By Donna Williams

Most people are aware of the co-occurrence of treatable gut and immune issues co-occurring in a fairly large part of the autistic population (see Shattock, Waring, Gupta). It ain't rocket science to understand the effect of chronic digestive system and immune system disorders on impairing the efficient supply of nutrients to the brain. But whilst we become blinkered to focusing simply on the gut/immune issues in autism we may be blinkered to the role that severe chronic stress has to play in exacerbating and bringing such conditions to the surface and that for some people a large part of that severe chronic stress may come down to a treatable case of 'fleas'. Quite simply, if you give the dog enough fleas and no flea powder, eventually the stress is going to lead to a break down in the dog's health or bringing any pre-existing inherited weaknesses to the surface.   

Fleas are things, which interfere, distract, and disrupt. If we think of conditions such as epilepsy, mood disorders (such as Childhood Onset Bipolar COBD or depression which are now known to occur even in infancy), Tourette's (which can occur as young as age 2) or OCD as fleas, we might look at the mystery of many cases of 'autism' a little differently.   

Various studies show that the co-occurrence of Dyslexia, Scotopic Sensitivity, Epilepsy, Mood disorders, Tourette's and OCD is high in people with ASDs. If severe, these additional conditions are thought to likely compound (make worse) the developmental and information processing problems of autism. Furthermore, the majority of these additional conditions may be manageable or treatable either through dietary intervention, nutritional supplementation and/or small doses of medication (provided appropriate to the co-morbid condition) together with an environmental approach which is RELEVANT to not just the label 'autism' but the co-morbid conditions compounding and sometimes underlying the     information processing problems of autism. So what about addressing the fleas?  

For example, whilst ABA is surely useful in some forms, in some situations, with some people, it certainly isn't going to be so in all of its forms, in all situations or with all people. There may be little point addressing the persistent disabling behavioural and/or vocal tics of Tourette's or OCD through ABA (and it's likely to be extremely frustrating, perhaps even damaging to convince such a person their problems are a matter of learning appropriate responses) and to use ABA whilst ignorant to the mechanics of Bipolar could result in exacerbating very explosive and unpredictable behaviour, or even complicate unipolar depression which may then blamed on the 'autism' rather than the inappropriateness of the environmental approach. Rewarding children with sweets who have no immunity to fight Candida or rewarding people with food allergies or food intolerances with the very substances, which send them off their head, is madness. The water is awfully muddy and a market pushing THE approach to autism doesn't help. 
 
If the majority of cases of autism are actually compositions of a combination of co-morbid conditions combining to severely disrupt development, communication and information processing (not to mention the effect 'fleas' may have on chronic digestive/immune disorders), then the idea that someone who is severely autistic will grow up to be just as severely autistic, may in many cases depend on whether the compounding co-morbid conditions are recognized and addressed. Once the label 'autism' has been applied, many of the conditions underlying this may simply be overlooked. 
 
Many doctors, however, whilst acknowledging the high incidence of epilepsy occurring in autism (between 25-50% depending on whose studies you read) will overlook severely impairing behavioural tics attributable to treatable conditions such as Tourette's or OCD or disabling mood disorders underlying progressive phobic responses to overstimulation (such as Exposure Anxiety), withdrawal and self injurious or explosive behaviours, too often attributing these things instead to 'the autism'. Even when medication is given for such things, it is unfortunate that what may often be happening is that the person gets overly drugged in order to supress the behaviours rather than address the underlying biochemistry issues appropriately and comprehensively which may involve a much smaller dose of a more appropriate medication or combination of dietary intervention, supplementation and minor medication. When looking at the incidence of co-morbid conditions such as severe mood disorders, Tourette's or OCD, the idea of finding a cure for 'autism' may also be a myth.

There may be many answers in identifying and reducing all the compounding factors underlying the presentation of what gets called 'autism' and what we need are multidisciplinary experts who are not blinkered to look just for the ' triad of impairments ' associated with autism but actually ask about the indicators of these other co-morbid conditions, perhaps underlying or exacerbating conditions, as an indicator of how to address the underlying causes of each particular person's autism so fewer people are so severely effected and real wholistic and appropriate help comes at an earlier age. However much many high functioning people on the autism-spectrum may celebrate their 'autism' and see it as a 'culture', finding answers to the fleas which exacerbate or underly autism is not about loving some myth ideal of normality nor hating autism but about caring about the freedom of people to develop beyond the very real limitations of what can be a severe disability. 
 
and now...some excepts from stuff on the web...
 
In fact: 
 
As many as 65% of children with ADHD also struggle with at least one other learning disorder, and sometimes bipolar disorder and/or Tourette’s Syndrome (TS) [4-5]  5-10% of all children have dyspraxia and of these 50% also have ADHD [4, 8,9]. 

