There is a popular and common saying within the autism community that “when you’ve met one person with autism, you’ve met one person with autism.” It becomes clear that this is true when one considers the variety of conditions which occur comorbidly with ASD. Being on the autism spectrum is only one characteristic of an individual, who may suffer from other unrelated conditions and face challenges and deficits not included in the diagnostic criteria for ASD. Some of these may have no connection to autism; there is no law against winning more than one genetic lottery – in fact, it happens all the time within the typical population as well. Others may be related, but not technically be part of the syndrome or fall under any of its diagnostic criteria. Still others can occur in connection with, or as a result of, living on the autism spectrum in the context of a typical world. We will consider a few examples and cases of all these categories, as well as some that have affected me personally.
Common Comorbid Traits That Are Not Part of ASD
One common deficit of many an autistic is poor physical coordination, to the extent that it has become a stereotype. There is nevertheless something to this one, because many of us have always been poor at sports and other physical activities. When I first attended a support group shortly after my diagnosis over 20 years ago, many members told stories about how bad they were at sports, and there was much commiseration among the group. More significantly, learning to drive a car poses a significant challenge to many autistics (including myself, and an alarmingly high number are never able to do so). Although none of the diagnostic criteria for ASD involve physical coordination or any aspect thereof, these deficits are common enough that there clearly must be some connection. A few researchers have suggested that diminished size or development of the cerebellum may provide a possible explanation.
Among those autistics who are athletic, they are much more likely to excel in an individual sport than in team sports. This should not come as a surprise, since the latter require coordination with other players in addition to having good coordination oneself. Even then, I have known at least one autistic in my local community who is a successful Special Olympian in various team sports. As for myself, I was always so bad that I had to be excused from physical education classes in later grades. Not to mention, learning to drive was also difficult for me. This is just one of many mysteries to which my autism diagnosis finally provided an explanation.
Another frequent problem that many autistics face involves gastrointestinal issues. Much has been said and written about this, and autism researchers have been looking into so called “brain-gut connections” in their attempts to explain it. Still, however, it once again does not appear in any diagnostic criteria for ASD, and the connection largely remains unknown. I learned that this is a common issue among autistics and have even lived with it for much of my life; in fact, I suffered chronic GI pains at the age of six for which I was given an extensive battery of tests that did not lead to any conclusive results (yet another mystery explained by my ASD diagnosis). I did not fully appreciate how common this is in the autism community, however, until it came up at a support meeting that I was facilitating, when I asked the group members if they experienced GI problems. To my amazement, at least three-fourths of the people in attendance raised their hands! Once again, there must be a connection between this and the autism spectrum.
Conditions That Are Often Comorbid with ASD
There are many other conditions, largely neurodivergent and psychiatric, that often occur concurrently with ASD. Although I have no background whatsoever in neuroscience or mental health, I have both learned about and personally encountered numerous cases of such during my involvement with the autism community, particularly while attending and facilitating adult support groups.
Among the most common are conditions such as ADHD (which itself was often a misdiagnosis for ASD), OCD (which can appear similar to the repetitive behaviors of ASD), and various others. This does not surprise me, because all these conditions are neurologically based. There is so much that has yet to be learned about the brain, its functions, and its disorders that it is easy to see how different conditions can overlap or be related, depending upon the structures or processes in the brain that might be involved.
Also common are learning disabilities and deficits such as dyslexia and dyscalculia. Ironically, both go against common autistic stereotypes. Dyslexia, for instance, flies in the face of the precocious and hyperlexic reader with an encyclopedic memory for facts in specialized areas of interest, whereas dyscalculia constitutes the exact opposite of an autistic persona who has a phenomenal ability with numbers and even great mathematical talent. Intellectual disability, of course, is also often comorbid with ASD. What all of these have in common is that they are considered developmental disabilities, as is ASD itself. Once again, it is easy to see how there might be some connection.
