Autism Spectrum Disorder is a neurodevelopmental disorder which is associated with multiple co-morbid disorders.
These co-morbid disorders include genetic disorders such as fragile X syndrome, tuberous sclerosis, 15q duplications, and untreated phenylketonuria; electroencephalographic abnormalities which is seen in 20–50% of cases such as in epilepsy; intellectual disability which is seen in approximately 70-75% of cases; medical conditions that are noted in 15–37% of cases such as sleep disturbance, gastrointestinal symptoms, obesity, asthma, allergies; autoimmune diseases such as hypothyroidism, hyperthyroidism; sensory issues; and psychiatric disorders such as major depression, bipolar disorder, anxiety disorder, schizophrenia, and OCD.
Mannion and Leader (2013, 2015) explain that one of the most researched topic, and not fully understood, has been the relationship between autism and epilepsy. The risk of autism is greater with epilepsy associated with tuberous sclerosis complex (TSC), and epilepsy associated with neurofibromatosis (NF-1). When we compare idiopathic autistic disorder and epilepsy, epidemiological studies have found that they co-occur in approximately 30% of individuals with either autism or epilepsy. The prevalence of autism is significantly higher than in the general population where 2% has been diagnosed with epilepsy (Tuchman, et al. 2010).
According to a research by Christelle, et al. (2015), all seizure types have been reported associated with autism. However, the most common type of seizures found in individuals with autism and epilepsy is complex partial and generalized seizures, where the activities are more frequent in temporal and parietal areas of the brain. In addition, there are shared genetic risk factors for autism and epilepsy. There are several copy number variants (CNVs) which are linked to both autism and epilepsy [e.g. 1q21.1 deletions, 7q11.23 duplications, 15q11.1-q13.3 duplications, 16p11.2 deletions, 18q12.1 duplications, and 22q11.2 deletions.]
The challenging behaviors such as repetitive behaviors, self-injurious behaviors, psychomotor agitation with disruptive behaviors and aggression in individuals with autism and epilepsy represent a difficult task in term of understanding and treatment options because some of these behaviors may be considered also part of the epilepsy phenotype.
Often we see that parents, educators, clinicians and custodians become frustrated at the challenging behaviors of this patient population. We believe that the best approach to developing a comprehensive treatment plan involves an interdisciplinary team that includes geneticists, psychiatrists, pharmacists, neurologists and psychologists.
Francisco Monegro currently serves as the residential Clinical Director of adult services programs at QSAC. He is also a consultant on autism for the PSCH clinic and the Shield Institute. Dr. Monegro received his MD/PhD in clinical psychology from the University of Santo Domingo/University of Kansas. In 1988, he received a diploma from the American Board of Medical Psychotherapists, Nashville, and from the International Academy of Behavioral Medicine, Counseling and Psychotherapy, Dallas, TX.