiety/ Separation Anxiety The Diagnostic and Statistical Manual (DSM-V) identifies Separation Anxiety Disorder as a “developmentally inappropriate and excessive fear or anxiety concerning separation” causing “clinically significant distress or impairment in social, academic, occupational, or other important areas of functioning.”

Some symptoms include: - recurrent, excessive distress, nausea, vomiting, headaches, or stomachaches when anticipating or experiencing separation from an attachment figure - persistent and excessive worry about loss of attachment figures or possible harm to them, such as illness, injury, disasters, or death - persistent reluctance or refusal to go out because of fear of separation - persistent and excessive fear or reluctance about being alone or without major attachment figures at home or in other settings - persistent reluctance or refusal to sleep away from home or to go to sleep without being near a major attachment figure - nightmares on the theme of separation

Children with 3 or more of these symptoms may need a structured plan guided by a psychologist to work through their anxiety.

The resolution to separation anxiety is emotional security that is allowed to grow over an extended period of time. But emotional security may be elusive for a child with chronic, severe anxiety.

Here are some tips to help: 1. Start with very brief or superficial separations - Plan an outing away from your child where someone will be with them that can keep them engaged in activities while you're gone. Spend short amounts of time away at first, like a walk around the block. Then, gradually lengthen the time away. Attend sessions (therapy/school) with your child at first, then slowly transition yourself to be there less and less. 2. Use positive language - things like “Your mother is gone” or “She left” can be devastating for our little ones. Have caregivers use positive language instead; “Your dad will pick you up at 11:45” or “Your mother will be back right after story time.” 3. Social story & photo story - consider making a picture story that includes photos of the child with alternate caregivers and school classrooms or other places they will go and be separated from you. Social stories work best when illustrated. 4. Magic bracelet - one recommendation is that parents give a child a “magic bracelet” to whisk away anxiety. The bracelet can be made of materials that remind the child of his or her parents, or it may be something that belongs to the parents. The idea is to use the bracelet as an attachment object to transfer emotional security from the parent to the child. 5. Say goodbye with a smile - make sure that they are engaged or about to be engaged in something positive, then say goodbye with a smile. Maybe a brief explanation of what you'll be doing and when to expect you back. 6. Let the child walk away from the parent - children may be more comfortable with the separation if they are the ones to walk away first, like walking off to go do something or greet someone. 7. Practice with games like hide and seek - for children with severe separation anxiety, this simple game draws out raw emotions. Keep it light by hiding in ridiculous places (behind a very skinny, small tree) and making lots of noise in your hiding place. Walk around and point out all the best hiding places before the game starts. 8. Take field trips together to increase the child’s world knowledge - field trips to reduce sensitivities and increase awareness of other people, ways of thinking, and life experiences, which is essential for everyday coping skills. 9. Cognitive behavioral therapy - a systematic way to address behaviors and thought processes related to anxiety. 10. Play Therapy - builds on the natural way that children process their emotions. A play therapist directs the play to work through specific issues affecting the child.

Read more about Separation Anxiety & Autism: https://theplaceforchildrenwithautism.com/.../dealing... https://www.theplightofthesendparent.co.uk/why-separation... https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6982590/ https://carmenbpingree.com/blog/autism-and-anxiety/ OCD - Obsessive Compulsive Disorder OCD in children can be distressing for them and their caregiver. No one wants to see their child struggling. These thoughts can cause anxiety and make children very upset. These thoughts can not just be ignored and can interfere in your child’s happiness and well-being.

OCD can be an obsessive need to complete tasks, do things a certain way, preform tasks over and over again, say certain things over and over, checking on things repeatedly (such is is the door locked), having to do things a certain way in a certain order for it to be right.

Treatments can include medication and behavior therapy. It is important that all the stakeholders in the child’s life are on board with the treatment options so they don’t exacerbate the child’s anxiety (home, school, therapists, etc). A cohesive united approach is the best way to support your child.

