Addressing Poor Health & High Death Rates in Autism
“We must first recognise ASD as a whole body disorder”
Autism, or Autism Spectrum Disorder ASD, is traditionally seen as the result of behavioural and neuropsychiatric dysfunction. However there is a strong evidence that various physical, or biomedical, problems can directly cause many autism-related symptoms and behaviours.
There is also growing evidence that physical health-related problems can, through their influence on brain development and functioning, cause the core autism symptoms that form the very diagnosis of the disorder.
It is an undeniable and sad fact that individuals with autism suffer much poorer health and shorter lifespan than their peers without autism. Multiple studies have shown this including one published in 2018, an important investigation of over 27,000 Swedish people diagnosed with ASD which revealed that the average life expectancy among the people studied with severe autism is 39.5 years, rising to only 58 years for those with high-functioning autism, or Asperger syndrome.
It is therefore very welcoming to see a peer-reviewed research paper that highlights a number of physical problems associated with autism, and discusses how to overcome the roadblocks and challenges in providing appropriate health care for those affected by autism.
“There is a wealth of scientific data demonstrating the over-representation of various mental and physical health conditions alongside ASD. There is, however, still insufficient recognition amongst healthcare professionals that such symptoms could be related to comorbid physical health conditions rather than being commonly dismissed as “part of autism” or “autistic behaviours”.
In this paper, we provide a literature review of the key physical comorbidities identified in people with ASD covering the areas of neuroinflammation and immune dysregulation, GI dysfunction, metabolic abnormalities, as well as seizure disorders such as epilepsy.
We also discuss how healthcare professionals…have a duty to be informed about the challenges and considerations in identifying physical comorbidities in this population.”
In the paper ‘Bridging the Gap Between Physical Health and Autism Spectrum Disorder’, recently published in the journal Neuropsychiatric Disease and Treatment, the authors explain how autism does not typically appear as a stand-alone condition.
Various health conditions that are common in autism can not only have a detrimental effect on daily functioning, social communication and behaviour, but they can also increase the risk of developing serious medical conditions and lead to early mortality.
The paper highlights some of the conditions affecting the immune and gastrointestinal systems, metabolism, and brain function in autism. It discusses how professionals, working with those with autism and their parents and carers, should recognise the impact of such conditions on individuals’ lives and long-term wellbeing.
The authors lay out the argument that the main barrier to better awareness and recognition of health issues in autism is the paradigm within which many healthcare professionals operate that erroneously sees autism and all associated symptoms and manifestations as being solely the result of behavioural and neuropsychiatric dysfunction.
Dissolving myths about poor health outcomes in autism
Most medical conditions are significantly more prevalent in individuals with autism than in typical population. They span a whole range of different disorders affecting various systems of the body including neurological – involving both central and autonomic nervous systems – immune, gastrointestinal, and metabolic disorders.
Poor health outcomes and early mortality in autism are often explained away solely by the fact that individuals with autism are less able to communicate their symptoms to healthcare professionals, are more likely to skip regular health checks, and may avoid visiting their GP altogether.
While such factors certainly could contribute to negative health outcomes in some cases, their role is dwarfed by the evidence of physical health problems being not only persistent during the whole lifespan, but also being intrinsically linked to the very emergence of autism.
Results from multiple large scale studies have shown that early-life health conditions differentiate babies and toddlers who are at high risk of developing autism. Infant dysregulation and signs of physical distress such as feeding and sleeping difficulties, and abnormal crying, can be used as red flags for early autism screening.
Children who are exposed to pregnancy or birth complications, such as preeclampsia, premature separation of the placenta, meconium-stained amniotic fluid, or shortage of oxygen during birth, are much more likely to be diagnosed with autism later on.
More importantly still, medical problems also override genetic factors for autism. In pairs of identical twins where only one twin has autism researchers found significantly higher rates of autism in those siblings who had a history of early medical problems, such as foetal distress and hypoxia during delivery, minor infections (for example throat or ear infections), allergies and seizures. At the same time their genetically identical siblings who did not experience such adverse physical events often did not develop autism.
What can be done to improve poor health and high death rates in autism?
Recognising the physical problems in individuals with autism can be challenging. The paper explains the main reasons why and how to overcome them.
One of the barriers to effective identification of physical issues in autism is that their expression can be atypical. Individuals with autism often respond to pain and discomfort with what the others see as ‘odd’ or challenging behaviours—for example aggression or self-injurious behaviour in individuals with autism can be the primary symptom of a hidden physical condition.
However, the largest roadblock to better recognition and treatment of health problems in autism, as identified by the authors of this paper, is the framework within which most healthcare professional operate, and how they view their patients with autism.
In many cases a healthcare professional will erroneously believe that autism is solely a behavioural dysfunction. He or she will not be familiar or not even aware of the mountain of scientific data on the intrinsic connection between autism and physical health.
“Symptoms such as grimacing, appetite disturbances, insomnia and strange postures are not core features of ASD. A considerable volume of scientific evidence points to the possibility of an underlying physical cause to such behaviours. To avert diagnostic overshadowing, screening for physical conditions should be initiated when such behaviours are observed.”
As a result of the wrong paradigm in which they see their patients with autism, the healthcare professional will not be attuned to the high risk their patient faces and the physical strain they could be under.
Healthcare professionals will also not be attuned and able to recognise symptoms of medical problems when those manifest simply as ‘odd’ or challenging behaviours. They will instead dismiss those as ‘autism behaviours’. This can happen even when the symptoms could be indicative of serious and potentially deadly medical issues.
Finally, the authors recommend that in order to reduce morbidity and preventable death in autism it is of utmost importance to provide regular physical health checks and to maintain high level of clinical suspicion towards physical health problems in autism.
Sala R, Amet L, Whiteley P, at al. Bridging the Gap Between Physical Health and Autism Spectrum Disorder.
Neuropsychiatr Dis Treat. 2020;16:1605-1618 https://doi.org/10.2147/NDT.S251394
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