Milestones Autism Resources

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Co-existing Conditions

Physical and Mental Co-existing Conditions 

Being autistic doesn’t exempt children or adults from having an additional condition. The following gives you information about common co-existing conditions. Our goal is to help you understand what the signs you’re seeing might mean and provide you with resources for further information. Mental conditions like anxiety and depression can be challenging for many self-advocates, often on top of sensory issues they already face.

Minimizing mental health changes can affect your physical health. It’s important to weigh the difference between common manageable challenges and behaviors as opposed to signs that you or a family member may have a mental health condition like anxiety, depression or self-injuring behavior that should be assessed by a professional. There are various conditions like these that can be common in autistic people and it’s vital to get professional help and support. They are often treated with therapy and/or medication. 

While some people may hesitate to go to a therapist, sometimes you need a neutral, objective person to talk to who understands your situation. When you have a medical challenge like diabetes you see a doctor and may take medications like insulin. Your brain is a vital organ that needs support, too. Seeing a therapist is a way to get that support to help you through.

Bear in mind that many mental health conditions have biological causes like chemical imbalances in the body that can be helped with medications and therapy. In addition at puberty many of these issues can change even if they’ve been under control with particular medications or approaches. As the changes of puberty happen the condition or how a teen’s body responds to medication may be different.

The service options and recommendations may also change as an individual grows up and at different stages of their life.

It is important to consult a professional to assess and get the appropriate evidence-based help and support. The Milestones free autism Helpdesk can connect you with professionals and resources. 

Trust your instincts if you are worried about your loved one and ask your doctor for help. If you are not satisfied with your doctor’s opinion or diagnosis you have the right to get a second opinion from another medical specialist.

Many African American families and those from other cultures are not able to get their health concerns and diagnosis and are not taken as seriously as those of white parents. If you think your loved one has a co-existing condition or issue, continue to pursue getting help.

We are also mindful of families who do not live near quality medical care, in which case so much development time can be missed.

Mental Health Co-existing Conditions

Because autistic people are neurologically wired differently, they can have additional mental health conditions. For example, anxiety or depression can be more common in autistic children or adults and it is important to get diagnosed by a professional and get evidence-based help like psychotherapy or medications from an appropriate medical professional. The National Alliance on Mental Illness (NAMI) provides useful resources including  this helpful list of warning signs for different types of conditions.

Executive functioning impairments such as Attention Deficit Hyperactivity Disorder (ADHD) involve challenges in maintaining appropriate focus to the right things (such as school or work activities), processing information, impulsiveness and/or needing constant motion. Executive functioning refers to a set of brain functions for managing your daily living including working memory, organizational skills, flexible thinking and self control. For more details on executive functioning see the article for children or for teens in the Milestones Autism Planning (MAP) Tool and this article from Understood

Mood and anxiety disorders include generalized anxiety, panic disorders, phobias, social anxiety, Obsessive Compulsive Disorder (OCD), Post Traumatic Stress Disorder (PTSD), depression and bipolar. People with anxiety exhibit excessive worry or need for reassurance. Mood disorders are characterized by sadness, irritability or mood swings. Sometimes this could look like aggression.

Self-injurious behavior such as biting on their hands, hitting their head on things or banging which can become a perseveration. Perseveration is repeatedly doing or saying something without direct cause that is difficult for the person to stop doing. Other types of self injurious behavior include cutting which refers to intentionally cutting oneself.

Self-injurious behaviors can be aimed at releasing pain or bigger overwhelming emotions. The body is trying to move out and handle to be able to express their big emotion that they don’t know how to do. Self-injurious behavior can be related to anxiety, stress or a number of other things. It’s vital to consult a professional for help who understands the dynamics in an autistic person. 

Pica is when people eat things they shouldn’t be eating.

Substance abuse and use. Autistic people may overuse alcohol, marijuana or other drugs to help with social anxiety, coping with stress or sensory issues. Watch for differences in behavior or patterns, sleepiness or smells. 

Schizophrenia  and schizo-effective disorder (combination of schizophrenia and mood disorder). Schizophrenia is a long term serious mental illness that typically has onset in late teens or young adulthood. Helpful resources are the National Alliance on Mental Illness (NAMI) and the National Institute of Mental Health.

