Autism is a neurodevelopmental disorder that affects communication, social interaction, and behavior. It is characterised by a wide range of symptoms and is considered to be a spectrum disorder, meaning that individuals with autism can experience varying degrees of impairment. Due to different presentation and masking many girls with Autism go undiagnosed.
Autism can be associated with a few or many conditions. We deal with Autism and conditions that span the ALPIMS domains (overlaps with those in ALPIM Syndrome).
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Anxiety and depression is common in Autism source: Harvard https://adult-autism.health.harvard.edu/resources/anxiety-and-depression
- Depression is four times more likely than for neurotypicals
- Anxiety impacts up to 70% – symptoms may present differently
- Orthostatic intolerance or POTS may be contributing to anxiety (see video by psychiatrist Dr Jessica Eccles).
- Anxiety can be worsened by fatigue and sensory overload both of which can contribute to meltdowns and shutdowns and irritability.
- Certain nutritional deficiencies can worsen anxiety and depression, but addressing with supplements and diet needs to done cautiously and wisely, and under the supervision of a medical professional, especially if the person is also dealing with allergy or intolerance.
- Autism has a complex relationship with medication, and poor tolerance and side effects to medications for anxiety and depression is common.
- Buspirone and mirtazapine in very small doses to start have been shown to help anxiety, with slow and steady dosing up to a typical amount. (Harvard Adult Autism)
- Psychological therapies can need to be modified for Autistic individuals (and also in the overlapping condition ME/CFS). If you also have ME/CFS you may be interested in the CBT recommendations in the NICE guidelines
- Modified Dialectal Behavioural Therapies may be beneficial for managing emotional distress and dysregulation
- May be localised e.g. hands, feet, or widespread like in hypermobile EDS and joint hypermobility syndrome.
- Increased prevalance in people with Autism
- Management requires help from a medical professional and physical therapist
- Increases the risk of developing pain syndromes, and bladder and digestive problems including IC/PBS, IBS and GERD
- Risk of nutritional deficiencies is increased in EDS
- MCAS/Dysautonomia is over represented in people with hypermobility and may be contributing to other symptoms they may be experiencing in some people (overlaps with ME/CFS and fibromyalgia and POTS, also histamine and food intolerance)
Abdominal pain can be a frequent concern across a persons lifespan https://adult-autism.health.harvard.edu/resources/abdominal-pain/
- Communicating Pain can be difficult for some people with Autism
- Girls tend to have higher sensitivity to pain than boys
- Neuroscience News on People with Autism Experience Pain at a Higher Intensity
- Recent research on autism and pain in adults
New research replicates previous findings to show that autistic people have higher rates of all central sensitivity syndromes1, which are a varied group of conditions that are related to dysregulation of the central nervous system, compared to non-autistic people. Central sensitivity syndromes include irritable bowel syndrome (IBS), temporomandibular joint syndrome (TMJ), migraine, tinnitus, myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), and fibromyalgia2. (Source: University of Cambridge3)
Video Source: Complex Chronic Disease Program
For ME/CFS refer to NICE ME/CFS guidelines. Parents of children with ME/CFS can require Safeguarding. Due to poor understanding of the condition (including by many health and mental health professionals), parents are at increased risk of being wrongly accussed of child abuse, and symptoms can be put to trauma due to Childhood ACES contributing to a lower window of tolerance (WOT) and psychological symptoms.
There many kinds of headaches, and migraine headaches are much more common among autistic adults (42%) than the general population (10%).
As with the general population, females are three times more likely than males to experience migraines, so autistic females are especially prone to these types of headaches.
Learn more https://adult-autism.health.harvard.edu/resources/migraine-headaches/
When migraines occur more than 15 days a week it is a form of chronic daily headache. This is common in people who also experience visual snow, epileptic seizures, or functional non epileptic seizures (FNES) and other functional neurological symptoms.
Both seizures and migraine can be linked to hyperosmia (smell hyper-reactivitity).
It is important for individuals with autism who experience chronic daily headaches or seizures to seek medical care to rule out any underlying serious conditions and receive appropriate treatment.
Source: https://adult-autism.health.harvard.edu/resources/sleep-problems/
Sleep problems are common in autistic people. As many as 50-80% experience some kind of sleep difficulty as compared to 25-30% of neurotypical people. Sleep issues vary widely and include:
- Difficulty falling asleep
- Interrupted sleep
- Early waking
- Needing very little sleep
When sleep problems arise in the adult years, there could be a variety of explanations, including environmental factors, changes in family or living arrangements, transitions to new day programs or employment, or environmental factors such a seasonal allergies or other air quality issues. Sleep problems can also be caused or exacerbated by underlying medical conditions such as:
- Sleep apnea
- GERD or acid reflux
- Constipation
- Seizures
- Erupting wisdom teeth
- Restless legs syndrome
Psychological factors and emotional distress can also contribute to sleep problems. Anxiety, depression, stress, or trauma are just a few of the factors that can create or exacerbate sleep problems. Some types of medications, such as stimulants, beta blockers, corticosteroids, and decongestants can also affect the quality and duration of nighttime sleep.
Lifestyle changes can help
Six simple things to do to improve sleep:
- Increase the amount of exercise during the day, such as walking and swimming
- Minimize alcohol and caffeine intake
- Limit screen use at night when possible
- If heartburn or acid reflux are suspected, prop up the head of the bed or use extra pillows to avoid laying completely flat on the bed
- Keep the bedroom cool and as dark as possible
- Consider a weighted blanket to help calm nerves and give calming sensory input
Seeking care
When simple interventions don’t help, make an appointment with a PCP. A wearable device such as a smart watch or using a phone app that tracks sleep quality and waking patterns can provide useful feedback. Based on symptoms, history, and assessment, a referral to a neurologist or mental health clinician may be recommended. If symptoms include snoring or disrupted breathing, a sleep study to rule out sleep apnea or narcolepsy can often be done at home. If an overnight sleep study is required, there are accommodations than can make these studies less stressful. The Vanderbilt Kennedy Center has a guide for helping children with sleep study protocol that is also useful for adults.
Resources for sleep issues
Learn more about sleep and autism, and the impact of sleep patterns on other conditions common in older adults:
- Spectrum News discusses the latest sleep research in Cracking Sleep’s Conundrum
- Harvard Health Publishing on Sleep Problems and Risk of Stroke
- Harvard Health Publishing on sleep problems and the increased risk of cardiovascular disease
- Healthy Sleep Tips from the Harvard Division of Sleep Medicine
- Sleep Strategies for Teens with Autism Spectrum Disorder from the Vanderbilt Kennedy Center and Autism Speaks
The information is provided for general information only. It does not constitute health advice and should not be used to diagnose or treat any health condition. This information has been put together by laypeople, completeness and accuracy can not be guaranteed.
Please consult with your doctor or other health professional to make sure this information is right for you or your child.