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

3 comments:

  1. The point about hyperlipidemia is rather interesting. Especially considering that a large group of children go the opposite way - they have too little cholesterol. Then again, I seem to remember some research out of Japan that showed that some children were hyper- as well.

    I wonder why cholesterol goes to such extremes in autism.

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  2. Thanks for the comment MJ. I read your post on cholesterol last April and agree with your point about values heading the other direction in some cases. I don't know enough about cholesterol to give any informed answer aside from what I read about LDL and HDL and perhaps there might be some differences there. I think more important to this work is the cumulative factors involved in things like metabolic syndrome and the onward 'risks' from that. At the end of the day, until there is some universally agreed protocol for screening such parameters in cases of autism, snippets of research such as the Tyler paper are all we have.

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  3. Thanks for posting this!

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