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Resource Guide

Understanding autism co-occurring conditions: examples and resources

June 7th, 2024

AutismBC

For Everyone

An overwhelming majority of autistic people have some co-occurring health condition, according to our recent survey. Among the most common are anxiety, selective mutism, ADHD, sensory processing differences and more. 

Understanding the intersection of autism and co-occurring conditions is essential for providing comprehensive support and enhancing the quality of life for autistic people.

 It’s important to note that not all autistic individuals will have these co-occurring conditions, and the severity and combination of co-occurring conditions can vary widely among individuals. Therapies and support strategies should be tailored to each person’s specific needs. 

Selective or Situational Mutism  

Selective mutism is an anxiety disorder that is diagnosed when an individual consistently does not speak in some situations but speaks comfortably in other situations. It is most often diagnosed in childhood.  

Selective mutism traits 
  • Desire to speak that is held back by anxiety 
  • Fidgeting, eye contact avoidance, lack of movement or lack of expression when in feared situations 
  • Inability to speak in school, work and other specific social situations
  • Use of nonverbal communication to express needs
  • Anxiety and reluctance to interact with others
  • Speaking easily in certain situations (e.g., at home or with familiar people)
  • May speak only in a whisper or use noises to communicate  

What is selective mutism? | Jade’s Mental Health Story

How to Support:  

The best support for selective mutism is patience and understanding. Remember, they are not choosing to stay silent but are unable to speak due to anxiety.

Removing the pressure to speak and allowing communication on their terms will allow the individual to feel more comfortable. Giving adequate time to warm up to new environments and people is crucial for alleviating anxiety. An individual with SM may need to meet someone many times before they will communicate with them; in some cases, this will take years.

In classroom settings, a child may struggle to ask for help, use the washroom, or communicate a need. Visuals are useful for communication in a high-anxiety setting. Allowing a child to arrive early and settle into the classroom before other children arrive can help alleviate some anxiety.  

If a child cannot speak during class time, having them record themselves reading or spelling at home can be a useful tool. They can also tell the teacher their interests and dislikes through writing or video without the anxiety of speaking to them directly. Many forms of communication are not speech. Pecs and touch speech technology also work well.

 

The best support for selective mutism is patience and understanding.
Further resources: 

Anxiety Canada 

Parents of Children with Selective Mutism (Facebook) 

Selectivemutism.org 

Speech and Hearing BC 

Cornerstone Psychology (Lower Mainland SM specialists) 

Selective mutism and autism  

 

SPD (Sensory Processing Differences) 

Sensory processing differences are when people experiences sensory input differently. The way they feel exhaustion, hunger, lights and sound can be challenging and overwhelming. Some people may also experience temperature or pain differently. For example, they may not react as much as expected to the pain of a scraped knee or the discomfort of extreme cold or heat.  

 Like autism, SPD exists on a spectrum and may affect only one sense like hearing, or taste, or all of them (familydoctor.org, 2023). Some individuals with SPD are sensory sensitive, meaning they avoid sensory input due to discomfort, whereas some are sensory seeking and prefer strong pressure and stimulation. It is common that a sensory profile includes a combination of both sensory sensitive and sensory seeking needs. 

Sensory sensitive: 
  • Finds clothing feels too scratchy or itchy 
  • Sensitive to light 
  • Sensitive to sound
  • Uncomfortable with hair washing, brushing and other forms of touch  
  • Sensitive to food texture and smell 
  • Experiences balance and spatial awareness differently  
  • Uncomfortable with spinning or swinging  
  • Sensory meltdowns due to overstimulation  
Sensory seeking:
  • Enjoys frequent movement 
  • Loves jumping, heights, and spinning 
  • Can spin without getting dizzy 
  • May enjoy tight hugs, compression clothing and seek touch  
  • Enjoys chewing on none-food items 
  • Seek visual stimulation (like electronics) 
  • May need less sleep than expected 
  • Enjoys a variety of textures 

Ask an Autistic #9 — What is Sensory Processing Disorder? 

How to Support: 

Supporting a person with sensory differences can be done in a variety of ways. For the sensory seeker, crash pads, compression clothing and chewable necklaces can provide enjoyable sensory input. Providing deep pressure and massage can be very soothing. Fidget toys are widely available and are often welcome in the classroom and workplaces.

For sensory sensitive individuals, seam and tag-free clothing can be found online and in some retailers. Calming music or noise-canceling headphones can lessen noise discomfort, as can calming scents such as lavender for those sensitive to strong smells. This is often known as a sensory diet, an individualized plan of physical activities and supports to help a person meet their sensory needs. This plan provides the sensory input needed to stay focused and supported throughout the day.

