Comorbidities

Emily Kay
Dec 7, 2024
12 min read

https://www.youtube.com/watch?list=PLsEvtZl1d5vDuCudMXfhEjbo8IRofyxyU&v=ZraDnvGLLDI

Intro

Hi, I am EmKay Archlink. I am the founder of Archlink, LLC, the author of Unseen Powers, and a self-proclaimed advocate for those with Autism Spectrum Disorder. I was professionally diagnosed with Autism Spectrum Disorder: Level 2 in September of 2022, and I have been working to educate myself on the topic ever since.

With that being said...

Welcome to RAW-tism, a podcast about my autistic experience and opinions on the world. On this podcast, I will be raw and unfiltered. You are always welcome to disagree with me as long as you do so respectfully and with no name-calling. Any usage of the r-slur will get you immediately blocked.

Explaining Comorbidities

In the past, an autism diagnosis was viewed as a death sentence. Parents didn’t want their children to be “lesser” compared to their peers. The troubles those with undiagnosed autism faced were ignored and help that is desperately needed help was rarely given. The few diagnoses found were given to young boys. It was believed that the kids simply “grew out of it” with time. No adults, or females of any age, were believed to have autism. This is simply untrue. I am living proof as an AFAB (assigned female at birth) individual diagnosed at 22-years-old.

Now that autism has been the subject of more research, it is more commonly known that not only can anyone be diagnosed with autism, but they also have one of the millions of comorbidities that come along. The dictionary definitions of comorbidity are “the simultaneous presence of two or more diseases or medical conditions in a patient” and “a disease or medical condition that is simultaneously present with another or others in a patient.” The second definition better fits what I want to discuss about the subject. Basically, the diagnoses that tend to be added when diagnosed with autism. For those who listened to the previous episode, “My Diagnosis,” you would know that my comorbidities include ADHD and OCD, which are both pretty common.

Prosopagnosia, the difficulty of recognizing faces or “face blindness,” is a common comorbidity to an Autism Spectrum Disorder diagnosis. It is a neurological disorder caused by how the individual’s brain is formed. Researchers have suggested that it could be a symptom of autism itself. Still, according to the DSM-5-TR (The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision), it is not yet labeled as such.

Depression is another comorbidity that is commonly used in casual conversation rather than its intended meaning as a diagnosis. Depressive disorder is a prolonged experience of loss of pleasure or interest in things the individual would otherwise enjoy. It can also be diagnosed as a temporary condition called Situational Depression, which is usually reserved for those grieving or experiencing big life changes. According to Medical News Today, “Autism and

depression are distinct conditions that can co-occur in some individuals. Autistic people have a higher risk for depression and may be more likely to experience symptoms, such as feelings of hopelessness and social withdrawal. Treatment for depression is similar for autistic people and those without autism.” I have heard the same information from other sources in the past, but I

liked the way this quote sounded when I was fact-checking on the internet. The sad truth of this comorbidity is that depression is much more common amongst autistic people than allistics (non-autistic people, as explained in my first episode, “Let’s Not Be Ableist”). Depending on the source, autistic people are found to be 3-7 times more likely to experience suicidal ideation, injurious behaviors, and death because of their struggle with depression.

That being said, please reach out if you think you might be included in this statistic or are just tired of being down all the time. Your life is worth living. I promise you that. I understand that sometimes it doesn’t feel that way, but those problems are temporary, and suicide is permanent. Do those who love you, including me, a favor and be patient. Life will get better. I know you’ve got this if you try your best. Resources can be found in the description for this episode, on the transcript for this episode (which is always free on my Patreon), and on any search engine if you type a variation of “I need help” or “depression help.”