Some 30 to 50 percent of children with dyslexia have ADHD and vice versa. (The Dyslexia Research Institute in the UK puts this figure at 60%) [4]. 

People with dyslexia are three times more likely to suffer from depression than are people without a learning disability [4]. 

35% of students with learning disabilities reportedly do not finish high school (the number is actually much higher since many drop out without their learning disabilities ever being officially diagnosed) and of those who do finish, 62% do not have a full-time job one-year later [5-6]. 

It is estimated that 60% of people with Tourette’s Syndrome (TS) have ADHD and 50% have Obsessive Compulsive Disorder (OCD) and that there is a high association of these two disorders in their family histories [7-8].  
 
and 
 
According to a recent study at the Duke University Medical Center, some cases of autism may  be associated with a family history of depressive illness. Autism, a disorder marked by social withdrawal and an inability to interact with the environment, seems to appear more frequently in families with a strong history of bipolar illness, the study found.  In connection with his study of 40 autistic children, Duke researcher Dr. Robert DeLong reported in the Journal Developmental Medicine and Child Neurology that in 14 of the cases reviewed  there was a strong family history of depression or manic depressive illness. 
 
The study hypothesized that when manic depression strikes in early infancy, it may blunt the child's cognitive, social, and emotional development irreversibly, so that the child's brain never develops the framework in which to build communications skills. In extreme cases, this may lead to clinical autism. (Reprinted from the National DMDA Newsletter, vol. 7, no. 1)  
 
and elsewhere  
 
CONCLUSIONS: Comorbidity between Tourette's disorder and bipolar disorder does not appear to be due to chance co-occurrence of the two disorders. Although a genetic mechanism may play a causal role, in the absence of family studies an explanatory model involving the concept of canalization of basal-ganglia-mediated dysfunctions is offered. In such a construct, Tourette's disorder would be a likely accompaniment to other conditions, including bipolar disorder, whose pathogenic determinants might channel through neural pathways involving the basal ganglia. The presence of significant developmental disabilities may further enhance factors culminating in comorbid Tourette's disorder and bipolar disorder.  
 
Kerbeshian, J., Burd, L. Tourette’s Disorder and Bipolar Disorder: An Etiologic Relationship.
American Journal of Psychiatry 1995, 151, 1646-1651.  

and 

Autism Presents comorbidly with a number of other psychiatric disorders, further compounding diagnosis, such as Tourettes syndrome, obsessive-compulsive disorder, and bipolar disorder. There is the following Information regarding a review of literature of comorbidity of specific symptoms in persons with autism: 64% had poor attention or concentration; 36% to 48% were hyperactive; 43% to 88% showed morbid or unusual preoccupation; 37% exhibited obsessive phenomena; 16% to 6% showed compulsions or rituals; 50% to 89% demonstrated stereotyped utterances; 68% to 74% exhibited stereotyped mannerisms; 17% to 74% had anxiety or fears; 9% to 44% showed depressive mood, irritability agitation and inappropriate affect; 11% had sleep problems; 24% to 43% had a history of self-injury; and 8% presented with tics. 

and 

The neurobiologic/psychiatric conditions occurring with autism that may respond to pharmacological treatment and thereby relieve confounding symptoms that impair the autistic individual's ability to function can be subdivided into 6 large categories:  
 
Seizure-Related Behavioral Symptoms 
Hyperactive-inattentive impulsive-distractible symptom cluster 
Tics, Tourette syndrome, and movement disorders 
Compulsive-sameness oriented-explosive symptom cluster 
Mood disorder symptom cluster 
Seizure-related behavioral symptoms 
Other or nonspecific behavioral symptoms and for those who don't know what Tourette's is...
 
Tourette Syndrome (TS) is a neurological disorder characterized by tics -- involuntary, rapid, sudden movements or vocalizations that occur repeatedly in the same way

Although the word "involuntary" is used to describe the nature of the tics, this is not entirely accurate. It would not be true to say that people with TS have absolutely no control over their tics, as though it was some type of spasm; rather, a more appropriate term would be "compelling." People with TS feel an irresistible urge to perform their tics, much like the need to scratch a mosquito bite. Some people with TS are able to hold back their tics for up to hours at a time, but this only leads to a stronger outburst of tics once they are finally allowed to be expressed. 

Another important thing to remember about coprolalia is that although the media has sensationalized this symptom, it is actually rare, occurring in less than 30% of people who have a severe case. 

Simple tics are movements or vocalizations which are completely meaningless, whereas complex tics are movements or vocalizations, which make use of more than one muscle group or appear to be meaningful. 

www.donnawilliams.net

Permission granted from Donna Williams to reprint this article.  

Posted 03/19/2006