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Identifying Associations Among Co-Occurring Medical Conditions in Children With Autism Spectrum Disorders
Ann M Neumeyer1, Julia Anixt2, James Chan3
1Lurie Center for Autism, MassGeneral Hospital for Children (AM Neumeyer), Harvard Medical School, Lexington, Mass.
Insights
Children with autism spectrum disorder (ASD) frequently have co-occurring medical issues. This study identified new, significant associations between conditions like feeding, speech, and sleep disorders in children with ASD.
Area of Science:
- Pediatric Medicine
- Neurodevelopmental Disorders
- Medical Genetics
Background:
- Autism spectrum disorder (ASD) is frequently accompanied by various medical conditions.
- Understanding co-occurring conditions in ASD is crucial for diagnosis and treatment.
- Previous research has identified some common comorbidities, but less is known about their specific co-occurrence patterns.
Purpose of the Study:
- To identify statistically significant associations among co-occurring medical conditions in children with ASD.
- To improve the understanding, identification, and treatment of these associated disorders.
- To explore potential common pathways underlying these comorbidities.
Main Methods:
- A study of 2114 children (17 months–5 years) and 1221 children (6–17 years) with ASD.
- Clinician-reported diagnoses were grouped into 12 core conditions.
- Statistical analysis identified pairs of conditions with significantly higher or lower co-occurrence than expected.
Main Results:
- Previously known associations, like sleep disorders and anxiety in older children, were confirmed.
- New associations were found, including feeding disorders with sleep disorders (younger children), constipation with sleep disorders, feeding disorders with speech disorders, and constipation with speech disorders.
Conclusions:
- New associations among co-occurring medical conditions in children with ASD have been identified.
- These findings may help in understanding common underlying pathways.
- Further research can leverage these associations for improved clinical management.
Objective:
Children with autism spectrum disorder (ASD) have a high prevalence of co-occurring medical conditions, including speech, sleep, and gastrointestinal disorders (constipation and feeding difficulties); developmental delay; attention deficit/hyperactivity disorder; hypotonia; epilepsy; anxiety; disruptive behavior; pica; and eczema. Less is known about whether these commonly coexist in the same children. We sought to determine clinically meaningful, statistically significant associations among co-occurring medical conditions in children with ASD that could lead to better understanding, identification, and treatment of these disorders.
Methods:
We studied 2114 children with ASD aged 17 months to 5years and 1221 children aged 6 to 17years at 15 Autism Speaks Autism Treatment Network Registry sites. Clinician-reported diagnoses and problems were grouped into 12 core conditions. We determined the observed prevalence (O) of co-occurring conditions and the estimated expected prevalence (E) across the network, adjusting for sitevariability in the prevalence of individual conditions. Pvalues were calculated using a Cochran-Mantel-Haenszel test stratified by site. We identified pairs of conditions co-occurring more frequently than expected (O/E >1) and less frequently than expected (O/E <1) and highlighted statisticallysignificant differences.
Results:
Among the 66 condition pairs for each age group, we confirmed previously identified associations, such as sleep disorders and anxiety symptoms, in older children. We found some associations not previously described, including feeding with sleep disorders (younger children only), constipation with sleep disorders, feeding with speech disorders, and constipation with speech disorders.
Conclusions:
We have identified new associations among co-occurring medical conditions in children with ASD, offering the potential to examine common pathways.
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