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Explaining Comorbidities (cont'd)

ADHD (Attention-deficit/hyperactivity disorder) is another clinical diagnosis that has become a more self-diagnosed disorder within younger generations. They end up being right some of the time, but there are many who misdiagnose themselves. If you can, please see a professional before you identify as part of this demographic. You can use any healthy coping mechanism from those with a disorder to help in your own life, but claiming a difficulty that you don’t have is quite harmful to society’s view of those who actually have these diagnoses. ADHD isn’t simply having the attention span of a toddler and needing colorful toys in the classroom. It may look that way to the observer, but it’s much more intricate than that. As I am not confident in my ability to explain this particular disorder well, I will quote from Psychiatry.org:

“Many children may have difficulties sitting still, waiting their turn, paying attention, being fidgety, and acting impulsively. However, children who meet diagnostic criteria for ADHD, differ in that their symptoms of hyperactivity, impulsivity, organization, and/or inattention are noticeably greater than expected for their age or developmental level. These symptoms lead to significant suffering and cause problems at home, at school or work, and in relationships. The observed symptoms are not the result of an individual being defiant or not being able to understand tasks or instructions.

There are three main types of ADHD:

Predominantly inattentive presentation.

Predominantly hyperactive/impulsive presentation.

Combined presentation.

A diagnosis is based on the presence of persistent symptoms that have occurred over a period of time and are noticeable over the past six months. While ADHD can be diagnosed at any age, this disorder begins in childhood. When considering the diagnosis, the symptoms must be present before the individual is 12 years old and must have caused difficulties in more than one setting. For instance, the symptoms can not only occur at home.”

ADHD, as a comorbidity to ASD, is often referred to as AuDHD, a combination of the two. As someone officially diagnosed with both, I enjoy identifying as being AuDHD. It’s a fun way to feel like a part of a community of fellow people who happen to need help in similar areas. A common comorbidity to ADHD that likes to tag along with AuDHD is APD (auditory processing disorder). APD is difficulty processing auditory stimuli. With this disorder, someone with normal, and sometimes even above normal, hearing can have difficulty understanding what exactly they are hearing. I struggle from this and it makes my sensory issues a lot worse.

OCD (obsessive-compulsive disorder) is by far the one I hear misused most in common speech. Every time I hear, “I’m a little OCD,” I die a little. If I had a dollar for every time people tossed around OCD casually, I’d be f^cking rich. OCD is “a long-lasting disorder in which a person experiences uncontrollable and recurring thoughts, engages in repetitive behaviors, or both.” It’s not needing your work area to be organized or hating seeing dust on surfaces. It’s a disorder that causes significant distress in the diagnosed party’s daily life. Like depression, OCD is its own distinct disorder that can often have similar symptoms to ASD or can concur. A study in Europe found that 17% of children diagnosed with ASD are also diagnosed with OCD. I personally have been diagnosed with OCD, but the professionals I’ve talked to have suggested that I could have OCPD (obsessive-compulsive personality disorder). This differs from OCD mostly in that the obsession and compulsions lean more toward controlling the world around them. Those with OCPD are stubborn and conscientious. They have an idea of how the world should work and have difficulty deferring from it.

For me, I was so stuck on the rules of the Catholic Church growing up that I was rigid with the concept of rules, very critical of myself, and would experience extreme distress when others would break these rules. In my mind, there was no such thing as an exception or extenuating circumstance. Thanks to therapy, I am in a much better place now. I still feel distressed, but I have learned to cope and accept that I can’t control everything around me. Some rules will be bent or broken, but that’s okay: there will either be consequences or exceptions. Even if I don’t understand the reasoning, I can accept what is happening and move on. It’s been a real struggle, which gives some insight into why using the term lightly bothers me so much. It is such a huge part of what makes my life difficult, and I feel horribly upset when someone uses the disorder as a cute little joke about neatness. Yeah, I like things neat and organized, too, but OCD is more about behaviors like obsessively checking the locks on the doors, pressing the lock on my car remote three times, and having to redo parts of my routine if I got them slightly wrong. If you can’t sleep because you can’t remember whether you put your work water bottle in the

correct spot but are too exhausted to get up and check, so you’re stuck in a loop of questioning your will to live, you may need to see a professional about an OCD diagnosis. If you just like everything organized and it’s slightly annoying when you see messes, you’re just a neat person, and that’s okay! Being who you are is amazing. You don’t need a bunch of letters to describe your personality.