Here are a few tips: - Educate yourself and your child on OCD and how it affects their thanking - Give their OCD a silly name that they are ok with to help them feel more comfortable talking about it - Do not get overzealous and point out all of your child’s rituals, you don't want them to feel targeted - Don’t be part of their rituals if at all possible - Keep an eye out for new rituals so you can work together as a team

Read more about OCD & Autism: https://www.anxioustoddlers.com/child-with-ocd/#.ZBKEIKROlzC https://www.spectrumnews.org/.../untangling-ties-autism.../ https://www.autism.org.uk/advice.../topics/mental-health/ocd PDA - Pathological Demand Avoidance All kids avoid doing things they're asked to do from time to time. But some go to extremes to ignore or resist anything they perceive as a demand. That pattern of behavior is called pathological demand avoidance, or PDA. It is seen most often in people with autism. It has been found that some of the recommended strategies used with autistic children are not effective for a child with a PDA. People with a PDA are driven to avoid everyday demands and expectations to an extreme extent. This demand avoidance is often accompanied by high levels of anxiety.

The distinctive features of a demand avoidant profile include: - Resists and avoids the ordinary demands of life - Uses social strategies as part of avoidance, for example, distracting, giving excuses - Appears sociable but lacks some understanding - Experiences excessive mood swings and impulsivity - Appears comfortable in role play and pretense - Displays obsessive behavior that is often focused on other people.

People with this profile can appear excessively controlling and dominating, especially when they feel anxious. However, they can also be confident and engaging when they feel secure and in control. It’s important to acknowledge that these people have a hidden disability. People with a PDA profile are likely to need a lot of support. The earlier the recognition of PDA, the sooner appropriate support can be put in place.

A PDA profile is usually identified following a diagnostic assessment for autism. This is usually by a multi-disciplinary team made up of a combination of professionals, including: - Paediatricians - Clinical and educational psychologists - Psychiatrists - Speech and language therapists - Occupational therapists It’s important to understand that people with PDA are not deliberately choosing to oppose you – they are having difficulty adapting and overcoming their need to be in control of their environment. Having the right support may, therefore, mean that their trust and self-confidence grows, and with it their ability to cope more flexibly with the everyday demands of life.

Read more about PDA & Autism: https://www.autism.org.uk/advice-and.../topics/diagnosis/pda https://childmind.org/.../pathological-demand.../.... https://www.pdasociety.org.uk/what.../about-autism-and-pda/ ODD - Oppositional Defiant Disorder ODD is characterized by a pattern of hostile and defiant behavior directed toward adults. It is typically diagnosed during childhood, and some children are able to outgrow it as soon as 8 or 9 years old. It’s more common in boys than in girls, and also presents differently. While boys with ODD typically react with physical violence and intense outbursts, girls can be more indirect in their defiance, like lying and refusing directives from teachers or parents.

Symptoms of ODD in your child may include: - Consistent temper tantrums and losing their temper - Being easily annoyed by others and deliberately annoying them - Being uncooperative, openly defiant, and argumentative with adults - Deliberately engaging in mean, vindictive, and spiteful behavior - Blaming others for their behavior The behavior should last at least six months in order to get a proper diagnosis and must be disrupting life in one or more places, such as school, home, or work. If the child is younger than five, ODD symptoms should be present on most days for over 6 months, according to the DMS-5; if the child is older than five, the symptoms must be present at least once a week for six months.

Treatment of ODD involves learning skills to help build positive family interactions and to manage problem behaviors. Other therapy, and possibly medicines, may be needed to treat related mental health conditions.

Read more about ODD & Autism: https://www.stephstwogirls.co.uk/.../the-difference.... https://blog.theautismsite.greatergood.com/oppositional.../ https://www.mayoclinic.org/.../symptoms-causes/syc-20375831 If you suspect your child may have one of these disorders, please make an appointment with your pediatrician/primary caregiver to discuss strategies and any options to help and/or obtain a referral to a specialist/therapist.