Psychiatric Comorbidity and Differential Diagnosis of Autism Spectrum Disorders

Dr. Ozonoff’s presentation on Psychiatric Comorbidity and Differential Diagnosis of Autism Spectrum Disorders

Comorbidity is the simultaneous co-occurrence of two independent clinical diagnoses.  Dr. Ozonoff talks about a lot of different reasons why it is difficult to diagnosis an individual with ASD with a co-morbid disorder because it is hard to differentiate between the symptoms and deficits that people with ASD presents with.  Dr. Ozonoff talks about Occam’s Razor, which states that the parsimonious explanation is the explanation that you should try to work with first before adding things to make it more complicated.  With regards to an FBA and comorbidity, I don’t really think that it matters what the specific diagnosis is, as long as you are aware of the skill deficits of the individual that you are assessing.   In an FBA, you are looking at specific, measurable behaviors that can be directly measured, so whether or not the individual has something in addition to ASD might not affect the outcome of the FBA.  You are observing the antecedent events, the behavior itself, and the consequence; from this you can determine the function of the behavior.  It is in the practice of ABA to assume the most parsimonious explanation is the appropriate one, so you would deal directly with the behavior that you are observing and measuring rather than assume the individual has Obsessive compulsive disorder or anxiety.  This is the practice because as behavior analysts, there might not be anything that we personally can do for an individual who is diagnosed with these disorders regarding mediation or other things that are beyond our control, but we can address the behaviors that are exhibited by the individual and try to rearrange their environment in a way that can increase adaptive behaviors and decrease maladaptive behaviors.   I think it is necessary to talk to your student’s parents or nurse to try to figure out if there are events beyond your control (medication making the student sleepy, or hyper , etc).  but the diagnosis itself, if not totally complete or if it is unsure that there might be a comorbid behavior, we can still address the behaviors that are occurring.  Of course, using a team approach, you would speak to the parents, teachers, behavior analysts, OT, PT, SLP, etc. to get a very well rounded picture of what is going on with the child.