KUALA LUMPUR, May 15 — Last year, my daughter was diagnosed three times with septic tonsillitis in the same number of months. Investigations revealed that the root cause of her problem had nothing to do with her throat but with her congested sinusitis, which in turn, caused a back-flow onto her tonsils. This was the identified culprit!

She was then prescribed treatment to address her sinusitis issues and the result was amazing.

Her snoring reduced dramatically and with no more snoring, she began sleeping soundly through the night. We noticed that she was more alert with no more yawning during her waking hours.

It was also evident that after only a few days of treatment, she completely stopped rubbing her nose/face, a behaviour we had associated with autism ever since she was diagnosed when she was just two and a half years old!

She used to rub her face when she was excited and she rubbed her face when she was irritated and/or agitated. The rubbing of her face was always a pre-cursor signal to us who knew her well.

We, her family, had assumed that this behaviour was an “obsessive compulsive behaviour” related to her diagnosis of autism and had translated it into an “autistic behaviour” in our minds.

It was surprising, and a little disconcerting for us, when we realised that her “face rubbing” had absolutely nothing to do with autism and had everything to do with discomfort linked to congested sinuses!

She was just unable to express this fact to us adequately enough. We felt dreadful that we had not identified this earlier for her.

For my daughter who has autism, her “sinusitis” is what is called a “co-occurring disorder” to her “Autism Spectrum Disorder” diagnosis.

A “co-occurring disorder” is essentially other issues that sometimes challenge children outside of their diagnosis (whatever that diagnosis may be).

Co-occurring disorders can result as a consequence of living with a disorder like autism, or, it could be co-occurring from birth.

Identifying potential co-occurring disorders and their sources is challenging for parents and professionals alike but identification of co-occurring disorders is essential and important because “learning” is generally viewed as a process of constructing new layers of knowledge on foundations of prior less sophisticated development.

In simple terms, this means that effective learning builds upon a learner’s prior understanding and experience. Each mastered step in turn serves as a foundation for the next step to be learnt.

When a child does not follow the normal pattern of development, assessment should aim to identify potential “obstacles”, not only caused by the primary condition that was diagnosed but also any obstacles that may be present stemming from other sources as well.

The list of co-occurring disorders varies and can be quite long depending upon the individual. Some examples of co-occurring disorders include: reactions to certain food, diet choices, irregular sleep patterns, eczema, sensory motor issues, anxieties etc.

For some children, identified conditions are a primary condition but in others, it can be a secondary condition. For example, take speech-language delays. This condition can be considered secondary, if a child has another difficulty which has impacted on their language development (such as autism, hearing impairment, global developmental delay etc).

Obviously, when a language delay is a primary concern, there will be no other difficulty identified. The fact that a condition can be a primary condition or a secondary condition, muddies the waters and makes the task of identifying the root causes difficult for parents and professionals alike.

This being said, it is vital that parents and professionals always endeavour to consider co-occurring disorders and to address them. Living with co-occurring disorders is an obstacle to learning and to developing and generally, they make it harder for the individual to develop in a positive manner.

As a parent, you are in the best position to assist because you are with your child for the majority of the time. You can help by:

* Observe if your child is displaying any day-to-day symptoms and make a note of what they are. Question if these noted symptoms can be disassociated from the primary condition which has been diagnosed. For example, Autism Spectrum Disorder (ASD) and Attention Deficit Disorder (ADD); ASD with seizures; ASD with hearing impairment and/or middle ear effusion etc.

* Note if the symptoms observed are constant or intermittent. If the symptoms are intermittent, note under what conditions they emerge.

* Watch and try to identify possible factors that may worsen the symptoms through a process of elimination and/or inclusion.

* Try and determine if the symptom is “behaviour” related or “organic” in nature.

* Investigate the noted symptoms by discussing the management of the symptoms with your GP.

* Get a consensus of information from persons/caregivers across environments (home; school etc) to gain more insight into the symptoms you have noted.

* Discuss the above with the professionals working with your child.


* This article is written on behalf of the Malaysian Association of Speech-Language & Hearing (MASH) in conjunction with the “Better Hearing and Speech Month” celebrated in the month of May each year. MASH focuses on raising public awareness, knowledge and understanding of communication impairments encompassing hearing, speech, language and voice, as well as, on issues associated with such difficulties. Communication impairments can affect anyone and the process of identifying problems and associated co-occurring difficulties which may be further compounding the situation is particularly important.