Other Co-existing Conditions:

Gastroenterology (GI), Feeding and Nutritional Issues

Since autistic children and teens often have limited foods they will eat, it can be tricky to tell when they have something more minor vs. a deeper issue. Sensory issues involving texture and smell can especially impact food preferences. However autistic people can also have food sensitivities or allergies that cause picky eating.

It depends on the age, but failure to thrive could derive from a GI issue. Toileting issues can also cause constipation. Other warning signs of a more significant problem are vomiting, blood in urine or stools, or sharp belly pain. 

A gastroenterologist can assess for issues, and they often have nutritionists who specialize in feeding issues who can help. Your pediatrician or internist can be helpful as well. Occupational therapists can also help with feeding issues and behavioural specialists can help with toileting challenges. The Milestones Toilet Training Tool Kit provides detailed guidance including developing your plan, communication tips and things to consider for toilet training a child with special needs. 

Challenges with Sleep

Autistic people are neurologically wired differently, which can impact their internal rhythm and clock that help most of us function. Ask your doctor for advice about keeping a schedule and routines that help with sleep, and whether melatonin may help. The Milestones Sleep Tool Kit provides strategies for helping autistic people improve their sleep as well as signs of a potential sleep disorder and how to get help. 

Tourettes, Seizures and Tics

These are neurological conditions that can occur in autistic people. Autism is a condition in which people’s neurological wiring is different. People can develop seizures or tics (involuntary body movements the person cannot control) that may be part of that wiring.

If your child or loved one experiences any of these issues it is important to see a neurologist, and it may also be helpful to consult with a nutritionist.

Tourettes is a neurological developmental disorder characterized by repetitive tics and blurting out words that may include curse words through no intent on their part. It is a nonvoluntary, neurological condition caused by different wiring in the brain. These strong tics and the vocalization of words can cause the person to be misunderstood as aggressive or inappropriate when it is caused by their disability. If Tourettes or seizures are left untreated they can cause other physical challenges so it is important to seek help.

Gross and Fine Motor Issues

Gross and fine motor issues involve movement differences including how they are walking, balance and muscle coordination that can tie into sensory issues. Gross movement refers to broader body movement like walking, while fine motor relates to how you use your hands for different purposes such as can you hold a writing utensil properly which impacts writing.

Appropriate evidence-based intervention and therapy can help. Physical Therapists help build physical movement and strength through different exercises and approaches. Occupational therapists provide fine motor support and often can help with sensory issues. The Milestones Helpdesk can connect you with resources to meet your needs or you can search in the Milestones Resource Center.

If you see these issues in early or any stage of childhood you should ask your pediatrician for help. Trust your instincts if you think important physical milestones are not met (such as rolling from side to side or learning how to walk). Or if you see your child walking in a different way or not able to hold a crayon or pencil at the expected age. Each child presents differently. You should feel comfortable asking for a second or third opinion if you’re not seeing improvement or getting the help you think you need. 

Resources for Mental Health Diagnosis

If your mental health is impacting your child's or a loved one's health, seek help.  

Additional Resources

The Milestones Mental Health Tool Kit provides an overview of mental health services available for autistic individuals as well as professional roles and forms of therapy.

CDC Anxiety and Depression in Children

Milestones Blog Articles

Depression and Autism

Living with Anxiety and Autism

Ask the Expert: Heather Dukes-Murray, PhD: Anxiety, Autism and Interventions

Substance Abuse and Autism

External Resources

Three Things You Need to Know: An Anxiety Guide for Kids, Teens and Adults by Meghan Barlow, Ph.D.

The Job Accommodation Network can be helpful for finding information about ideas of accommodations for different needs

AASPIRE Healthcare Toolkit for Patients & Supporters

American Association of Suicidology


CHADD (Children and Adults with ADHD)

NAMI section on ADHD

NIH National Institute of Mental Health 

Executive Functioning

Executive Function Skills by CHADD, the nonprofit Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD)

Executive Function & Self-Regulation from the Harvard University Center on the Developing Child

Understanding Executive Functioning Issues

What Are Executive Functioning Skills?

Executive Functions

Tourette’s Syndrome

Tourette's Tip Sheet

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