Co-occurring Conditions in Autism: A Parent Guide to Common Ones

Co-occurring conditions in autism are other health, mental health or developmental conditions that an autistic child has as well as autism. They are very common. Large reviews show that many autistic children have conditions such as ADHD, anxiety, sleep problems, gut problems or epilepsy [1][2]. Knowing what to look for helps your child get the right care sooner.

What are co-occurring conditions in autism?

A co-occurring condition is any condition your child has alongside autism. You may also see the words “autism comorbidities” or “conditions that go with autism”. Many of these conditions can be treated or supported.

The biggest review so far, by Micai and colleagues in 2023, pooled 340 publications with about 590,000 participants [1]. The most frequent conditions included developmental coordination disorder, sleep-wake problems, gut problems, ADHD, anxiety, and feeding and eating disorders [1]. An earlier review in The Lancet Psychiatry looked at mental health diagnoses across 96 studies [2].

Treat the numbers below as a rough guide. Studies differ a lot in who they include and how they measure each condition [1]. Rates from clinics also tend to be higher than rates from whole-population studies [2].

In the US, the American Academy of Pediatrics (AAP) says pediatricians should watch for and manage common co-occurring conditions in routine care [3]. In the UK, NICE guidance asks professionals to recognize common coexisting conditions such as epilepsy and sleep problems [4]. NICE reviewed its advice in September 2025 and decided not to change its recommendations on coexisting mental health conditions [5].

Mental health and attention

ADHD

ADHD is one of the most common autism comorbidities. Lai’s review found a pooled rate of 28% [2], and Micai’s broader review estimated 37% [1]. Your child may find it very hard to stay on a task, act before thinking, or seem always on the go. Read more about autism and ADHD.

Anxiety

Lai’s review found anxiety disorders in 20% of autistic people [2], and Micai’s estimate was 35% [1]. Signs can include more meltdowns, clinging, stomachaches before school, poor sleep, or a stronger need for sameness. See our guide to autism and anxiety in children.

Depression in teens

A meta-analysis of 66 studies found a lifetime rate of depression of 14.4% and a current rate of 12.3% in autistic people [6]. Lifetime rates rose with age [6]. Watch for a teen who loses interest in favorite topics, withdraws more, sleeps or eats very differently, or seems more irritable. If your child talks about wanting to die or hurts themselves, get help the same day.

Autism and epilepsy

The Lukmanji 2019 systematic review included 74 studies with 283,549 patients [7]. It found a median rate of epilepsy of 12.1% in people with autism, with results varying a lot between studies [7]. The authors found this consistently higher than estimates for the general population [7]. Micai’s review estimated 16% [1].

Seizure signs to watch for

Not every seizure looks like falling and shaking. The CDC describes several types [8]:

• Staring spells. Your child stares into space, blinks quickly, or makes chewing or hand movements. These are easy to mistake for daydreaming.
• Stiffening or jerking. Muscles go stiff, or there is rhythmic shaking or quick, lightning-like jerks.
• Sudden drops. A sudden loss of muscle tone can make a child fall or drop their head.
• Dazed behavior. Your child seems confused, picks at clothes, smacks their lips, or does not respond for a few minutes.

If you notice any of these, write down what happened, take a video if you can, and tell your child’s doctor. The AAP says an EEG (brain wave test) is not a routine test unless there is concern about seizures [3]. An unusual loss of language should be checked by a doctor [3].

Sleep, gut and feeding problems

Sleep problems

Micai’s review estimated sleep-wake problems in 43% of autistic people [1]. Formally diagnosed sleep-wake disorders were lower, at 13%, in Lai’s review [2]. NICE advises checking for physical causes of poor sleep, such as reflux, ear or toothache, constipation or eczema [4]. See our guide to autism sleep problems.

Autism and gut problems

A 2014 meta-analysis in Pediatrics combined 15 studies [9]. Autistic children were more likely than other children to have gut symptoms overall (odds ratio 4.42), constipation (3.86), diarrhea (3.63) and stomach pain (2.45) [9]. Gut pain can show up as behavior. Look for straining, hard or rare stools, pressing on the belly, new aggression, or waking at night.

Feeding issues and ARFID

ARFID (avoidant/restrictive food intake disorder) is when avoiding foods affects growth, nutrition or daily life. A 2025 meta-analysis estimated ARFID in 11.41% of autistic groups [10]. This came from only three studies with a very wide range, so it is uncertain [10]. NICE advises checking feeding, growth and nutrition, including restricted diets [4]. Our guide to picky eating and autism has practical steps.

