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Diagnosing Secondary Medical Issues for Kids with Autism

Submitted by on April 17, 2014 – 12:53 pmOne Comment

Diagnosing Secondary Medical Issues for Kids with Autism

My Son with Autism and the Ghastly Horrible, No Good Wretched Day at the Doctor’s Office

 

by Michael J. Cameron, PhD, BCBA-D

When a child with autism spectrum disorder enters a doctor’s office, are they being treated with the same care and attention as a child not on the spectrum?

In many cases, they experience a ghastly, no good wretched day. It can be frustrating for families to spend the time and energy to get medical help for an ongoing issue, like gastrointestinal problems, only to be told “it’s just behavioral and we can’t help.”

Contrary to what some in the medical profession might believe, these issues are real for families. According to research from the University of California:

  • 55% of children with autism have a sleep disturbance
  • 45% of children with autism have a gastrointestinal disturbance
  • 10% to 60% of children with autism have epilepsy
  • 70% of children with autism have a co-morbid psychiatric disorder such as an anxiety disorder

(Statistics from Daniel Geschwind: Program in Neurogenetics, Department of Neurology, Center for Autism Research and Treatment, Semel Institute, David Geffen School of Medicine, University of California)

Although there’s a statistical concurrence between many secondary conditions and autism, the dangerous linear thinking in the medical community still exists. When a doctor’s reflexive response is “it’s autism, therefore it’s behavioral and not a medical issue,” they do a disservice to the child and his or her family. The family leaves feeling frustrated and hopeless, and the patient is no better off.

Towards a Behavioral Medicine Approach

In contrast to the medical treatment that many children on the ASD spectrum experience, a behavioral medicine approach allows medical professionals to uncover the true causes of disturbances and find solutions that work for families. The goal is to promote health in order to produce good behavior outcomes and promote behavior change to produce health changes, not just sweep the possibility of a health diagnosis away simply because ASD in involved.

By using an integrated knowledge from multiple sciences, we’re able to bring that knowledge to bear on the health issues of those on the spectrum disorder. The techniques bridge behavioral and biomedical sciences in order to reach solutions that help children and families cope.

The Case of Alex

Alex, a boy on the ASD spectrum, had uncontrolled emesis. His regular vomiting made it difficult for him to be accepted by his peer group at school, and at home his family dreaded mealtime and constant clean up. He was non-verbal, so he was unable to report his discomfort.

After being informed of what was a behavior problem by the medical community, his mother referred him to my clinical team and we used a “scatter plot” to identify the commonalities in his emesis incidents. We took a computational behavioral medicine approach and systematically excluded and included foods to identify what might be causing the constant emesis.

Through a series of changes, we discovered that Alex wasn’t vomiting on purpose – as had previously been suggested. He had a reaction to histamine-rich foods which were then eliminated from his diet. When the offending foods were gone, his emesis disappeared as well.

The Next Steps for the Medical Community

Alex is not alone – there are hundreds of children just like him. By adopting a computational behavior medicine approach for children with ASD, the medical community can start being a true ally to their patients and their families. The prevalence rate of common issues like gastrointestinal disturbance, emesis, disruptions in sleep/wake cycles and psychiatric disorders means that primary care physicians are going to see more and more of this in their patient population. It only makes sense to shift to an interdisciplinary approach.

Establishing clinical decision protocols for systematically examining the causes of common presentations is essential. With protocols in place, physicians can be empowered to assist families and discover the true causes of these disturbances. Enlisting clinical expertise helps families identify the right treatment plan for each individual. Until those protocols are in place, families need to be proactive. Be prepared to hear that a child’s issues are related to ASD, and not a medical condition. Fuel yourself with questions about what could be the cause, and continue to be your child’s advocate.

Having a ghastly, horrible no good wretched day at the doctor doesn’t have to be the reality for families dealing with ASD.

Dr. Michael J. Cameron, a Board Certified Behavior Analyst (Charter Certificant 1-00-0010) is The Chief Clinical Officer for Pacific Child and Family Associates (PCFA) and experienced in the area of behavioral medicine, behavioral health assessment, intervention for diverse populations, and higher education. Prior to joining PCFA, Dr. Cameron was a tenured Associate Professor and the Founding Chair of the Department of Behavior Analysis at Simmons College. Dr. Cameron earned a master’s degree in applied behavior analysis and a Ph.D. in experimental psychology from Northeastern University.  To learn more, visit http://pacificchildandfamily.com/

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