Understanding Common Medical Issues Associated with Autism
LEARNING
OBJECTIVES
OUR TOPICS TODAY :
Exploring Metabolic and Heart Health in Autism
Managing Epilepsy and Autism
Understanding Gut Health and Autism
Exploring Sleep in Autism
Understanding Genetic Connections in Autism
55% more risk of developing diabetes (both type 1 and type 2)
70% risk of having elevated cholesterol
45% more risk of developing cardiovascular diseases over their lifespan
High blood pressure associated with autism in childhood; with a risk reaching up to 2x
METABOLIC HEALTH IN AUTISM
Autistic People Have:
SCREENING & DIAGNOSIS
Given the higher rates of obesity and the metabolic issues in autism, regular screening should be done at your child’s regular check-ups.
Measuring your child’s vital signs; i.e. heart rate, blood pressure
Measuring your child’s weight and height to calculate their body-mass index (BMI)
Taking your child’s measurements; with special focus on waist circumference to detect abdominal obesityl
Doing routine laboratory tests such as their blood glucose levels, cholesterol, and triglyceride levels
CAUSES
Medication
These include the side effects occurring due to drugs commonly used in managing different symptoms occurring with autism
These drugs can increase appetite in up to one-third of autistic children, with a known link to weight gain, higher cholesterol, higher blood sugar
CAUSES
Sleep Abnormalities
Inadequate sleep in autism has been linked to weight gain
Sleep deprivation directly alters the brain receptors related to hunger and fullness, also ncreases stress hormones which cause subsequent weight gain.
Food Selectivity
Autistic people can be picky eaters. They often avoid certain colors, textures, or smells due to sensory concerns.
Being food-selective can cause autistic people to have issues with balanced nutritional intake. They could be in love with carbohydrates; yet avoid proteins…etc.
CAUSES
ARFID
Also known as avoidant/restrictive food intake disorder
Autistic people are at increased risk of eating disorder, known as ARFID. They often avoid certain colors, textures, or smells due to sensory concerns.
Being food-selective can cause autistic people to have issues with balanced nutritional intake. They could be in love with carbohydrates; yet avert proteins…etc.
CAUSES
Autistic people are at increased risk of eating disorder, known as ARFID. They often avoid certain colors, textures, or smells due to sensory concerns.
Being food-selective can cause autistic people to have issues with balanced nutritional intake. They could be in love with carbohydrates; yet avert proteins…etc.
CAUSES
ARFID
Some Autistic individuals may have impaired motor functions, such as: Low muscle tone, clumsiness, and delayed childhood milestones.
There is often a lack of initiation in starting activities outside the house, due to social anxiety.
This may cause them to unintentionally have lower amount of physical activity compared to their typically-developing peers.
DAILY MOVEMENT
If on medications- make sure doctor is monitoring for metabolic side effects and has a plan in place if they arise.
Consider referral to autism and intuitive eating focused dietician, many insurances will cover this.
Proactively plan physical activities your child likes, walking, swimming, hiking, karate.
MANAGEMENT
Physical therapy referrals, adaptive personal training, can also help for strength training to build muscle and speed up metabolism
Manage co-occuring conditions, like sleep problems, gut health problems, manage stress and treat mental health issues
Make sure your child is getting regular labs and blood pressure screening, height weight, BMI measurements.
MANAGEMENT
Good sleep is essential for everyone – but is often hard to define. One way to look at it is through something called sleep efficiency.
Sleep efficiency is the time spent asleep while in bed. It is calculated by dividing the amount of time spent asleep, by the total time spent in bed.
Quality sleep involves getting enough deep stages of sleep, so that your body can effectively recover from the day and reset itself for the next one.
SLEEP HEALTH IN AUTISM
This isn't just a quality of life matter, but in fact it is crucial to one’s overall physical and mental health.
Sleep serves as our body's natural housekeeper, flushing out toxins from the brain areas that have accumulated debris during the day.
Our brains clear out leftover cell waste during sleep, allowing for cell repair and limiting inflammation. But more than that, many digestive processes happen during sleep.
WHY IS SLEEP IMPORTANT IN AUTISM?
Disrupted sleep can precipitate problems including seizures, hyperactivity, depression, anxiety, school problems, cognitive decline, as well as family problems.