Development, learning and movement

Autism and intellectual disability

The latest CDC report, published in 2025, looked at 8-year-olds at 16 US sites in 2022 and found autism in 1 in 31 children [11]. Cognitive test data were available for 61.4% of autistic children [11]. Of these, 39.6% had an intellectual disability (IQ 70 or below), 24.2% were in the borderline range, and 36.1% were in the average or higher range [11].

Language disorder

Some autistic children also have a language disorder, which affects understanding or using words. Good numbers are hard to find: Micai’s estimate came from just four studies with a very wide range [1]. The AAP says children with language delay should have their hearing checked [3].

Developmental coordination difficulties

Many autistic children find running, catching, handwriting or using cutlery hard. In the US SPARK study, 86.9% of 11,814 autistic children aged 5 to 15 were at risk of motor difficulties on a parent questionnaire, but only 31.6% were getting physical therapy [12]. The study used parent reports without clinical checks [12]. An occupational therapist or physical therapist can assess your child.

Tic disorders

Tics are sudden, repeated movements or sounds, such as blinking, shrugging or throat clearing. Micai’s review estimated tic disorders in 10% of autistic people [1]. Tics can look like stimming, so a video helps the doctor.

Genetic syndromes, hearing and vision

Genetic syndromes

A review found autism features in 30% of males with Fragile X syndrome and 36% of people with tuberous sclerosis complex [13]. The AAP notes that about 0.45% of autistic people have the full Fragile X mutation, and advises offering genetic testing, including chromosomal microarray and Fragile X testing [3]. Read more about genetic testing for autism.

Hearing and vision

Micai’s review estimated hearing problems in 4% of autistic people [1]. The AAP says hearing should be tested when a child has language delay, and vision considered when a child seems visually inattentive [3]. A 2025 Taiwanese study of 20,688 autistic children found higher risks of long-sightedness, short-sightedness, astigmatism and strabismus (a turned eye) [14]. Watch for squinting, sitting very close to screens, or not turning to sounds.

Spotting co-occurring conditions in autism: diagnostic overshadowing

Diagnostic overshadowing is when a new symptom gets blamed on autism instead of being checked properly. For example, head banging might be called “just autism” when the real cause is an ear infection, toothache or constipation.

The AAP says it is important to look at both medical and behavioral causes when behavior changes, and to address pain and discomfort [3]. NICE lists pain and gut problems as possible causes of behavior that challenges, and advises looking for new factors when behavior changes [4]. You can say, “This is new for my child. Can we rule out a physical cause?”

How to keep a health log

A notes app or paper notebook works well. Try to record:

• Sleep. Bedtime, wake time and night waking.
• Toileting. How often your child poos and what it looks like.
• Food. What they ate, new refusals and weight changes.
• Behavior changes. What happened, when, and what came just before.
• Possible seizures. The time, how long it lasted, what it looked like, and a short video if safe.
• Medicines. Any new medicine, dose change or missed dose.

Bring the log to appointments. A few weeks of notes makes a short visit much more useful.

Questions to ask your child’s pediatrician

• Screening. Which co-occurring conditions should we check for at my child’s age?
• Physical causes. Could this new behavior be caused by pain, constipation, poor sleep or infection?
• Seizures. Do these staring spells or jerks need an EEG or a neurologist?
• Hearing and vision. When were these last checked, and are they due again?
• Genetics. Has my child been offered genetic testing?
• Referrals. Should we see a gut specialist, sleep service, dietitian or therapist?

When to get urgent help

• Seizures. Call 911 in the US or 999 in the UK if a seizure lasts longer than 5 minutes, another follows soon after, your child has trouble breathing or waking afterward, or it is their first seizure [15]. Roll your child onto their side and never put anything in their mouth [15].
• Mental health crisis. In the UK, call 999 or go to A&E if a life is at risk, or call NHS 111 and choose the mental health option [16]. In the US, call or text 988 [17], or call 911 in an emergency.
• Sudden changes. See a doctor soon if your child loses skills, stops eating or drinking, has severe belly pain, or shows a big change in behavior.

Frequently asked questions

What is the most common co-occurring condition in autism?

It depends on the study, but the most common conditions include movement and coordination difficulties, sleep problems, gut problems, ADHD and anxiety. Many autistic children have one or more of these. Rates vary a lot between studies, so ask your child’s doctor which conditions are worth checking for at your child’s age and stage of development.

Does every autistic child have another condition?

No. Co-occurring conditions are common, but not every autistic child has one, and each child’s mix is different. Some conditions show up later, such as anxiety or depression in the teen years. That is why regular check-ups matter. Keep watching for changes in sleep, eating, toileting, mood and behavior, and raise anything new with your doctor.

Can co-occurring conditions be treated?

Yes, many can. Constipation, sleep problems, ADHD, anxiety, depression and epilepsy all have treatments or support that can help. Treating a co-occurring condition does not change who your child is, but it can make daily life more comfortable. Many families find their child is calmer and happier once pain, poor sleep or worry is properly managed.

