The co-morbid concept is dicey

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Merriam Webster definition

To me either something is an autistic trait or it is not. Not every autistic is going to have a co-morbid condition but not everybody is going to have an autistic trait. Looking at the definition above the flu can be defined as a co-morbid of autism.

From what I see there are two main reasons people are calling things co morbid of autism

1. Since autism and autitistic traits have been seen as so bad for so long it has been neccessary to point out and emphasize the positive. It is better public relations to call a condition that is impairing a co morbid then an autistic trait

2. If a condition is common amoung autistics but the relationship to autism is not or poorly understood it is sounds better to say it is a co mordid rather then we don't know.

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Sockpuppets, astroturfing and anti-stigma campaigns
Pharmaceutical Industry Agenda Setting in Mental Health Policies

Richard Gosden and Sharon Beder Excerpt

The use of sophisticated public relations techniques for setting political agendas has become a standard practice in most advanced democracies. The consequences are slowly becoming apparent. The system of representative democracy is being reshaped into a new kind of “managed corporatocracy” in which public opinion and government policy are custom-made products that can be shaped, packaged and sold by skilled public relations experts.

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I'm not sure I see what you're getting at, the definition is perfectly clear to me, and your example of the flu is spot on. Which common co-morbidities do you feel are part of autism rather than independent conditions?

As far as your two points go, I would say:-

1) If the conditions are co-morbid then by definition the person is still autistic. I fail to see how this would improve the situation for anyone facing discrimination - they would now have two or more labels to be judged by, and one of them is still "autism". Which of the common life-long co-morbidities have significantly less stigma? Not many I would think. In my experience, prejudiced or ignorant people don't care what fancy names conditions have, they're just going to hear "nutjob" or "ret*d" whatever words are used.

2) Saying something is co-morbid with autism is not the same as saying "don't know". It is saying that a separate condition is present which has a diagnosis and symptoms which can also be clearly identified in people who are not autistic. The biggest single co-morbidity for autistic people is probably depression or anxiety. They occur in autistic people at a much higher rate than the general population, and we can make some pretty good guesses why that is. But they are still separate conditions that anyone could have; and happy, carefree autistic people are not considered any less autistic.

Are you autistic?

The question, during a diagnostic assessment, is frequently (using a specific example)

Is the client an autistic person with ADHD traits, or an ADHD person with autistic traits?

There are many times when this distinction is difficult to assess.

ASPartOfMe- you've brought up something that is tickling my brain. Something I learned in my two social statistics classes. Maybe another member will know more about this.

To have, let's say two, co-morbid "disorders," these would be our variables. We would want to know are these variables truly different from each other, or are they the same thing? There is a procedure called canonical correlation where you can check the two variables against each other.

I only barely remembered this or vaguely understood it to begin with. Another person could tell you how this is done to see if say, diagnosis 1 autism and diagnosis 2 ADHD truly are separate, or if one set of behaviors is a result of the other set of behaviors.

But we as regular people can do what the analysis is saying. Put the two things each in their own column and list all the things about them that you have. If a significant number of one disorder ALSO occurs in the second disorder, you can be pretty sure that you don't have one of those two disorders. Whatever is left over, you can ask yourself, why am I doing this? There may be a THIRD issue that you are not considering, which we would call spuriousness. The third issue could be causing some of the symptoms or behaviors in your columns. So the third issue could replace one or more of your previous variables or co-morbid diagnoses.

Flu CAN be 'co-morbid' with autism. So can tooth decay.

Co-morbid just means you have two issues going on at once. So I dont know what the problem is that you're having with the concept.

Yes I am autistic.

Every autistic trait is a trait non autistic people have and some of them are quite common.

I would say executive functioning is where sensory sensitivities were a few years ago. Considered a common co morbid but not a trait. Now sensory is considered a diagnosable criteria

The questions are what percentage of autistic people must have the trait before it is considered a co morbid, what percentage of autistics must have it before it a diagnosable trait?. Breaking it down further should the trait be impairing, significantly impairing, or is it enough to say the person has the trait?. Right now there are no guidelines, it is just mush, what opinion makers feel to be true.

Last edited by ASPartOfMe on 15 Mar 2016, 8:31 am, edited 1 time in total.

If that is the standard the concept is totally useless. When people talk about co morbids it is another condition that occurs enough times in autistics to make it a consideration in disgnosing and treating autistics

I would say in that case that your confusion is justified - but only in the sense that your original understanding of the word is correct (e.g. flu could be co-morbid), and people using in the way you just described above are probably using the word incorrectly. Listing common co-morbidities may be useful in medical studies, or for deciding if a patient requires other assistance, but by definition should not be part of the diagnostic criteria for the autistic spectrum condition itself.

I think that's a slightly different issue than the shifting of the diagnosis. IMHO, updating diagnostic criteria to better represent a condition is the right thing to do, just as any scientific theory should be open to amendment when better data become available. But it should only be changed where the trait in question is truly an essential part of autism. Easier said than done, of course, especially where there is disagreement among the "experts"!

Let us remember the World Health Organization's ICF (functionality) survey among autistic individuals being conducted by leading researchers and clinicians worldwide. The survey is expected to be completed and published in September. The goal of the survey is, first, to identify those functionalities that appear to be characteristic or co-morbid among autistic individuals, and, second, to evaluate the validity of such functionalities within clinical settings. This monolithic effort could add dozens (or hundreds) of possible functional characteristics and co-morbids within an autism diagnosis. In other words, the spectrum could get bigger and more spectrumie than before.

Well that will be interesting.

Indeed. It won't, of course, change the diagnostic criteria, but it should give a broader description of diagnoses' effects within an individual's life.

When the professional autism community or more broadly the professional psychiatric community refer to co-morbidities of autism, they share an understanding that goes far beyond the Merriam Webster definition. They mean a condition that in our experience tends to co-occur with autism to a significant degree. They mean it in a helpful sense: if you diagnose autism, also check for: mood disorders, anxiety disorders, ADD, learning disorders, substance abuse, and so on. They are also suggesting that if you have trouble making sense of a slew of symptoms in an individual, you might not be looking for just one diagnosis but two. The treatment plan, also, may need to provide relief from the co-morbidities as well as strategies for dealing with the autism.

In short, co-morbidity is psychiatric or medical jargon, something which is well understood by participants in the field but often confusing to those outside.

I find it annoying when people confuse actual autistic traits with co-morbities. If I tell someone I have ADHD/focusing issues or anxiety and depression they later ask about autism. Why would they do that?