A lack of regular deep sleep leads to poor concentration, an inability to process information correctly, impulsive behavior and social challenges
Not getting enough sleep can also have serious consequences on heart health, including increased risk of high blood pressure, high cholesterol levels, higher blood sugar
WHY IS SLEEP IMPORTANT IN AUTISM?
Brain Based Causes:
Abnormal brain development and maturation: On studying the sleep pattern of autistic children, a sleep brain wave pattern replicating that seen in infants was observed.
Abnormal circadian rhythm: A circadian rhythm is the internal body clock controlled by different brain hormones and chemical substances produced by our bodies.
CAUSES OF SLEEP
DISTURBANCE IN AUTISM
Sleep problems in autism can be from non medical causes as well.
Behavioral/Extrinsic Causes: Behavioral insomnias are the most common cause of insomnia in autistic and non-autistic children.
This cause depends on the autistic person’s dependence on a certain form
environment, person, or object in order to fall asleep.
CAUSES OF SLEEP
DISTURBANCE IN AUTISM
CO-OCCURRING MEDICAL PROBLEMS
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Gastrointestinal problems Sleep apnea and breathing problems Allergies Anemia Epilepsy Psychiatric conditions including depression and anxiety: which might cause overthinking
and prevent them from sleeping
Medications that can negatively affect sleep as a side effect
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CAUSES OF SLEEP
DISTURBANCE IN AUTISM
Sleep Assessment Tools
Polysomnography, aka Sleep Study: This method has been the gold standard for diagnosing sleep pattern abnormalities for the longest time.
Uses different tools to monitor brain electrical waves, muscle movements, eye movement, heart rhythm (EKG), and breathing patterns
It usually is being carried out in a specialized sleep center
There are also at home sleep tests,
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DIAGNOSING SLEEP
DISORDERS IN AUTISM
Objective Sleep Assessment Tools
Actigraphy
≫Actigraph is a watch-like device (fit bit) that detects different sleeping stages using limb movement
assessment
≫This software determines: Total time of sleep, sleeping time, awakening time, frequency of night-time
awakening, and sleep efficiency
≫Must use the device for five to seven days before analyzing the results to adequately get results
DIAGNOSING SLEEP
DISORDERS IN AUTISM
Subjective Sleep Assessment Tools
Sleep Questionnaires: There are numerous questionnaires you can fill out on behalf of your child to help you and your doctor figure out cause of sleep issues.
The most widely-used questionnaire is the Children’s Sleep Habit Questionnaire (CSHQ). A higher score in this questionnaire indicates a worse sleeping pattern. We have a link below of a sleep questionnaire.
DIAGNOSING SLEEP
DISORDERS IN AUTISM
Cognitive Behavioral Therapy for Insomnia
Has shown benefits to improve child and parent sleep, child behavior and arousal, and parent fatigue.
≫Improving Sleep Environment ≫Sleep Hygiene: ≫Faded Bedtime: ≫ Reinforcing: ≫Chronotherapy: ≫Stimulus Fading:
There are even phone applications, or digital CBT-I (dCBT-i), that have been validated by multiple clinical
trials. Some of the commonly-available platforms include: Sleepio, Shuti, Sleeprate, and CBT-I Coach.
TREATMENT OF SLEEP
DISORDERS IN AUTISM
It is heavily influenced by environment, stress, diet, medical conditions and genetics
Diet: The microbiome is a collection of microorganisms responsible for a normal gastrointestinal functioning.
The microbiome has its own biological and circadian rhythm, its own DNA, and secretes its own chemicals and hormones that are responsible for many bodily functions
GUT HEALTH:
LET’S START WITH MICROBIOME
HOW COMMON IS IT?
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Gastrointestinal problems are present in a high percentage of autistic children
Autistic children are four times more likely to have gastrointestinal complaints, compared to their non-autistic counterparts
COMMON GI SYMPTOMS in Autism
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Increased intestinal gases or flatulence (60%) Bloating (40%) Diarrhea (30%) Burping (25%) heartburn (15%) Constipation (10%) Abdominal pain (35%)
Functional abdominal pain
Due to hypersensitivity to pain
sensation
Due to abnormal gut-brain axis
EFFECT OF CHRONIC GI SYMPTOMS ON MENTAL HEALTH
Prolonged gastrointestinal disturbance has been linked to:
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More challenging behavior: Particularly seen with abdominal pain and constipation Higher irritability and tantrums: Particularly seen with persistent diarrhea More withdrawal and depression: particularly seen with persistent nausea Higher hyperactivity Higher sensory over-responsivity
DIETARY INTERVENTIONS
Dietary Intervention
There is no diet specific for improving GI symptoms in autism; many have been studied
The goal is to have a diet that keeps your child fed, and supports healthy microbiome, gets in
sufficient macronutrients ( protein, carbs, fats)
Limit ultra=processed food when able.
