What is Autism Spectrum Disorder (ASD)?
Autism Spectrum Disorder (ASD) is a developmental disorder that affects an estimated 18 million people worldwide. This disorder results in disruptions in social, cognitive, and behavioral functioning as individuals with this condition are more likely to have difficulties interacting with peers, communicating with others, and may experience repetitive or obsessive behaviors. 
There are numerous molecular mechanisms that contribute to the development of many of the symptoms within ASD, including an excess of neurons and synapses within the brain. This surplus of synapses leads to overstimulation of the senses, resulting in greater sensitivity to light, noise, and tactile stimuli in many individuals with ASD.
Health Disparities in those with ASD
Individuals with Autism Spectrum Disorder, compared to adults without ASD are twice as likely to develop:
- Diabetes
- High Blood Pressure and Cardiovascular Diseases
- Gastrointestinal Disorders
- Psychological Disorders (e.g. Schizophrenia, Depression)
- Neurodegenerative Disorders (e.g. Parkinson’s Disease)
On average, individuals with ASD have a life expectancy that ranges from 20 to 36 years shorter than those without the disorder. Additionally, the suicide rate of a person with ASD is 9 times greater than the general population.
Although having ASD indeed increases vulnerability to various health conditions due to physiological consequences of the disorder, many other factors contribute to the greater risk of comorbidity. A prominent factor is the degree to which ASD individuals have access to affordable health care as a result of socioeconomic status. Studies have shown that children with ASD have both greater healthcare costs and needs, yet they maintain poorer access to affordable healthcare than children without the disorder.
Additionally, both children and adults with ASD may be deterred from pursuing healthcare due to an extreme deficit in accommodations for patients with ASD in both inpatient and outpatient settings. As mentioned above, many of those with ASD experience an overstimulation of the senses as a result of excess neural connections. Since healthcare settings are filled with bright lights, countless noises and beeping sounds, and other intense sensory stimuli, ASD individuals may avoid essential services due to this overwhelming characteristic of the healthcare environment. This aspect demonstrates the need for the development of ASD-friendly healthcare initiatives that make the healthcare experience more individualized and comfortable for each patient with ASD.
ASD-Friendly Healthcare
Many of the following strategies have already been introduced in various healthcare settings across the nation, including Boston Medical Center in Massachusetts.
These strategies include:
- increased access to and affordability of healthcare services that are geared towards ASD patients
- education and training of healthcare personnel to increase awareness of how they can treat their patients with ASD with highest level of respect and compassion
- individualized care plans, in which the patient with ASD fills out an autism support checklist (ASC) that collects patient preferences regarding preferred communication style, triggers, sensory sensitivities, and other considerations of the patient
- providing ASD patients with information that will detail exactly what their healthcare appointment will entail in order to decrease anxiety before and during the appointment
- specific rooms that have reduced fluorescent lighting and fewer noises
- alternative communication methods (e.g. communication picture cards, whiteboards, tablets, etc.)
- a “sensory toolbox” that the patient can use to increase level of comfort during the visit. In this toolbox there might be noise-cancelling headphones, sunglasses, fidget toys, communication cards, and other helpful objects.
Autism and Gynecology: A primary example for the need of ASD-friendly healthcare
Reproductive health procedures and examinations can be quite overwhelming and uncomfortable for any patient. This level of discomfort can be amplified in those with ASD, as overstimulation of the senses and a detrimental lack of accommodations accompany these appointments. This unfortunate reality contributes to many women with ASD avoiding these appointments, putting them at a much higher risk for countless genitourinary complications, including cervical cancer that would be detected via pap smears. 
This area of medicine therefore demonstrates a large need for numerous strategies and accommodations to make gynecologic appointments more comfortable for patients with ASD. These strategies include:
- thoroughly explain the procedure steps, how long the procedure may take, and how this procedure contributes to the maintain of their reproductive health
- provide charts, pictures, and anatomical models that can further explain the procedure
- reducing the amount of time the patient is undressed
- ask/warn the patient before touching them
- continue to ask them throughout the procedure if they are comfortable/feeling okay
- come up with a word or sign that signals they need a break from the procedure
Looking Ahead
Individuals with ASD are at much greater risk for developing cardiovascular diseases, gastrointestinal disorders, and other conditions than those without ASD. However, they are often deterred from seeking out services that will reduce the risk of comorbidity due to the overwhelming and uncomfortable environment within healthcare settings. As awareness increases regarding the initiatives pursued by healthcare settings across the nation in the hopes of accommodating ASD patients, more inpatient and outpatient settings will hopefully adopt some of these same strategies.
