Right at the beginning of this series, I suggested that Asperger's by itself isn't a debilitating condition. I stand by this. It is not simply Asperger's that is the problem but the co-conditions which frequently exist alongside it. Often these co-conditions are called comorbids but it is a word which I have stopped using because there are limitations on what can and cannot be referred to as the a comorbid. I'm not ready to accept those conditions.
It's hard to determine whether or not a co-condition is an entirely separate condition existing at the same time as Asperger's or whether it is simply a facet of the Asperger's itself. Sometimes the conditions seem to start out as part of the aspergers but separate later into fully fledged conditions of their own - sometimes it goes in the opposite direction.
I think that it varies from person to person and from condition to condition.
When a co-condition exists as a part of aspergers, it is never as severe as the condition would be by itself. Many of the lesser symptoms manifest themselves and there are social and functional problems which arise as a result. Although these mini-conditions aren't as severe, there is a good chance that a person with aspergers could display a smattering of mini-conditions all of which combine to make their own lives more difficult.
Some of the most common co-conditions are as follows;
- OCD Obsessive-Compulsive Disorder
- SPD Sensory Processing Disorder
- ADHD Attention-Deficit Hyperactivity Disorder
- Tourette's syndrome
- Bipolar Disorder
- Learning Difficulties and Non-Verbal Learning Disabilities
I don't have a lot of room in this post to describe each condition and I'm by no means an expert on any of them. I'll try to highlight what I see as the differences between the condition as part of aspergers versus the condition on it's own but please don't take this a medical advice - it's purely opinion.
OCD Obsessive-Compulsive Disorder
Asperger's already contains some elements of obsessive-compulsive disorder. It is most notable as one of the driving forces behind the need for routine. This, I think is part of "normal aspergers" and I think all aspies have OCD to one degree or another.
Obsessive-compulsive disorder as a co-condition manifests itself in a number of ways with Asperger's. In particular, "lite" OCD can combine with the Asperger's special interests to create compelling and sometimes financially difficult collections. This is the sort of thing which you see on television about Star Wars collectors who have every single figure, spaceship. poster, book - even cutlery. This might not seem to have a great impact on the persons life however you need to think of the social consequences of inviting friends over to a house filled with memorabilia and also the problems of needing to own certain items. Sometimes such OCD desires can actually cause aspies to commit crimes.
Of course, co-condition OCD is nothing compared to its full-fledged counterpart. OCD can cause an individual to continually go through a repetitive set of unnecessary routines. This can make simple things like "leaving the house" become a three-hour job where every appliance, tap, light and lock needs to be checked several times over.
Sensory Processing Disorder
Sensory Processing Disorder is another condition which seems to be part of the core Aspergers condition. In particular, SPD is responsible for the lack of eye contact, the intolerance to loud noises and the difficulty wearing certain clothes. Once again, I believe that most people with Asperger's have this to one degree or another. When SPD is severe enough to be identified as a co-condition with aspergers it moves from simple difficulty with the environment to major levels of intolerance.
People with SPD as a co-condition will often find themselves completely unable to enter a room because of ambience issues. These can be caused by issues with lighting, sound or textures. They have great difficulty wearing certain clothes and may even have difficulty wearing clothes at all. It's obvious how an SPD could turn aspergers from a "passable" condition into something which causes the individual to retreat from society.
Many people with SPD as a co-condition need to wear suppressants such as sunglasses, earphones or gloves when they're out and about.
SPD has a life of it's own as a completely separate condition. In it's severest forms, it can prevent children who are particularly resistant to touch from playing with others, and may even interfere with their relationship to their parents.
Attention-Deficit Hyperactivity Disorder
ADHD and it's sub-condition ADD (the non-hyperactive type) are some of the most frequently misdignosed components of Aspergers. Children with ADHD are extremely distractable by outside influences but tend to "zone out" in close discussion. Sometimes it feels impossible to get their attention. ADHD/ADD can significantly impact learning as children have difficulty paying attention to the right signals and difficulty staying on track.