A sensory diet can prevent sensory and emotional overload by meeting the nervous system’s sensory needs; however, it can also be used as a recovery technique (https://autismawarenesscentre.com/what-is-a-sensory-diet/, 2024). Understanding a person’s sensory profile and the activities which create calmness and regulation can help when a person feels overwhelmed. Keeping a regular schedule of sensory activities can support focus, attentiveness, and interaction. 

Below are links to further information on sensory diets and supports:  

Intro to sensory diets 

What is a sensory diet? 

Sensory Friendly Clothing in Canada 

Sensory Products for Adults 

ADHD (Attention Deficit Hyperactivity Disorder)  

More than half of all individuals who have been diagnosed as autistic also have traits of ADHD. In fact, ADHD is the most common coexisting condition of autistic people (chadd.org, 2023) 

Both ADHD and ASD are neurodevelopmental differences. They are differences in the brain’s executive functioning, which is responsible for decision-making, impulse control, time management, focus, and organization skills. For many people, this also includes differences in social and communication skills. 

Often, children with ADHD have challenges focusing on one activity or task. When they are engaged in their daily activities they may be easily distracted. It is challenging for children with ADHD to complete one task before jumping to another, and they are often physically unable to sit still. But some children with ADHD may be so interested in a topic or activity that they fixate on it, or hyperfocus.  

Although focusing on one thing can be positive, it may mean the individual may struggle with transitions from a preferred activity.   

ADHD present itself in distinct ways and varies greatly from person to person. Traditionally associated with hyperactivity, some may display impulsivity and restlessness. On the other hand, others may exhibit the inattentive subtype, characterized by differences in sustaining attention and organizing tasks. People with hyperactive ADHD may find themselves in constant motion, struggling with impulse control and a restless energy that can be disruptive to daily life. On the other hand, inattentive ADHD often leads to difficulties in maintaining focus, forgetfulness, and organizational challenges. 

Often, people with ADHD have challenges focusing on one activity or task. When they are engaged in their daily activities they may be easily distracted. It is challenging for some with ADHD to complete one task before jumping to another, and they are often physically unable to sit still. But some people with ADHD may be so interested in a topic or activity that they fixate on it, or hyperfocus. Although focusing on one thing can be positive, it may cause the person to struggle with transitions from a preferred activity.   

Many adults grapple with executive function challenges rooted in undiagnosed ADHD, affecting their ability to plan, organize, and execute tasks. Recognizing the diverse presentations and potential co-occurring conditions is crucial for accurate diagnosis and effective management of adult ADHD. The gender differences in presentation can further complicate diagnosis, as societal expectations may influence how symptoms are expressed and perceived. The misdiagnosis of ADHD as conditions like BPD, anxiety, or depression can delay appropriate supports hindering individuals from addressing the core challenges they face. The prevalence of executive function differences in undiagnosed adults with ADHD underscores the need for increased awareness and comprehensive assessment methods to ensure accurate identification and support for those navigating the complexities of adult ADHD. 

Fortunately, a range of supports are available for adults with ADHD. Psychoeducation is a key component, helping people understand their unique challenges and develop effective coping strategies. Cognitive-behavioral therapy (CBT) can be beneficial in addressing specific behaviors and thought patterns associated with ADHD, while coaching and organizational skills training assist in managing daily tasks. Medication may be prescribed by healthcare professionals to help regulate attention and impulse control. Additionally, support groups provide a valuable space for individuals to share experiences and strategies, fostering a sense of community. Workplace accommodations, such as flexible schedules or task modifications, can also contribute to a more conducive environment for individuals with ADHD. Tailored approaches that consider the individual’s strengths and challenges are essential for optimizing the support available. 

The landscape of social media is teeming with coaches and influencers who passionately highlight ADHD, autism, and the intersection of the two. From Instagram to YouTube, a diverse array of voices offers personal experiences, strategies, and advocacy for neurodivergence. Coaches specializing in ADHD often offer practical tips, time-management techniques, and emotional support, creating virtual communities where folks can connect and share their journeys. Similarly, influencers focusing on autism bring visibility to the unique strengths and challenges of the autistic community, fostering understanding and breaking down stereotypes. The power of social media in raising awareness and creating a supportive online environment is evident, with these coaches and influencers contributing significantly to a more inclusive and informed conversation about ADHD, autism, and neurodivergence. 

Could I Have ADHD And Autism?

How to Support  

If you want to be supportive of someone who has ADHD and is autistic, try providing:

  • Extra time on tests or written work  
  • Positive reinforcement and feedback 
  • Using technology to assist with tasks 
  • Allowing breaks or time to move around 
  • Changes to the environment to limit distraction 
  • Extra help with staying organized 
  • An established peer-review system to double-check detailed work 
  • Altered work hours to accommodate peak periods of focus and attention 
  • Written-out directions, instructions, and training materials for future reference 
  • Diagnosis with potential for medication 
  • Spoon Sharing 

Understanding Executive Function 

Cleaning Tips for Autistic Adults 

The ADHD Iceberg 

ADHD and Autism Relationship Accommodations — How to Get Your Needs Met

 

Obsessive Compulsive Disorder 

Obsessive-compulsive disorder (OCD) can affect anyone, but research suggests autistic people may be more likely to experience it. A Danish study conducted in 2014 reported, autistic people are “twice as likely to receive a diagnosis of OCD and people with OCD are four times as likely to also be autistic.” Although both OCD and autism have similar traits, they are different conditions. OCD is a mental health disorder, whereas autism is a neurological difference. People are born autistic, whereas OCD can develop during a person’s lifetime.

