Asperger's Comorbid Conditions

Depression is Common Among Those with Asperger's.|stock.xchng http://www.sxc.hu/

Asperger’s Syndrome (AS), one of the five conditions found on the autism spectrum, is a developmental disorder that mainly affects a person’s social communication. There are certain comorbid conditions that are found quite frequently among individuals with Asperger’s Syndrome. These conditions do not need to be present in order to receive a diagnosis of Asperger’s Syndrome, but one or more is usually found alongside the AS diagnosis.

Sensory Processing Disorder (SPD)

Although not officially a diagnostic category in the Diagnostic and Statistics Manual of Mental Disorders (DSM), sensory processing disorder is widespread among all individuals on the autism spectrum, including those with Asperger’s Syndrome. Individuals with AS are usually over-responsive to sensory stimuli; loud noises, scratchy clothing, and unusual textures all serve as sources of irritation among those with AS.

Attention-Deficit Hyperactivity Disorder (ADHD)

According to an article published on Medscape, one study of children with Asperger’s Syndrome showed that 62.5% of the participants also showed clinical symptoms indicating attention-deficit hyperactivity disorder (ADHD).

Anxiety

Anxiety is extremely common among individuals with Asperger’s Syndrome. According to Tony Attwood, “We know that more people with autism spectrum disorder (ASD, e.g. Asperger’s syndrome, autism) experience anxiety and depression than people who do not have ASD.” Anxiety can take the form of obsessive-compulsive disorder, specific fears and phobias, and generalized anxieties.

Depression

According to an SMHAI study, approximately 1 in 15 individuals with Asperger’s Syndrome also meet the diagnostic criteria for depression. It is unknown exactly what causes the depression but it is likely that it is a combination between the individual’s realization of their difference from their peers and the ostracizing that occurs from these peers. Bullying is an extremely common problem among individuals with AS; this bullying could very likely lead to an increased rate of depression among the AS population.

Dyspraxia

Sometimes called motor-planning disorder, dyspraxia is seen in a large majority of individuals with Asperger’s Syndrome. In fact motor clumsiness is so common that one diagnostic model for Asperger’s Syndrome, Gillberg’s Criteria for Asperger’s Disorder, includes motor clumsiness as a symptom which must be present in order for an individual to receive an AS diagnosis.

Tourette’s Syndrome

Although not seen as commonly as ADHD and anxiety disorders, it is not unusual to see individuals with Tourette’s syndrome as well as Asperger’s Syndrome. Tourette’s syndrome is characterized by repetitive vocal and motor tics.

These six conditions exist in the general public and in the absence of Asperger’s Syndrome. However, the rate of diagnosis among individuals with AS is unusually high when compared with those not on the spectrum. In time, scientists hope to better understand the link between these conditions.

Source

Where tics and compulsions meet: TS plus OCD

Tourette Syndrome and Obsessive Compulsive Disorder often occur together.  In fact, the Centers of Disease Control and Prevention states that more than one-third of persons with Tourette Syndrome also have Obsessive Compulsive Disorder.

Often, tics and compulsions can look similar and be difficult to distinguish. Actually, to an observer it may be impossible to determine whether a behavior is a compulsion or a tic without asking the person performing the behavior and even then it may remain a mystery. The key to distinguishing a tic from a compulsion is the motivation behind the act.

As an example, lets break down a simple motor tic which could very well be a simple compulsive behaviour .  The behavior is blowing on the back of the right hand. If the behavior is a tic the person may feel a premonitory urge to perform the tic.

The premonitory urge could be a tickle on the hand, a sensation in the elbow joint prompting the movement, a sensation in the lips to purse, a feeling in the chest prompting a need to exhale a breath.  Premonitory sensations may be any feeling or urge that prompts the tic, creating the itch that needs to be scratched. The person scratches that itch and the tic is performed.

If the behavior is a compulsion, the person is prompted by a different mechanism to perform the exact same behavior.  The person may have an obsession that there may be dust on the back of the hand, a thought that they may need to blow on the back of the hand to prevent something bad from happening, a feeling of anxiety or emotional unease unless they blow on the back of their right hand. The person then performs the behavior, (not a tic), and temporarily relieves the uneasiness or anxiety.

As you see from this scenario, the behavior from the outside observer is identical.

To the person, the behavior may be triggered from and performed for very different reasons.  It could also be that the person themselves may be unaware of the difference as well.

Distinguishing the “why” the behaviour occurs requires some cognitive awareness, maturity and insight.  A child, for example, may not be able to determine the “why” and just know that they have to do the act.  A person with many tics and compulsions may have a low reserve of mental energy to distinguish the “why” of the behavior.

A person who has little understanding or insight about their differences may also be unable articulate whether they are compelled due to anxiety to perform the act or if the act is a sudden, intermittent, unpredictable, repetitive, nonrhythmic movement that is classified as a tic.

Now lets throw more uncertainty into the simple blowing on the back of the right hand. Perhaps this tic or compulsion is linked with another behavior.

For example, the person has established that the blowing on the back of the right hand is a tic but immediately after performing the tic they are compelled to do it over until it feels just right.  Now the behavior may be motivated by anxiety and the following act is a compulsion.  So the person blows on the back of the hand twice, once performing a tic, the second time because of a compulsion but both times in the exact same way. Alternatively, it may be the opposite, where the initial act is a compulsion which then triggers the tic.

