Co-morbidity in ASD

Dr. Sally Ozonoff was very helpful in explaining the challenges with co- morbidity of ASD and the difficulties that may arise when assessing an individual. 

The analogy Dr. Ozonoff used regarding "two sides of the same coin" was helpful for me to understand the connection between differential diagnosis and co-morbidity. 

Dr. Ozonoff also mentioned the importance of Occam’s Razor theory, or the simplest diagnosis is often the right choice. And even though this theory is still used today in medical fields, it is essential to look at all the possible concerns of the behavior versus just focusing on one when assessing an individual. For example, if a child has ASD and bipolar, we cannot simply treat bipolar and disregard the ASD symptoms. This is just one of the many challenges an evaluator faces when assessing an individual who has co-morbid characteristics. 

One statement I found of interest is being aware the DSM isn't consistently accurate with determining a diagnosis. Subsequently, one may misdiagnose an individual’s symptoms, resulting in the wrong treatment. Dr. Ozonoff gave one example of this when the diagnosis is the result of “subdividing a set of symptoms into two different things when it’s actually one thing". Subsequently, this is why the DSM is always being updated every five to ten years. This is a very important factor to be aware of when assessing an individual.

There are many challenges with assessing a child with co-morbidity disorders that are important to consider when completing a fundamental behavioral assessment. One of these challenges is measurement. Although there are standardized measurements for many disorders, there are less standardized tools to measure ASD.  

Another challenge occurs with assessing an individual when instruments are used that are based on self-report. This is evident when questions are used that an individual with ASCD has great difficulty understanding. 

An additional challenge, and resulting concern, involves symptom overlap. This is a common issue that can arise when assessing a child because many disorders have the same core symptoms.

There are a wide variety of methods to consider when dealing with co-morbidity disorders. As a result, it is important to carefully review each individual’s developmental history, including the age of symptom onset, whether there were symptoms that developed over time, as well as if the individual’s response to treatment/medication has changed from the time when it was first used.  

There is a large amount of information presented by Dr. Ozonoff that is both very new to me and extremely interesting. For example, I was unaware of the amount of attention and thought is involved with assessing a child with a co-morbid disorder. It is very clear now that this is not a straightforward task, but involves many considerations.

It is now very apparent how important it is to be aware of not over lapping a diagnosis, as well as avoiding under and/or over diagnosis.

 Our goal is to treat ALL symptoms present, to ensure that a child with ASD can have a desirable quality of life.