Asperger's Disorder may not be the only psychological condition affecting a certain individual. In fact, it is frequently together with other problems such as:
- Attention Deficit Hyperactivity Disorder (ADHD)
- Oppositional Defiant Disorder (ODD)
- Depression (Major Depressive Disorder or Adjustment Disorder with Depressed Mood)
- Bipolar Disorder
- Generalized Anxiety Disorder
- Obsessive Compulsive Disorder
Attention Deficit Hyperactivity Disorder (ADHD)
Attention Deficit Hyperactivity Disorder presents with difficulty in focusing (inattention), hyperactivity and impulsiveness. Almost 60-70 % of children with Pervasive Developmental Disorders ( = PDD or Autistic Spectrum Disorders) have severe enough inattention, hyperactivity and impulsiveness to meet the diagnostic criteria for ADHD. Technically, if a child is diagnosed with any of the PDD diagnoses (Autistic Disorder, Asperger's Disorder, PDD-NOS or others), a separate ADHD diagnosis cannot be made. However, I believe that it is important to recognize the presence of co-existing ADHD since this syndrome can respond to medication treatment, unlike the core PDD symptoms. When ADHD co-exists with Asperger's Disorder, anger may easily turn to aggression because of the individual's impulsiveness. Methylphenidate (Ritalin, Concerta, Metadate, Focalin), dextroamphetamine (Dexedrine, Adderall), atomoxetine (Strattera), bupropion (Wellbutrin) or tricyclic antidepressants (imipramine, nortriptyline and others) may be beneficial. Common complications of untreated ADHD are ODD (see below), depression (losing self esteem due to academic failure and repeated negative feedback and punishment from adults), increased likelihood of drug and alcohol use, breaking traffic rules more frequently and having more accidents, and eventually getting lower-paying jobs for not fulfilling true potential.
Oppositional Defiant Disorder (ODD)
ODD represents more of a relationship dynamic between a child and the authority figures around her or him, than a disease process itself. Symptoms include argumentativeness with adults, talking back, refusing to follow adults' requests or rules, losing temper, deliberately annoying others, not taking responsibility for one's own actions, and being touchy, angry and resentful all the time. This can happen only at home, or may start at home and may eventually spill over to the school. Most children with ADHD, if untreated, eventually develop ODD because of daily negative feedback and punishment from adults, as a consequence of their impulsive behaviors. It is important to note that depression, in children and adolescents, may present with similar symptoms, rather than the expected symptoms like looking sad and crying frequently. A Child and Adolescent Psychiatrist should be consulted to differentiate the two. There is no medication treatment for ODD. Individual psychotherapy and sometimes family therapy are the best treatment methods. If there is ADHD underlying ODD, it has to be treated with medication for psychotherapies to be effective.
There are studies which suggest that Bipolar Disorder is more common in the families of individuals with Asperger’s Disorder. Bipolar Disorder itself is very difficult to diagnose as a separate entity in an individual with Asperger’s Disorder, though, because the mood regulation is already unstable in autistic spectrum disorders. When these folks get angry they are extremely angry, when they get sad, they are extremely sad, when they are happy, they are extremely happy, etc. Rather than the daily reached extremes, if there is a distinguishable pattern of lows alternating with elation or irritability, each mood state dominating for at least a few days, may be an indication for a co-existing Bipolar Disorder.