1. Research Data Repository 3. Environmental Risk Factors 5. Behavioural Research 6. Autism Research...
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1. Research Data Repository 3. Environment al Risk Factors 5. Behavioural Research 6. Autism Research across the Lifespan 2. Genetic and Stem Cell Research 7. Policy Change 4. Neuroimagin g Research
1. Research Data Repository 3. Environmental Risk Factors 5. Behavioural Research 6. Autism Research across the Lifespan 2. Genetic and Stem Cell Research
1. Research Data Repository 3. Environmental Risk Factors 5.
Behavioural Research 6. Autism Research across the Lifespan 2.
Genetic and Stem Cell Research 7. Policy Change 4. Neuroimaging
Research
Slide 2
Dr. Geraldine Leader & Ms Arlene Mannion Irish Centre for
Autism and Neurodevelopmental Research National University of
Ireland, Galway
Slide 3
What is Comorbidity? Comorbidity is defined as the
co-occurrence of two or more disorders in the same person (Matson
& Nebel- Schwalm, 2007). A comorbid condition is a second order
diagnosis which offers core symptoms that differ from the first
disorder.
Slide 4
Why is it important to study comorbidity in ASD? Comorbidity in
ASD is a topic that has been infrequently addressed and requires
more research. Important that one disorder is diagnosed as the
primary disorder and the other(s) as secondary. Design and
implementation of effective treatment plans.
Slide 5
Why is it important to study comorbidity in ASD? Comorbid
conditions result in a more complex diagnostic treatment picture.
Comorbidity can make the overall problems more severe and treatment
resistant.
Slide 6
Why is it important to study comorbidity in ASD? There are
considerable differences in symptoms of ASD. What are the core
symptoms of ASD? How are those symptoms different to symptoms of
comorbid disorders?
Slide 7
Mannion, Leader & Healy (2012) An investigation of comorbid
psychological disorders, sleep problems, gastrointestinal symptoms
and epilepsy in children and adolescents with autism spectrum
disorder. Participants were 89 children and adolescents with a
diagnosis of ASD. The mean age of the sample was 9 years, ranging
from 3 to 16 years. 83% (n = 74) were males and 17% (n = 15) were
female.
What are Gastrointestinal Symptoms? Gastrointestinal (GI)
symptoms include: Nausea Bloating Abdominal pain Constipation and
Diarrhoea
Slide 11
Why is it important to study GI symptoms? They can cause pain
and discomfort to individuals with ASD. Can have an effect on
challenging behaviour. Can interfere with learning.
Slide 12
Why are GI symptoms difficult to diagnose in ASD? Many
individuals with ASD are non verbal and cannot express pain or
discomfort through speech. Cannot communicate symptoms as clearly
as their typically developing peers. Those who can verbally
communicate may have difficulty describing subjective experiences
or symptoms.
Slide 13
Why are GI symptoms difficult to diagnose in ASD? Insistence on
sameness can lead individuals to demand stereotyped diets, that may
result in inadequate intake of fibre, fluids and other foods, which
can cause gastrointestinal symptoms. If medication is administered,
it can influence gut function.
Slide 14
Prevalence of GI symptoms The prevalence of gastrointestinal
abnormalities in individuals with ASD is incompletely understood.
The reported prevalence in children with ASD has ranged from 9 to
84%. It is an area that is in need of future research.
Slide 15
Mannion, Leader & Healy (2013) Used the Gastrointestinal
Symptom Inventory (Autism Treatment Network, 2005). Measured
nausea, abdominal pain, bloating, constipation and diarrhoea. 79.3%
of children/adolescents had at least 1 GI symptom. 23% had 2
symptoms. 13.8% had 3 symptoms. 14.9% had 4 symptoms. 6.9% had all
5 GI symptoms.
Slide 16
Mannion, Leader & Healy (2013) Of those with GI issues,
most common symptoms were: Abdominal pain (51.7%) Constipation
(49.4%) Diarrhoea (45.9%) Nausea (29.9%) Bloating (25.3%)
Slide 17
We identified a link between gastrointestinal symptoms problem
behaviour. An emerging literature suggests that individuals with
ASD and GI symptoms may be at higher risk for problem behaviours
than those with ASD who do not have GI symptoms. We also found a
link between gastrointestinal symptoms and sleep problems.