Echolalia, as mentioned in a previous episode, “Struggling with my filter,” is another common comorbidity for ASD. Echolalia is the echoing of prior words or phrases heard or spoken as a vocal stim. There are many different types of echolalia. I already described my experience in the aforementioned episode, “Struggling with my filter,” so I will keep this explanation brief.

Echolalia is explored in four different categories. The first category is immediate or delayed. Pretty self-explanatory: immediate echolalia is the repetition immediately as the words are originally spoken. Delayed echolalia is when there is a bigger space of time between the original statement and the repeated words. This usually leads to confusion and does not fit into the conversation.

The second category is communicative or semi-communicative. Communicative echolalia has meaning within the conversation. If I ask the baby I nanny if he wants milk, that question is usually answered as a “yes” or “no,” but the baby will most likely just repeat “milk” to show that it is what he wants. Semi-communicative echolalia’s echoes are less clear from the conversation, which I see as closely related to delayed echolalia. When the baby just starts repeating “milk, milk, milk” long enough after I’ve asked the question and it no longer makes sense at the moment, that would be categorized as semi-communicative and fit better as delayed echolalia because the echo is later and no longer fits within the current conversation.

My favorite category is unmitigated or mitigated. Mitigated speech is basically whether or not the repetition is in the same tone and pitch as how the original speaker said a word or phrase. Unmitigated speech is just repeating the same word or phrase in the same rhythm without the same tone or pitch. I love mitigated speech; it is so funny when the kids I nanny repeat something I’ve said in a completely different tone or pitch. It sounds like they are mocking me, but they are just learning different speaking methods by repeating my words.

The last category is ambient or echoing approval. The echolalia that I experience, for the most part, as described in a previous episode, “Struggling with my filter,” is considered ambient echolalia because I tend to subconsciously repeat words that I hear within my environment. Echoing approval is similar to communicative echolalia; the same example applies here. The same baby repeating “milk” to show he wants me to get him some will also sometimes echo my words to show approval of the idea I present. Echolalia is common in toddlers as they learn to

speak, but this does not automatically mean that the child has autism or will continue to have echolalia as an adult. This is another example of how I see autism as feeling like a toddler in an adult body. Autistic children tend to learn language a little differently than allistic children. What are normal behaviors in children can become uncommon behaviors as adults. These differences can carry on into adulthood when they develop into disorders that impact everyday life.

PTSD (post-traumatic stress disorder) is pretty much what it sounds like a disorder that causes stress based on post-traumatic events. PTSD can consist of flashbacks, intrusive thoughts, nightmares, triggered distress, and physical responses to mental strife. Adults with autism are much more likely to experience symptoms of PTSD than allistic adults. This is, unfortunately, because the world is not structured in a way to help autistic children, and trauma is created that affects autistic people later in life. Being neurodivergent is a great recipe for bucketloads of trauma, even when your early life looks perfect on paper. This is one of the reasons why I advocate for autism education and acceptance. If we can change how the world views autism, maybe we can help make PTSD and other similar disorders less common in autistic children.

Now for one of my favorites, which is GAD (generalized anxiety disorder). I say this sarcastically because anxiety has been a hugely negative part of my life. Anxiety is something that everyone feels at some point in our lives and helps us filter the world around us. Anxiety disorders develop when someone’s natural anxiety is being a bit too dramatic and affects their daily function. Being anxious about a test is normal. Feeling constant worry and nervousness about the basic things in life is not supposed to be normal, but for some, it is their reality. GAD is very likely to be a comorbidity for those with autism. The fear of being outed to the world as “different” or “wrong” is extreme and drives autistic people to mask their behaviors. Masking occurs when neurodivergent people suppress their “quirkiness” in order to appear neurotypical, which I’ll explain more deeply in a future episode. Anxiety helps strengthen an autistic person’s need to stim, ability to dive head-first into special interests, and resistance to changes.

