There are a plethora of physical problems that may accompany being an ASD patient. Sometimes referred to as ‘co-morbidities’, meaning “one or more disorders in addition to a primary one”, I prefer to think of the additional diagnoses as part of the autism spectrum itself. G-I problems, eczema, allergy, hyperactivity, apraxia, sensory disorders and behavioral conditions may each present as a single, separate pediatric medical condition. However, when such problems arise in ASD, I do not believe that they are separate at all. To effectively help ASD patients, diagnosis and treatment MUST include the whole picture. Or else, as many parents have experienced, their children go from one specialist to another, sometimes addressing the single problem, sometimes not even that. But NEVER – in my experience – addressing the autism itself.
ADHD encompasses a unique medical history and pathophysiology that is still the subject of much debate. Lectures and books offer various and sundry opinions, depending on the author’s background and point of view. Originally coined ‘hyperactivity’, the diagnosis has been expanded to include ‘impulsivity’ and ‘inattentiveness’ outside the range of normal for the child’s age.
In a similar manner, when the parent of an ASD patient describes their child’s (often disruptive) symptoms, depending on the practitioner, various theories and treatments are offered. Pediatricians tend to offer stimulant medications such as Ritalin or Adderall, neurologists may wish to focus on behavioral therapies, and psychiatrists sometimes suggest Abilify or Risperdal. There are several problems with such a variety of approaches.
Many times, I treat very young children who have been prescribed 2 or more stimulant and/or psychotropic medications. Often, I find that parents see only incremental or no improvement from complicated pharmacologic protocols. Worse, I encounter youngsters who suffer from many of the various medications’ side effects; such as tics, over- or under-eating, violent outbursts and sleep disturbances. Furthermore, what studies are available to assure parents that such medications are safe, especially long-term, and especially when they are prescribed in combination? “There are no studies to show…” is an oft-used phrase espoused by the conventional medical community to downplay the assistance offered by alternative and complementary practitioners. That doesn’t seem to apply when a doctor orders focalin, lithium and Prozac for a disorderly child. When a four, five, or six year-old child receives potent medications – what medications will be required by the age of nine, or twelve, or fifteen years and older?
Another approach is to insist that ABA is the only proven – and therefore necessary – therapy for the negative behaviors that are encountered in ASD patients. Such advice poses great difficulties for families who either 1) do not have private insurance or 2) their carrier does not cover this intervention. Sure, OT, PT, and/or S&L treatments have value, but they were never intended to address all of the behavioral problems that often accompany the ASD diagnosis.
Rather than merely declaring that the ADHD is “just another symptom of the autism”, patients who are ‘on the spectrum’ deserve an appropriate medical workup. Those suffering from impulsivity really need to have their gastrointestinal health evaluated. When kids “act like they have ants in their pants,” sometimes they actually have ants in their pants (that is, fungus, harmful bacteria, or parasites). When parents are concerned about constant activity, the medical workup needs to include thyroid and other metabolic studies (such as calcium, magnesium and vitamin D levels), in order to rule out treatable conditions. If the major problem is lack of focus, the professional should rule out sleep disturbances, dyslexia, problems with eyesight or an inappropriate educational setting.
Taking a detailed history and performing a thorough physical examination often provides clues as to why a child exhibits unusual behaviors. Then, even if ALL of the ADHD symptoms do not resolve with targeted interventions, there is enough abatement of extreme behaviors that, hopefully, less or even no medications are warranted in very young children. The traditional therapies that children receive also seem to work better when underlying medical problems are discovered and addressed.
Additionally, young children deserve to be evaluated by other professionals who might offer hearing therapy, RDI, neurofeedback, hippo therapy, and other valuable alternatives, which can be quite helpful. Over-the-counter remedies such as pycnogenol, tryptophan, magnesium or phosphatidylcholine can be useful by decreasing the anxiety that may exacerbate behaviors.
By taking such a holistic approach to the ASD patient with ADHD symptoms, the use of medication may be delayed, decreased, and even eliminated from the complicated course that families with autism must navigate.