And to make it more confusing, it may not be the exact same behavior, it may be any other tic or compulsion. For example, the person may be compelled to jiggle the door handle to make sure it is locked and then perform a tic by knocking on the door. The combinations may be endless and the compulsions and tics may interact in very intricate ways.

So why may it important to distinguish a tic from a compulsion? Sometimes it may not be. If the tic or compulsion is not intrusive, disruptive or bothersome to the person performing it, knowing the motivation for the behaviour may not be important to them.  If the person is bothered by the act, motivation is important in terms of modifying or extinguishing the behaviour.

Obsessive compulsive disorder may be treated using Exposure and Response Prevention, (ERP) and Cognitive Behavioral Therapy, (CBT). Tics may be treated or modified using Cognitive Behavioural Intervention for Tics, (CBIT).

Both of these therapies require gaining insight about the motivation that drives the behavior and thus determining whether it is a tic or a compulsion. The insight lays the groundwork for the appropriate behavioral intervention. But, not only is knowledge and understanding important for therapy, it helps us to better understand who we are, how our brains work and why we do what we do which will contribute to our overall self-awareness and emotional well-being.

Source

This post brought to you in part by

AmeriGlide.com

AmeriGlide offers wheelchair lifts for your vehicle and vertical platform lifts for your home or office. Our wheelchair lifts are safe, sturdy, and can be operated independently.

Man with Tourette Syndrome Denied Flight after Saying 'Bomb'

April 26, 2013 - WASHINGTON, DC - A man with Tourette Syndrome was denied boarding a plane Thursday after he said the word "bomb." Michael Doyle and Chaz Petteway are friends and travel companions. They were booked on a Jet Blue flight from Reagan National Airport to San Juan Puerto Rico Thursday to take part in a weekend Revolutionary War reenactment. "It was a really big deal for us. It was going to be fun. A very fun time," said Michael Doyle. Doyle says he was not allowed to board his flight because of his Tourette's. But they'd planned ahead, alerting Jet Blue and the TSA about his so-called ticking. That's frequent outbursts and vocalizing thoughts he's trying to suppress. "With all the stuff in the news about the Boston bombings and stuff... I started ticking 'bomb.' Because that when I get nervous and anything on my mind will come out. And things you're not supposed to say," said Doyle. It didn't cause any issues at passenger screening. "We went through TSA saying 'bomb' the whole time and no one stopped us. No one said anything because they were aware." But just minutes before boarding, the Jet Blue pilot put the kibosh on the trip. "I mean they stood me up in front of everyone and told me like I'm in kindergarten that I'm not allowed to go on the plane," said Doyle. "To me it looks like it was kind of discrimination you know," said Chaz Petteway. In a statement to FOX 5 News, Jet Blue officials says Doyle "was deemed a safety concern by the pilot in command after using the word "bomb." After further investigation, the situation was deemed innocuous." "It doesn't make up for the embarrassment or the fact that we missed something that we'd been planning for two years," said Doyle. "Tourette's was discovered over 200 years ago and we still don't have a cure," said Marla Gabala, chairwoman of Tourette Syndrome Association Of Greater Washington. She has two teenage daughters with Tourette's. "One of the biggest misconceptions is that they can stop doing it. And the perfect way to think about it, when you have Tourette syndrome it is a tick. It is an involuntary response like a sneeze." One that Doyle says leaves scars that run deep. "I mean this has happened multiple times in my life... And it's... it just...it hurts." Michael says he was offered a free round trip ticket on another Jet Blue flight but no guarantee this wouldn't happen again. The airline said his buddy Chaz could take the flight, but he decided to stay back with Michael. He did have outbursts during our visit, but none that crept into the critical points he was making during our interview.

Tourette’s Syndrome: Comorbid Disorders

Tourette Syndrome (TS) often occurs with other related conditions (also called co-occurring conditions). These conditions can include:

 attention-deficit/hyperactivity disorder (ADHD) obsessive-compulsive disorder (OCD)
, Mood disorders such as depression and Bipolar Disorder and other behavioral or conduct problems,
  and non-OCD anxiety disorders

People with TS and related conditions can be at higher risk for learning, behavioral, and social problems.

The symptoms of other disorders can complicate the diagnosis and treatment of TS and create extra challenges for people with TS and their families, educators, and health professionals.

Findings from a national Centers for Disease Control and Prevention (CDC) study1 indicated that 79% of children who had been diagnosed with TS also had been diagnosed with at least one additional mental health, behavioral, or developmental condition based on parent report.

Among children with TS:

64% had ADHD.

43% had behavioral problems, such as oppositional defiant disorder (ODD) or conduct disorder (CD).

40% had anxiety problems.

36% had depression.

28% had a developmental delay

Because co-occurring conditions are so common among people with TS, it is important for doctors to assess every child with TS for other conditions and problems.

Source:http://www.cdc.gov/ncbddd/tourette/otherconcerns.html

http://www.schoolbehavior.com/disorders/tourettes-syndrome/tourettes-syndrome-comorbid-or-associated-disorders/