A child with aspergers and an ADHD comorbid will have a much more difficult academic life than a child with only aspergers.
Most people with aspergers suffer from depression in one form or another. After all, given the the hardship that many people with Asperger's have in their lives, depression is to be expected. Some aspies cope well with depression, showing only a few outward signs of their inner sadness.
When depression takes over a person's life to the extent where they either start to self harm or seriously consider suicide, it stops being a merely irritating co-condition and becomes a fully fledged condition in its own right.
Sometimes however, the aspie isn't actually sad at all. Sometimes it is simply their lack of expression, both facial and tonal, which leads people around them to believe that they are depressed.
One final note on the misdiagnosis of depression, Sometimes self harm is considered to be depression when in fact it is actually a sensory thing. A good example of this is when people cut themselves or when they do things such as biting their nails down to the skin level. Sometimes such actions are about enjoying a feeling because some aspies have such high pain tolerance that they need intense feelings to feel anything much.
This is one of the conditions which has reduced my usage of the word "comorbid". Apparently Schizophrenia and Aspergers are supposed to be mutually exclusive. I do not believe that this is the case. I know people who have shown signs of Aspergers throughout their lives. They've since "developed" schizophrenia. If a diagnosis of schizophrenia starts with the person hearing voices, something that generally isn't present from the early ages, how then does someone separate it from Asperger's which shows up in childhood?
Anxiety is closely related to Asperger's and also to SPD and OCD. Many people with Asperger's are naturally anxious but this does not necessarily mean that they suffer from anxiety. To suffer from anxiety is to have persistent worries on such a frequent basis that it interferes with ones daily life and routines.
Sometimes, anxiety comes on in a wave, called a panic attack which lasts about ten minutes. For many people, these attacks come while doing things that they do every day such as shopping. It may simply be that some environmental conditions such as the number of bystanders or the volume of music has changed.
Unlike most conditions discussed here however, people are not usually born with true anxiety, it tends to be developed over time. The extreme form of anxiety, Post Traumatic Stress Disorder (PTSD), results from violent emotional trauma. Sometimes people with Asperger's can be more open to PTSD because of some of the memory issues associated with the condition or because their naturally anxious conditions exacerbate "normal" trauma.
Tourette's syndrome is similar to the ticks and physical and verbal stimming that people with Asperger's tend to do. Once again, while Asperger's itself tends to display some of the characteristics, there is a significant difference between Tourettes as a separate disorder and the co-condition of Tourettes symptoms with Aspergers. In Aspergers generally, facial tics and stimming (Simple Tourettes) may impact social functioning but there is little comparison with the wider issues of complex Tourettes, which involves more complex movements, seizures, utterances and self harm.
There are two major types of Dyspraxia, verbal/oral and motor. Verbal dyspraxia is a condition which it difficult to understand the speech of people. As a co-condition in Asperger's, dyspraxia can be likened to the monotone and speech issues that aspies suffer from. Motor dyspraxia can be likened to many of the coordination issues associated with Asperger's and low muscle tone.
As you would expect, full-fledged dyspraxia has considerably greater impact on the individual.
Some people with aspergers tend to be a little more polarised in their emotions - either very happy or very sad but usually not "neutral". It doesn't mean that they have bipolar disorder. I sometimes wonder if meltdowns are part bipolar - they're obviously related to some of the other co-conditions too.
What is obvious though is that there is some link between aspergers and bipolar. I'm constantly surprised by how many aspies have both conditions and how many people with purely aspergers talk about having a bipolar parent.
General Learning Difficulties and NVLD
Learning difficulties and Non-Verbal Learning Disabilities (NVLD) are quite common with aspergers. Although children with aspergers often have a great vocabulary, they often have problems reading and writing text. In particular, this comes out when they're called upon to do word-based mathematics problems.
I know that many aspies have difficulty in this regard but the presence of full-fledged NVLD can have such a significant impact on a child's learning abilities that they struggle, even with special education support, for the remainder of their academic lives.