Tuesday, 13 September 2011

Chronic illness and healthcare for autism

Three articles caught my eye today in relation to some recurrent themes on this blog about autism not being protective of other chronic conditions and how some of the most 'disabling' aspects of autism are not necessarily due to the presentation of overt symptoms or comorbidities.

The first paper by Tyler and colleagues* examined risk for several chronic diseases including obesity, high blood pressure and high blood cholesterol levels in autism vs. matched controls. They suggested that hyperlipidemia in particular, set adults with autism aside from controls but importantly noted that anywhere from a fifth to a third of the autistic population surveyed presented with one of the chronic illnesses specified previously. I don't need to say much more about this paper aside from the words 'it's about time'. It has taken long enough for society to realise that conditions such as schizophrenia might place someone at greater risk of some of these issues. Now perhaps autism can benefit from similar health screening.

The next paper by Lai and colleagues ** perhaps ties into several things already discussed on this blog in relation to the effects of unmet health needs. Lai looked at dental health, finding that 12% of parents questioned said their child with autism had unmet dental needs. Even 1 in 10 children who had been to the dentist were reported still to have unmet dental needs. Whilst they suggested that behaviour was one 'barrier' to getting those needs met, they also suggested that unmet dental needs were present across the autism spectrum, implying ability and severity were not deciding factors in this health care 'hole' but possibly also other things like cost. Dental hygiene and health is fast becoming an important variable in several health-related matters. How about oral hygiene and your risk of cardiovascular disease? With autism in mind, I have previously touched upon the need for some sleuthing when trying to determine factors associated with self-injury and aggression.

The final paper by Parellada and colleagues *** is the more 'feel-good' paper reporting not on unmet health needs or risk factors but rather what can be done to make healthcare more accessible to people with autism. I need to find out more about this paper so as to make a more detailed post on it but first impressions are that they were doing a pretty good job in looking not just at autism as a triad (dyad?) of symptoms but rather a more rounded approach encompassing things like nutrition and gastroenterology. Indeed realising that you have a person first and a person 'with autism' second, is a key advancement to removing some of the barriers that a label of autism might bring about and therefore making healthcare accessible to all.

* Tyler CV. et al. Chronic disease risks in young adults with autism spectrum disorder: forewarned is forearmed. Am J Intellect Dev Disabil. September 2011

** Lai B. et al. Unmet dental needs and barriers to dental care among children with autism spectrum disorders. JADD. September 2011

*** Parellada M. et al. Specialty care programme for autism spectrum disorders in an urban population: a case-management model for healthcare delivery in an ASD population. Eur Psychiatry. September 2011