Co-morbidity

Co-morbidity

Co-morbid Conditions in the context of neurodiversity. There is emerging evidence that neurodivergence is associated with multiple intertwined health conditions and that being neurodivergent correlates with increased morbidity and mortality relating to all organ systems.

There is emerging evidence that neurodivergence is not just limited to the restrictive criteria contained within the various classification systems but that the neurodivergent population often has multiple intertwined health conditions, forming part of a larger ‘constellation’1. Links have been demonstrated between neurodivergence and hypermobility (Ehlers Danlos syndrome), dysautonomia (POTS) and chronic pain2 and there is an increasing recognition of the co-occurrence of neurodiversity with many gastrointestinal conditions such as irritable bowel syndrome, bowel dysmotility, vitamin deficiencies, and metabolic disorders including obesity3.

Increasingly, research shows that being neurodivergent correlates to increased morbidity and mortality relating to all organ systems4,5.

Neurodivergent people are also likely to present with social comorbidities including friendship and relationship difficulties, educational and occupational under-achievement, greater risk of morbidity and mortality, substance misuse and increased rates of homelessness, unemployment and involvement with the criminal justice system6,7.

Neurodivergent patients also often experience co-existing mental health problems8 including insomnia, disordered eating9 , depression and anxiety, addictions, self-harm, and suicidality10. Lack of understanding of neurodiversity may lead to misdiagnoses and labels that may or may not be correct such as mood disorders, bipolar, personality and other mental health disorders11,12.

Taken in the round, it is apparent that neurodivergent patients make up a large proportion of primary care patients. A GP would be wise to consider neurodivergence in patients presenting with any of the above comorbidities, and vice versa.  As well as our patient population, there is also an increasing awareness of the numbers of GPs, trainees and medical students who identify as neurodivergent and need support.

We have proposed a motion about resources for primary care in this field at the 2023 England Local Medical Committees (LMC) conference - it was overwhelmingly supported and carried on a vote. Read about the motion here (page 9, motion 5).

References

  1. Everything is Connected to Everything: Improving Healthcare for Autistic & ADHD Adults – Clinicians.
  2. Csecs JLL, Iodice V, Rae CL, Brooke A, Simmons R, Quadt L, Savage GK, Dowell NG, Prowse F, Themelis K, Mathias CJ, Critchley HD, Eccles JA. Joint Hypermobility Links Neurodivergence to Dysautonomia and Pain. Front Psychiatry. 2022 Feb 2;12:786916. doi: 10.3389/fpsyt.2021.786916. PMID: 35185636; PMCID: PMC8847158.
  3. Bethany Donaghy, David Moore & Jane Green (2023) Co-Occurring Physical Health Challenges in Neurodivergent Children and Young People: A Topical Review and Recommendation, Child Care in Practice, 29:1, 3-21, DOI: 10.1080/13575279.2022.2149471
  4. Alabaf S., Gillberg C., Lundström S., Lichtenstein P.,Kerekes N., Råstam M., Anckarsäter H. (2019). Physical health in children with neurodevelopmental disorders. Journal of Autism and Developmental Disorders, 49(1), 83–95.
  5. Black, M. H., Van Goidsenhoven, L., Hens, K., Bourgeron,T., & Bölte, S. (2023). Risk and resilience in developmental diversity: Protocol of developing ICF core sets. Neurodiversity, 1.
  6. Neurodiversity – a whole-child approach for youth justice Professor Amanda Kirby, HM Inspectorate of Probation Academic Insights 2021/08.
  7. Kosheleff AR, Mason O, Jain R, Koch J, Rubin J.Functional Impairments Associated With ADHD in Adulthood and the Impact of Pharmacological Treatment. J Atten Disord. 2023 May;27(7):669-697. doi: 10.1177/10870547231158572. Epub 2023 Mar 6. PMID: 36876491; PMCID: PMC10173356.
  8. Baraskewich J., McMorris C. A. (2019). Internalizing mental health issues in individuals with neurodevelopmental disorders: Implications for practitioners. Current Developmental Disorders Reports, 6(1), 1–8
  9. Cobbaert, L. & Rose, A. (2023). Eating Disorders and Neurodivergence: A Stepped Care Approach.
  10. Suicide in Children and Young People by NCMD Programme | Oct 14, 2021.
  11. Curnow E, Rutherford M, Maciver D, Johnston L, Prior S, Boilson M, Shah P, Jenkins N, Meff T. Mental health in autistic adults: A rapid review of prevalence of psychiatric disorders and umbrella review of the effectiveness of interventions within a neurodiversity informed perspective. PLoS One. 2023 Jul 13;18(7):e0288275. doi: 10.1371/journal.pone.0288275. PMID: 37440543; PMCID: PMC10343158)
  12. Asherson, P., Leaver, L., Adamou, M.et al.Mainstreaming adult ADHD into primary care in the UK: guidance, practice, and best practice recommendations.BMC Psychiatry22, 640 (2022).