Slide 18
Slide 19
What are sleep problems? Insomnia Parasomnias Sleep related
breathing disorders (e.g. Obstructive Sleep Apnea, OSA) Circadian
rhythm sleep disorders
Slide 20
Why is it important to study sleep problems in autism? Sleep
disturbance is one of the most common concerns voiced by parents of
children with autism. Sleep affects not only children, but
families. Sleep problems are especially important comorbidities to
identify in children with ASD. The sleep community has identified
autism as a priority population for targeting interventions for
sleep disorders.
Slide 21
Why is it important to study sleep problems in autism? Poor
sleep impacts on the individuals health, and daily functioning, as
well as the family unit. Sleep disorders are highly treatable.
However, evidence-based standards of care for the surveillance,
evaluation and treatment of sleep disturbance in the ASD population
are greatly needed.
Slide 22
Mannion, Leader & Healy (2012) Used the Childrens Sleep
Habits Questionnaire (CSHQ) (Owens, Nobile, McGuinn & Spirito,
2000). CSHQ is a parental report sleep screening instrument. It is
not intended to diagnose specific sleep disorders, but rather to
identify sleep problems and the possible need for further
evaluation.
Slide 23
Mannion, Leader & Healy (2012) Score of 41 is clinical
cut-off for identification of probable sleep problems. Subscales:
Bedtime resistance Sleep onset delay Sleep duration Sleep anxiety
Night wakings Parasomnias Sleep disordered breathing Daytime
Sleepiness.
Slide 24
Mannion, Leader & Healy (2013) 80.9% of children presented
with a sleep problem (Score of 41 or over on the CSHQ). Study also
examined the predictors of sleep problems. Investigated whether
age, gender, comorbid disorders (including intellectual
disability), Autism Spectrum Disorder-Comorbid for Children
(ASD-CC) score or gastrointestinal symptoms predicted sleep
problems.
Slide 25
Mannion, Leader & Healy Avoidant behaviour (ASD-CC
subscale), Under-eating (ASD-CC subscale) and total GI symptoms
predicted sleep problems. Specifically, abdominal pain predicted
sleep anxiety. Future research needs to examine the link between
sleep problems and gastrointestinal symptoms.
Slide 26
Treatment of Sleep Problems Behavioural interventions-1 st
approach Visual Schedules for bedtime routines Reinforcement:
Stickers, Tokens, Basket of presents. Bedtime Pass-A token system
for minimizing bedtime resistance and night wakings.
Slide 27
Autism Treatment Network (ATN) Sleep Tool-kit Informational
booklet designed to provide parents with strategies to improve
sleep in their children affected by autism spectrum disorders.
Suggestions based on both research and clinical experience of sleep
experts. Can be downloaded for free. www.autismspeaks.org
Slide 28
In summary: 79.3% of children had at least one gastrointestinal
symptom within the last 3 months. 80.9% had sleep problems. 67.8%
of children had both gastrointestinal symptoms and sleep
problems.
Slide 29
In summary: We found a link between gastrointestinal symptoms
and behaviour problems. We found a link between gastrointestinal
symptoms and sleep problems..
Slide 30
Take Home Messages: It is important to diagnose comorbid
disorders in order to provide the best possible treatment for a
child with autism. It is essential that we distinguish between the
symptoms of autism and the symptoms of comorbid disorders.
Communication impairments in autism may lead to unusual
presentations of gastrointestinal symptoms, including sleep
disturbances and challenging behaviour. Sleep problems are highly
treatable.
Slide 31
Take Home Messages: We need parents to get involved in
research, even if their children are not presenting with comorbid
symptoms. By comparing children with autism with and without
comorbid symptoms, we can understand a lot more about comorbidity.
When we understand comorbidity better, we can then focus on
establishing the most effective treatment for children with
autism.
Slide 32
1. Research Data Repository 3. Environmental Risk Factors 5.
Behavioural Research 6. Autism Research across the Lifespan 2.
Genetic and Stem Cell Research 7. Policy Change 4. Neuroimaging
Research