Traits of OCD may include:

  • Fear of germs or contamination 
  • Unwanted or intrusive thoughts  
  • Excessive cleaning or handwashing 
  • Ordering and arranging things in a particular way 
  • Repeatedly checking on things, such as whether the door is locked or whether the oven is off 
  • Compulsive counting 

Staff Sharing: OCD and Mental Health — Blog — AutismBC 

OCD and Its Connection to Autism  

OCD vs. Autism 

 

Developmental Coordination Disorder

Individuals with developmental coordination disorder (DCD) have differences in motor skill development, and may take longer to use utensils, get dressed or learn to ride a bike. Playing sports may be challenging, and they may be more prone to injury due to coordination difficulties.  

People with DCD may:

  • Show a lack of interest in, or avoid, physical activities. For a person with DCD, performing motor skills requires significant effort. Fatigue may cause the individual to avoid participating in motor tasks. 
  • Need more time to develop certain motor skills such as catching a ball, jumping rope, doing up buttons, and tying shoelaces
  • Require support with activities that require constant changes in their body position or when they must adapt to changes in the environment (e.g., baseball, tennis). 
  • Require support with balance and core strength  
  • Exhibit differences in speech, printing, or handwriting. 
  • Require support with academic subjects such as mathematics, spelling, or written language which require handwriting. 
  • Have differences with activities of daily living  (dressing, using a knife and fork, brushing teeth, doing up zippers, organizing a backpack and so on).   

 If you want to support someone with DCD, try providing:

  • Strategies or accommodations to assist with tasks at home, school, work or in the community 
  • Modifications to the individual’s environment to make daily activities more accessible 
  • Ways to promote physical activity and increase participation while lowering demands for competitive play 
  • Extra time for handwritten assignments
  • Extra time for daily living activities
  • The option to use speech-to-text or other augmented and and alternative communication devices
  • The option to provide spoken answers instead of written ones
  • Opportunities for low impact sports such as swimming, which can build muscle strength without causing significant fatigue 
Resources:

Five Things Parents Should Know About DCD  

Children with DCD  

Classroom Accommodations for DCD  

Kids Physio BC 

AutismBC Blog: What is Physiotherapy? 

Dyspraxia in Adults 

Resouces for DCD Adults 

 

Gastro-intestinal Issues

Many autistic people experience gastrointestinal symptoms at a higher rate than the general population. Research has indicated that autistic children are more likely to experience GI symptoms such as abdominal pain, constipation, diarrhea, and gastroesophageal reflux (GERD) than neurotypical children (https://pubmed.ncbi.nlm.nih.gov/28856868/, 2024).   

 Sensory differences may contribute to digestive issues, causing nausea and other upsets. Sensory seekers may crave spice and strong flavours, or sensory avoiders may eat a select number of foods only. In addition, difficulty with interoception could contribute to GI issues. Interoception is a lesser-known sense that helps you understand and feel what’s going on inside your body. Autistic people with differences in interoception may struggle to know when they feel hungry, full, hot, cold, or thirsty.  

 Common GI conditions in autistic people include: 

  • IBS 
  • Crohns 
  • Colitis 
  • GERD 
  • Acid Relfux 
  • Celiac 
  • Lactose intolerance 
  • Gastritis 
  • Esophagitis 

 It’s important to note that not all autistic people experience GI symptoms, and GI issues are not exclusive to autism. Additionally, while research suggests an association between GI symptoms and autism, the nature of this relationship is complex and requires further investigation. 

 If you or someone you know is experiencing GI symptoms, it’s essential to consult with healthcare professionals who are experienced in neuroaffirming care. They can provide personalized assessment, management, and support tailored to the individual’s specific needs. 

Mental Health 

 Autism and mental health are deeply intertwined, with overlapping traits. In a recent survey, we discovered the highest co-occurring conditions for autistic people are anxiety and depression.  

 If you or your loved one need mental health care, please visit our blogs for support and resources. 

 

I’m Autistic and in Mental Health Crisis. What Can I do? 

Neuroaffirming Mental Healthcare for Autistic Clients 

The Mental Health Literacy Guide for Autism 

Supporting Autistic Adults with Mental Health Challenges 

 

 This blog is not exhaustive. Is there a condition missing from this list you’d like us to add? Contact us. 

 

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