ASD and Physical Disabilities – A question from a parent

I was unable to find any information regarding autistic children who also have physical handicaps as well. Our daughter Madeline was recently diagnosed with PDD-NOS and Cerebral Palsy by a team of doctors at the Mayo Clinic in Rochester. We are having a hard time overcoming both issues. Behavior issues are endless, but she also can’t stand, walk, talk properly, or self feed. Any information or resources would be greatly appreciated. Question submitted by Dale

What is cerebral palsy?
Since many of you in the autism community may not know what cerebral palsy (CP) is, I first want to define it before launching into a discussion about comorbid ASD and CP. Cerebral Palsy is a broad term used to describe a group of chronic movement or posture disorders. “Cerebral” refers to the brain, while “Palsy” refers to a physical disorder, such as a lack of muscle control. Cerebral Palsy is not caused by problems with the muscles or nerves, but rather with the brain’s ability to adequately control the body. Cerebral Palsy can be caused by injury during birth, although sometimes it is the result of later damage to the brain. Symptoms usually appear in the first few years of life and once they appear, they generally do not worsen over time. Disorders are classified into four categories:

* Spastic (difficult or stiff movement)
* Ataxic (loss of depth perception and balance)
* Athetoid/Dyskinetic (uncontrolled or involuntary movements)
* Mixed (a mix of two or more of the above)

There is currently no cure for cerebral palsy, however there are different treatment options. These options include therapy, medications, surgery, education and support. By taking advantage of one or more of these options, people with cerebral palsy can learn to improve their function and the quality of their lives.

Comorbid ASD and CP
When we talk about comorbidity, we are indicating that two or more medical conditions are existing simultaneously but independently within a person. There may be, but there is many times not, a causal relationship between the conditions (i.e. one condition did not necessarily cause the other and vice versa). In the case of ASD and CP comorbidity, there is no causal relationship between the two because CP is caused by brain damage and specifically impacts muscle control whereas ASD is a neurological disorder which impacts communication, social interactions and behavior.

Although there is no causal relationship between the two conditions, there are treatment options which can address the symptoms of both. The communication, social, behavior, and even physical impairments can all be addressed using the principles of Applied Behavior Analysis (ABA). The first thing that should be addressed, though, is communication because difficulties with communication are many times the root cause of behavioral problems.

For a child with CP whose brain is not able to control their muscles, including the muscles related to speaking, verbal communication may be extremely difficult. It may be necessary to teach the child to use an alternative form of communication (i.e. alternative and augmentative communication systems – AAC) such as Picture Exchange Communication System (PECS) or a Voice Output Communication Aid (VOCA; e.g. DynaVox VMax). When a child is able to functionally communicate their needs, this opens up a lot of possibilities and will many times reduce disruptive behavior because they’re able to communicate in a more appropriate way (disruptive behavior, after all, is a form of communication). A functional form of communication will not solve all your child’s issues, but it is definitely something that needs to be in place from the very beginning.

To address many of the issues, communication impairments, physical impairments (i.e. walking and standing) and adaptive skill impairments (i.e. self-feeding), utilizing the principles of Applied Behavior Analysis (ABA) to teach these skills is going to be the best method of treatment. When it comes to the physical capabilities of the individual, there may be some things they will never be able to do due to the damage to the brain, but that does not mean there is not benefit to teaching the skill or parts of the skill to maximize independence.

The basics of ABA comes down to using the principles of learning to teach new skills, increase the quality of skills, or decrease undesired behaviors. Most of the time we are going to focus on teaching, or increasing the quality of, desired skills and behaviors using positive reinforcement. To design an effective intervention based on the principles of ABA, it will be necessary to work with a trained behavior analyst. They will be able to help you prioritize which skills to work on and also teach you how to implement the interventions accurately.