IT IS RECOMMENDED TO CONSULT A SPECIALIZED DIETICIAN AND DOCTOR PRIOR TO MAKING ANY LARGE DIETARY PATTERN CHANGES
TREATMENT for constipation
Pelvic Floor Exercises
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This includes exercises to train and support the muscles that support the rectum and bowel control A pelvic floor physical therapist can assess your child for any pelvic floor issues and create a plan An occupational therapist can also assess for stool holding, bathroom behaviors and help create a treatment plan
Toilet stools such as TUSHY can be helpful
TREATMENT
Gut Microbiome Support
Gentle, yet effective tummy soothing herbs include Fennel, Peppermint (good for constipation and nausea) not good for GERD
Ginger and Chamomile, lemon balm soothing for digestive system.
Probiotics are controversial, with quality among brands ranging, and some studies showing benefit
and others showing no effect
ARRAE and ATRANTIL have been positive in my experience!
MEDICATION TREATMENTS
Nausea: zofran, phenergan, mirtazapine, metoclopramide
Abdominal Pain:
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Peppermint Oil
Antidepressants/Anti-Anxiety medications: May improve
symptoms of nausea, GI distress in resistant cases
Acid Reflux and heartburn:
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Dietary habit modifications (Decreasing fatty food)
Pepcid Increases gut emptying
proton pump inhibitors (ex. omeprazole)- goal to use these
short term, a few months Max and then try to taper if possible
TREATMENT continued
AVOID SENNA, STIMULATING LAXATIVES DAILY
Constipation:
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Dietary modification: increasing fiber and fluid intake
Exogenous fiber supplements (ex. psyllium, metamucil)
Laxatives: These are drugs that increase water content within the bowel, therefore softening the stool
and relieving constipation. They include
Diarrhea:
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Infection: see a GI doctor
Food Allergy Testing
SIBO (Small Intestinal Bacterial Overgrowth): Consider a SIBO specialist dietician, and/or GI doctor, who
can help customize a dietary intervention, and needed medications or probiotics to regulate gut bacteria
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Polyethylene glycol (ex. Miralax) Docusate (ex. Colace) Linaclotide (ex. Linzess)
SEIZURES IN AUTISM
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Seizures are present in at least 20 to 30% of persons with autism
Persons with co-existing intellectual disability are more likely to develop seizures, with or without autism.
Seizures usually occur in autistic people after the age of 10, with a peak in puberty
Does Autism Cause Epilepsy?
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The risk of epilepsy also increases in autism in the presence of intellectual deficits
People with autism often have abnormal electroencephalogram (EEG) signaling; as commonly seen with epilepsy, even if they have never experienced an actual seizure
There are numerous types of seizures, yet these are the most common types you might see:
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Generalized tonic-clonic seizure:
Focal tonic seizures:
Focal clonic seizures:
This is the most common type.
This includes sudden stiffening on one limb or the neck
This includes sustained rhythmic jerking on one group of muscles, could
look like chewing, lip smacking, repetitive blinking.
Absence seizures: A commonly underdiagnosed type characterized by sudden interruption of the
child’s activities, and loss of response to external stimuli. It is commonly accompanied by a blank
staring episode; with subsequent rapid recovery of consciousness.
TYPES OF SEIZURES
IMPORTANT PRECAUTIONS IN EPILEPTIC PEOPLE WITH AUTISM
Seizures in Autism and Water Safety
General precautions during water activities include:
Swimming be under close supervision by an adult who knows how to swim It should be in clear water (such as in swimming pools) They should avoid swimming in murky water (such as lakes or oceans) Some children with particular needs might need a one-to-one supervision by a trained
individual
Taking swimming lessons is encouraged
Lifejackets and floatation devices might be used during water activities
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