How do I know if a behavior is autism or something else?

Ask yourself whether the behavior is new, has suddenly got worse, or comes with other changes like poor sleep, eating less or holding their belly. These can be signs of pain, illness or worry. Keep notes and share them with your child’s doctor. Ask them to rule out physical causes before deciding the behavior is simply part of autism.

References

1. Micai M, Fatta LM, Gila L, Caruso A, Salvitti T, Fulceri F, et al. Prevalence of co-occurring conditions in children and adults with autism spectrum disorder: a systematic review and meta-analysis. Neurosci Biobehav Rev. 2023;155:105436. doi:10.1016/j.neubiorev.2023.105436 Link
2. Lai MC, Kassee C, Besney R, Bonato S, Hull L, Mandy W, Szatmari P, Ameis SH. Prevalence of co-occurring mental health diagnoses in the autism population: a systematic review and meta-analysis. Lancet Psychiatry. 2019;6(10):819-829. doi:10.1016/S2215-0366(19)30289-5 Link
3. Hyman SL, Levy SE, Myers SM; AAP Council on Children With Disabilities, Section on Developmental and Behavioral Pediatrics. Identification, evaluation, and management of children with autism spectrum disorder. Pediatrics. 2020;145(1):e20193447. doi:10.1542/peds.2019-3447 Link
4. National Institute for Health and Care Excellence. Autism spectrum disorder in under 19s: support and management. Clinical guideline CG170. Published 2013, updated 2021. Link
5. National Institute for Health and Care Excellence. September 2025 exceptional surveillance of autism spectrum disorder in under 19s: support and management (NICE guideline CG170). 2025. Link
6. Hudson CC, Hall L, Harkness KL. Prevalence of depressive disorders in individuals with autism spectrum disorder: a meta-analysis. J Abnorm Child Psychol. 2019;47(1):165-175. doi:10.1007/s10802-018-0402-1 Link
7. Lukmanji S, Manji SA, Kadhim S, Sauro KM, Wirrell EC, Kwon CS, Jette N. The co-occurrence of epilepsy and autism: a systematic review. Epilepsy Behav. 2019;98(Pt A):238-248. doi:10.1016/j.yebeh.2019.07.037 Link
8. Centers for Disease Control and Prevention. Types of seizures. CDC Epilepsy. Link
9. McElhanon BO, McCracken C, Karpen S, Sharp WG. Gastrointestinal symptoms in autism spectrum disorder: a meta-analysis. Pediatrics. 2014;133(5):872-883. doi:10.1542/peds.2013-3995 Link
10. Sader M, Weston A, Buchan K, Kerr-Gaffney J, Gillespie-Smith K, Sharpe H, Duffy F. The co-occurrence of autism and avoidant/restrictive food intake disorder (ARFID): a prevalence-based meta-analysis. Int J Eat Disord. 2025;58(3):473-488. doi:10.1002/eat.24369 Link
11. Shaw KA, Williams S, Patrick ME, et al. Prevalence and early identification of autism spectrum disorder among children aged 4 and 8 years: Autism and Developmental Disabilities Monitoring Network, 16 sites, United States, 2022. MMWR Surveill Summ. 2025;74(2):1-22. doi:10.15585/mmwr.ss7402a1 Link
12. Bhat AN. Is motor impairment in autism spectrum disorder distinct from developmental coordination disorder? A report from the SPARK study. Phys Ther. 2020;100(4):633-644. doi:10.1093/ptj/pzz190 Link
13. Richards C, Jones C, Groves L, Moss J, Oliver C. Prevalence of autism spectrum disorder phenomenology in genetic disorders: a systematic review and meta-analysis. Lancet Psychiatry. 2015;2(10):909-916. doi:10.1016/S2215-0366(15)00376-4 Link
14. Chen YL, Yen CF, Lai YH, Hsiao RC, Chou WP. Higher risks of hyperopia, myopia, astigmatism, and strabismus in children with autism spectrum disorder: a nationwide, population-based cohort study. Braz J Psychiatry. 2025;47:e20233515. doi:10.47626/1516-4446-2023-3515 Link
15. Centers for Disease Control and Prevention. First aid for seizures. CDC Epilepsy. Link
16. NHS. Where to get urgent help for mental health. NHS website. Link
17. Substance Abuse and Mental Health Services Administration. 988 Suicide and Crisis Lifeline. Link

Professional review: this guide is waiting for review by a qualified clinician. It was written and checked against the published sources listed above. How we check our guides.

This guide is general education, not medical advice. Always talk to your child’s doctor or care team. Last checked: October 2026.