health

Effective autism care requires attention to comorbidities, research indicates

Physicians can improve the health of youths with autism and related conditions by treating their associated problems.

By Christine S. Moyer — Posted Nov. 26, 2012

Print  |   Email  |   Respond  |   Reprints  |   Like Facebook  |   Share Twitter  |   Tweet Linkedin

Caring for youths with autism spectrum disorder can be overwhelming for some primary care physicians because of the multiple comorbid conditions that often accompany ASD, said Boston pediatrician James M. Perrin, MD. Such conditions commonly include constipation, insomnia and symptoms of attention-deficit/hyperactivity disorder.

But treating these associated health issues often helps children with ASD feel better and can improve their behavior and performance in school, said Dr. Perrin, a professor of pediatrics at Harvard Medical School in Boston and president-elect of the American Academy of Pediatrics. He also is editor of a special supplement on ASD that was published online Nov. 1 in Pediatrics.

The supplement, which features 18 articles, recommends behavioral therapy for treating insomnia, encourages looking for ADHD symptoms in children with autism and highlights the prevalence of supplement use among this population.

“Our hope is that this issue will help inform the health [professionals] and parents about the needs of children with autism and the evolving knowledge, practices and guidelines that can ultimately improve the quality of health care that children and their families receive,” said the editor’s note in the supplement.

Childhood autism diagnoses continue to rise in the United States. A study of 8-year-olds showed that one in 88 has some form of ASD. In 2006, the rate was one in 110, said the study, published in the March 30 issue of the Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report.

Common among this population is use of complementary and alternative medicine, or CAM, to ease symptoms of comorbid conditions, such as gastrointestinal problems, said a study of 3,413 youths age 2 to 18 with ASD that was in the Pediatrics supplement. CAM includes adhering to a gluten-free diet, avoiding processed sugars or receiving acupuncture.

To prevent negative interactions between CAM and prescribed drugs, physicians regularly should talk to families about whether a child is being treated with CAM, Dr. Perrin said.

Improving behavior issues

Some patients use alternative health practices to help control behavior problems, medical experts say. Those problems often are symptoms of ADHD that will improve with proper medical treatment, said a study of 3,066 youths ages 2 to 17 that was in the special supplement.

Researchers found that more than a third of children with autism and related conditions have some ADHD symptoms. Those symptoms are related to impairment in the person’s adaptive functioning and a poorer health-related quality of life.

The study encourages physicians to evaluate youths with autism for the presence of ADHD symptoms. If such symptoms are present, they should be treated, said lead study author Darryn M. Sikora, PhD.

“It’s not a good standard of care to assume that problems [in patients with ASD] are simply because of autism,” said Sikora, a pediatric psychologist at the Providence Child Center in Portland, Ore. “It’s important to look at other [potential health issues] and be mindful of the impact those problems could have.”

Addressing symptoms of ADHD “will make a positive difference” in the health of patients with autism and related conditions, she added.

So will treating insomnia in youths with ASD, according to two studies in the special supplement. Between 50% and 80% of children with ASD have trouble falling asleep or staying asleep, data show.

Insomnia is associated with an increase in problem behavior and emotional issues, including anxiety and emotional reactivity, said a study in the supplement of 1,193 youths 4 to 10 who have ASD and live in the U.S. and Canada.

A separate report in the same Pediatrics issue recommends that physicians screen all children with ASD for insomnia. For youths identified as having the condition, doctors should talk to parents about behavioral approaches to improve the problem, such as keeping a regular sleep schedule and offering positive reinforcement when the child displays appropriate sleep behaviors.

“Although medications and supplements are often used to treat insomnia experienced by children and adolescents with ASD, the evidence base for pharmacologic treatment is limited,” the report said.

Regardless of the treatment type, doctors should follow up with patients between two weeks and one month after starting therapy for sleep problems, said the review of 20 insomnia-related studies published between January 1995 and June 2010.

“We need to empower primary care physicians to know that they already have the skill set to work with children who have autism,” Sikora said. Doctors “can address these co-occurring behaviors head-on. It will make a positive difference.”

Back to top


External links

Special supplement on improving health care for children and youth with autism and other neurodevelopmental disorders, Pediatrics, November (link)

“Prevalence of autism spectrum disorders — autism and developmental disabilities monitoring network, 14 sites, United States, 2008,” Morbidity and Mortality Weekly Report, March 30 (link)

Back to top


ADVERTISEMENT

ADVERTISE HERE


Featured
Read story

Confronting bias against obese patients

Medical educators are starting to raise awareness about how weight-related stigma can impair patient-physician communication and the treatment of obesity. Read story


Read story

Goodbye

American Medical News is ceasing publication after 55 years of serving physicians by keeping them informed of their rapidly changing profession. Read story


Read story

Policing medical practice employees after work

Doctors can try to regulate staff actions outside the office, but they must watch what they try to stamp out and how they do it. Read story


Read story

Diabetes prevention: Set on a course for lifestyle change

The YMCA's evidence-based program is helping prediabetic patients eat right, get active and lose weight. Read story


Read story

Medicaid's muddled preventive care picture

The health system reform law promises no-cost coverage of a lengthy list of screenings and other prevention services, but some beneficiaries still might miss out. Read story


Read story

How to get tax breaks for your medical practice

Federal, state and local governments offer doctors incentives because practices are recognized as economic engines. But physicians must know how and where to find them. Read story


Read story

Advance pay ACOs: A down payment on Medicare's future

Accountable care organizations that pay doctors up-front bring practice improvements, but it's unclear yet if program actuaries will see a return on investment. Read story


Read story

Physician liability: Your team, your legal risk

When health care team members drop the ball, it's often doctors who end up in court. How can physicians improve such care and avoid risks? Read story