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Explaining Comorbidities (cont'd)

GI (gastrointestinal) issues are a very common comorbidity to autism. This can include GERD (gastroesophageal reflux disease), lactose intolerance, constipation, IBS (irritable bowel syndrome), hiatal hernia, Crohn’s disease, peptic ulcer disease, hemorrhoids, Coeliac disease, and gluten intolerance. I may go into further depth with these in a future episode, but I don’t currently have plans to cover them. All I will say for now is that I personally suffer from lactose intolerance, chronic constipation, and gluten intolerance.

Connective tissue disorders are another comorbidity common with an ASD diagnosis. I am not well-versed in these, but the most commonly mentioned ones are EDS (Ehlers-Danlos Syndrome) and hEDS (Hypermobile EDS). Dyslexia is another comorbidity that I do not suffer from, nor know much about other than its definition as a learning disability affecting the ability to read and process written language. The way I view it is having a form of APD for reading instead of hearing. Unfortunately, I do not have as much knowledge and information to share for these last few comorbidities. Still, I’d love to hear about your experiences or the experiences of people you know with these disorders. Please feel free to reach out to me at EmKayArchlink@gmail.com or RAWtismpod@gmail.com, and I’ll gladly record an updated episode with more to share!

This is not a comprehensive list by any means, but I hope that you learned something new about autism comorbidities. If it was not clear from my anecdotes within this episode, my comorbidities include ADHD, OCD, MDD, echolalia, PTSD, GAD, GI issues, and APD. I doubt these are all of them, but they are the ones I know currently. I hope I satisfied your curiosity about my life while also teaching you about the realities of ASD that go beyond just having an autism diagnosis.

Outro and Self-Promotion

Regardless of your thoughts and feelings toward me, I have a love for every one of you. You are wanted by many, loved by many, and so many want you to stay in this world. I am one of these “many”s and will always be. I hope you enjoyed this episode, and thank you for listening to RAW-tism.

Once again, I am EmKay Archlink, the founder of Archlink LLC where our mission is to spread autism acceptance and education. Supporting this podcast supports our mission. If you’d like me to come talk at your school, please fill out the Google Form in the RAW-tism section of EmKayArchlink.com.Your support means everything to me. I love you all. Remember to drink water, eat some nummies, and have your best life. Bye!!

Would you like to see more of me? In that case, visit emkayarchlink.com for links to my TikTok, Instagram, and YouTube. My book Unseen Powers is available in hardback, paperback, or digitally through Amazon.

Sources Used:

May 21, 6:13 PM

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3679259/

https://link.springer.com/article/10.1007/s10803-013-1777-z

May 21, 6:37 PM

https://www.nhs.uk/conditions/face-blindness/#:~:text=Prosopagnosia%2C%20also%20called%20face%20blindness,to%20help%20you%20recognise%20people.

https://my.clevelandclinic.org/health/diseases/23412-prosopagnosia-face-blindness

https://pubmed.ncbi.nlm.nih.gov/32150706/

https://www.medicalnewstoday.com/articles/autistic-depression #:~:text=Is%20depression%20common%20in%20autistic%20people?&text=The%20Centers%20for%20Disease%20Control,depr ession%20than%20those%20without%20autism.

https://www.autistica.org.uk/what-is-autism/suicide-and-autism

May 21, 6:51 PM

https://www.nimh.nih.gov/health/topics/attention-deficit-hyperactivity-disorder-adhd #:~:text=Att ention%2Ddeficit%2Fhyperactivity%20disorder%20(,interferes%20with%20functioning%20or %20development.