Autism medical comorbidities

Table 1 Autism comorbidities

Related disorders
Anxiety disorder
Obsessive-compulsive disorders
Attention deficit hyperactivity disorders
Mood disorders
Sleep disorders: Difficulty falling asleep, inability to sleep in a flat position, nighttime reawakenings, sleepwalking
Epilepsy
Systemic medical disorders
Accidents
Injuries, drowning, suffocation, etc.
Genetic disorders
Fragile X syndrome, Down syndrome, Duchenne muscular dystrophy, neurofibromatosis type I, and tuberous sclerosis complex
Metabolic disorders
Mitochondrial disorders, disorders of creatine metabolism, selected amino acid disorders, disorders of folate or vitamin B12 metabolism, and selected lysosomal storage disorders
Endocrine disorders
e.g., hypothyroidism
Neurological disorders
Congenital abnormalities of the nervous system, epilepsy, macrocephaly, hydrocephalus, cerebral palsy, migraine/headaches, paralytic muscular disorders like Duchenne muscular dystrophy, increase in sympathetic and a decrease in parasympathetic activity, and dysautonomia
Immune dysfunction
Neuroinflammation, immune deficiency and dysfunction
GI disorders
Chronic constipation, chronic diarrhea, eosinophilic esophagitis, gastroesophageal reflux and/or disease, nausea and/or vomiting, chronic flatulence, abdominal discomfort, ulcers, colitis, inflammatory bowel disease, food intolerance, and/or failure to thrive
Feeding disorders
Selective eating, difficulty swallowing, abnormal behaviors during meals such as ritualistic behaviour, throwing tantrums or gagging and vomiting
Allergic disorders
Asthma, nasal allergies, atopic diseases (immunoglobulin E-mediated), food allergies and intolerances
Toileting problems
Difficulties in learning how to use the toilet during the day and at night, knowing when they need to use the toilet, communicating the need to use the toilet, being able to get to the toilet independently or in time, learning to use different toilets with which they are unfamiliar, wiping themselves, sensory differences (dislike of the noise made by toilets, the sensation of passing urine/faeces, a cold toilet seat, or a preoccupation with water in the toilet), smearing faeces, a range of continence-specific difficulties, including bowel or bladder difficulties such as bedwetting and constipation

Table 2 Criteria of “Autism Friendly Emergency Department”

Staff
Available staff with additional training in autism management, and stakeholder engagement
Staff education includes awareness about sensory sensitivity, communication, and pain threshold, as well as how to interact with patients
Parenting with the experts
Minimizing the number of personnel to only the essential
Able to gain as much information as possible from both the patient and the caregiver
Facilities
Calming environment with offering calming objects like toys and iPads, or sending patients to separate, quieter waiting rooms and using dimmer lighting and noise control system
Special waiting room with calming toys and suitable TV shows
Short waiting time when possible
Available quiet examination room
Available admission questionnaire or checklist to help the physician discovered disorders that are difficult to be detected in children with autism
Well design exam room and treatment area to help motivate the children to stay in the room
Available sensory equipment to use such as ear defenders, sensory boxes filled with various sensory items, Picture Exchange Communication System cards, sensory toys (e.g., squeezy balls), social stories, and communication aids
Available items to provide support, comfort, and security, including compression vests, blankets. and noise reduction earmuffs
Avoiding using sensory stimuli such as clutter, loud equipment, bright or fluorescent lighting
Parents
The use of one-page autism alert card or patient passport to provide emergency physicians with the needed information
Adequate partnership with parents
Family-centered care
The caregiver should be the guide to success
Medications and instruments
When choosing a medication, sensory issues such as taste or smell, textures, and temperature of treatment materials should be considered
The child should be exposed to and to touch all materials prior to using them if possible
The intervention can be modelled on the caregiver
Splints or bandages can be covered with non-threatening images