I am a platypus of medicine: Comorbidity and friends.

[brightrosefox]

Post by Joanna Capello Paul.

Okay, so the above post on my Facebook has been getting a lot of awesome replies, and I wanted to share it here so people could see what I mean. I'm gonna copy the post itself here. If people's comments show, please don't bug the people.

Here is what I wrote:

So, fellow adult autists: Can we talk about autism comorbid conditions? When explaining the more annoying aspects of having an autistic brainworld to health professionals, the genuinely curious, and people who want to learn more, I've started talking more about autism's comorbidity. Because I have talked so much at length about cerebral palsy's comorbid conditions - which, in fact, can intersect with autistic comorbidities.

Also I ask all this since cerebral palsy is the result of static brain damage; ie periventrucular leukomalacia, which is closely related to, even can be a type of neonatal hypoxic-ischaemic encephalopathy. Cerebral palsy is technically a result of static non-progressive collective brain injury. So cerebral palsy itself stays as static damage, while its many comorbidities march on progressively, causing widespread chronic pain, a sort of premature organ aging ahead of chronological aging, bone and joint debilitation, muscle atrophy, etc - generally beginning in the late twenties, peaking in the mid thirties, and slowly moving forward through our lives.
CP alone is ugly and worrisome, but most research is so focused on children that older adult patients tend to be ignored. It's only recently that adults with cerebral palsy, specifically spastic CP, have been studied. Our systems are... I don't know the right phrase. Degrading? Slipping? Damaging? Certainly debilitating and disabling. As we hit our thirties, many of us do get worse. There has been a giant amount of self-denial in the CP community. It brings up a rallying cry of "I'm strong! I can fight this disease!" except strength isn't the point, you can't fight, and it's not a disease. It's a disability, and it's personal to each individual.

See, I'm spastic and ataxic hemiplegic, but mild enough that I've gotten "But you don't look disabled!" all my life. Even when my left side goes through classic flexion, internal shoulder rotation, toe walking, all very obviously (you see, it doesn't stay like that all the time, hence the mildness. But when it doesn it's obvious enough to get "What's wrong with your arm? Why are you limping so much? Were you in an accident?" comments.
However, the chronic illnesses that developed in my youth that we all ignored because we figured "it was just from CP" have gotten so much worse in my now 35 years. I am in a lot of fibromyalgia communities, for example.

Now! Since autism's comorbid conditions include anxiety disorders, sensory processing disorders, neurological disorders like ADHD and OCD, mental illnesses, epilepsy and seizures, visual problems, spatial problems, depth perception problems, I want to cross-check them with cerebral palsy's comorbids, which include... all of those, plus pain, joint issues, nerve issues, muscle pains, skin conditions.

But fellow autists, please correct me if I am wrong on things. I need to figure out how many of my comorbids are specifically connected to autism so I can sort them all out, charting and making patterns and checking them against the comorbids from cerebral palsy. What are other autism comorbids?
Also, I don't like saying things like "autism symptoms" since this is how I am wired from birth. Like cerebral palsy. So I've been saying "comorbid condition symptoms". Does anyone else do this?

Comments

[nightengalesknd.livejournal.com]

I have a saying: Anything that can affect the brain, can affect the brain.

It's not quite true, I'm sure. There are exceptions, things which only affect one part of the brain in one specific way. But most things that have the potential to affect the brain in some ways have the potential to affect it in other ways. (I haul this one out for medications a lot. Medications that are meant to help with seizures or mood have the potential to affect seizures or mood in the opposite direction too.)

So CP. Caused by damage to a developing brain. One neurologist I've worked with specified a "once normal" brain, meaning that people whose brains developed unusually before birth don't have CP, even if they have similar motor impairment symptoms. Other neurologists seem to call all motor impairment from early childhood CP, even if it isn't. I can't always tell if they disagree or just some of them aren't paying attention. Anyway. So CP is caused by damage to the motor areas of a developing brain. Hit in some places, you get leg involvement. Hit in other places you get arm involvement. Hit in some spots, spasticity. Other spots, dystonia. There are some patterns about where the brain gets hit. It tends to be most vulnerable around the ventricles, and in the places with less blood flow. But it isn't a sniper attack, more of a BB gun. So it makes sense that some people also get hits in the visual cortex and some people also get hits in a place that causes seizures and etc. And that people who are hit in more areas causing more motor impairment are more likely to also have more problems with learning, but don't necessarily.

So autism. We don't know as much about autism in the brain as we do about CP because things don't show up on regular MRIs as often. But it does seem to be related to differences in brain wiring, how the cells connect to one another. A lot of autism seems to be genetic but there is also more autism in former preemies, those who were the earliest. Who are of course, the ones more likely to have structural brain wiring differences for the same reason they were more likely to have CP. And it also makes sense that whatever wiring differences in autism can also affect other parts of the brain, such as the visual cortex or places that are vulnerable for seizures.

So I would imagine ANY brain difference that is common in one is common in the other. Learning problems, anxiety, depression, ADHD, seizures, visual problems, sensory integration problems. The frequency of those things in autism and in CP are different, probably due to the location of brain changes, but the higher likelihood of any of them are certainly higher than in neurotypical folks. Other things you speak of, such as chronic pain, I suspect are more likely secondary to muscle use differences from the CP than directly from the brain. But there are certainly pain centers in the brain, and autistics people often seem to process pain differently than non-autistic people so I may be wrong there

And even. . . well coordination problems are common with autism. The line between poor coordination and "mild" CP is often a really fine one, depending as much with the person doing the evaluating as with the person being evaluated. (I don't like using the terms mild/moderate/severe for CP because they don't actually have real definitions, but the scale I do like, no one has heard of.) The reason I didn't get my CP diagnosis until adulthood, I am convinced, is because I am right near that line and got refereed wrong as a kid.

[brightlotusmoon.livejournal.com]

Thank you for this. It makes me Think A Lot.

Hmm... are you in the CP group there? I think someone in the group is a physician. Is it you?

[nightengalesknd.livejournal.com]

I am in the CP group on LJ. I don't do Facebook. I try to read some groups sometimes but have a lot of trouble with the interface.

And I am a physician - developmental pediatrician in training. I specialize in autism and try to specialize in CP also but haven't been able to make that happen yet. And I'm an autistic CPer (self-dxed with both at age 12, formally diagnosed with both as an adult)

Wouldn't it be nice if the Expert People out there studying autism were actually studying this stuff, you know, by talking to us?