Psychiatric illnesses can also be comorbid with ASD. In my own community, I have known individuals on the autism spectrum who also suffered from bipolar disorder. I have also met those with psychotic or schizophrenic disorders. As far as anyone can tell, these conditions are separate and distinct from their ASD. Yet again, however, I must emphasize that these are strictly my own personal impressions based on limited knowledge and experience as a layperson. Thankfully, however, much research is taking place in all these areas, and we will hopefully learn more about the connections between these conditions and ASD in the not-so-distant future.
Conditions That Are the Result of Living with Autism
Some common psychiatric conditions are clearly the direct (or at least indirect) result of living with ASD and the many social, daily living, and other challenges that it creates for the individual. Challenges with daily living and deficits in basic life skills, for instance, can create tremendous anxiety for a person on the autism spectrum, and various anxiety disorders are known to be quite common in the autism community. Similarly, difficulties with socialization, making friends, finding romantic partners, and having a good relationship with others in the workplace or community can cause significant depression; once again, this is quite common in the autism community, as are the social anxiety disorders that can also result from this. Probably the most extreme condition, however, is post-traumatic stress disorder (PTSD) in autistics who have been the victims of long-term and persistent bullying or other social marginalization; this has been documented in some cases. Despite my lack of mental health background, it is easy for me, as a person on the autism spectrum, to see how these conditions can easily develop.
Unlike other comorbid conditions, those in this category have the advantage that they can be readily eliminated by addressing their root causes before they result in more severe consequences. Deficits in social skills and daily living skills, for example, can readily be identified and subsequently addressed. Also, therapeutic techniques for dealing with resulting conditions can be made more effective by recognizing the underlying causes during treatment, while simultaneously dealing with these causes to whatever extent is possible. Conditions resulting from societal factors, such as bullying, will require changes in our communities and in society, which will not be as simple to accomplish. Nevertheless, every effort must be made to address these issues for such comorbid conditions to be finally eliminated.
Eating Disorders Comorbid with Autism
I will conclude by discussing a condition often comorbid with autism that has affected me personally, namely eating disorders. I have had severe selective eating issues which developed at the age of 2 ½ years, at which time other classic autistic traits (e.g., lining up my toys in a row) also manifested themselves – this is how I know that they are related to autism.
What distinguishes the food issues common in autistics with more familiar eating disorders like anorexia and bulimia is that, whereas the latter are typically caused by concerns related to body image, autistic issues are more likely to involve a relationship with the food itself, which presents sensory stimuli such as taste and texture. In such cases, it can be regarded as a sensory issue comparable to the auditory and visual sensitivities that are so well-known in autistics. Still, this often results in poor eating habits that can in turn lead to obesity – yet another comorbid condition not uncommon among autistics.
I have lived with this condition my entire life and was known as an extreme “picky eater” throughout my childhood. As an adult, I often tell people that I have the eating habits of a 12-year-old, and to this day prefer the kinds of food that are typically found on a “children’s menu.” Many years ago, I was referred to by someone as “anorexic” because I was very thin at the time (I have since put on a few pounds!). In fact, the conditions that I have been living with are known as food neophobia and food aversion (again caused by my reaction to sensory stimuli).
I began to appreciate how much of an issue this was for autistics because, whenever I mentioned that I suffered from it on adult panels at conferences and workshops, someone would always approach me afterwards to discuss it because they had a child on the spectrum with exactly the same problem. A few years ago, I attended a specialized workshop about this at an autism conference. Luckily, I arrived early for the session because, after a short while, the room filled to capacity and was standing room only. I have also learned, whenever the issue is discussed, that even as everyone has their individual food preferences, the same kinds of foods repeatedly appear when different cases are presented; I jokingly refer to these as the “basic autistic food groups!”
Although there are numerous reasons for the individual differences that exist among autistics, the wide variety of comorbid conditions that they live with constitute a significant part of the diversity within our community.
Karl Wittig, PE, is Advisory Board Chair for Aspies for Social Success (AFSS). Karl may be contacted at email@example.com.