The association between Autism Spectrum Disorder and Chronic Fatigue Syndrome. A Care Plan Perspective, 2025, Nida Khubaib

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The association between Autism Spectrum Disorder and Chronic Fatigue Syndrome. A Care Plan Perspective | Mental Health: Global Challenges Journal

Mental Health: Global Challenges Journal is an open access peer-reviewed journal, whose main aim is to promote dialogue and debate on topics such as Mental Health, Mental Health Care Systems, international studies on MHC systems in the context of global social challenges. The Journal was...
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The association between Autism Spectrum Disorder and Chronic Fatigue Syndrome. A Care Plan Perspective​

Literature review​

Authors​

DOI:​

https://doi.org/10.56508/mhgcj.v8i1.265

Keywords:​

autism, autism spectrum disorder, chronic fatigue syndrome, myalgic encephalomyelitis, mental health, care plan

Abstract​

Introduction: Autism spectrum disorder (ASD) is a neurodevelopmental condition that shares clinical features with chronic fatigue syndrome (CFS), a condition affecting the neurological and immune systems. Emerging evidence suggests a potential link between the two conditions, including shared genetics and neuropathology. However, there is a paucity of data and lack of conclusive evidence to draw any definite associations.

Purpose: This review aims to gather available evidence to determine whether an association exists between autism and CFS and to report on published findings.

Methodology: The search was conducted on databases PUBMED, MEDLINE and Google Scholar. Eligibility criteria included studies examining the association between autism spectrum disorder (ASD) and chronic fatigue syndrome (CFS). Exclusion criteria included 1) studies that reported on autism and chronic fatigue syndrome separately 2) studies that evaluated the association of autism with conditions other than CFS and 3) and studies that looked at the association of CFS with conditions other than autism. Non-English language studies were excluded.

Results: A total of eight articles were reviewed for the study and the reported findings indicates the complex relationship between autism and co-morbid physical health conditions.

Conclusion: This study highlights the need for enhanced awareness among mental health practitioners regarding the complex interplay between autism and co-occurring physical health conditions like CFS presenting in children and young people and appropriate management of physical health symptoms as part of the overall care plan.
 
I'm sure it's true that there is a connection between autism and ME: autism does appear, to me, to be slightly over-represented amongst pwME. However, I think ME fatigue and autistic burnout fatigue need to be more closely compared before conclusions are reached as there may be differences. I have an autistic friend who thought she had CFS but on learning more about it realised that her fatigue was different to that described by ME people. There may be some overlaps and some differences. (Although there are, of course, many autistic people who also have ME.)
 
There is evidence to suggest that central sensitivity syndromes (CSS), which include chronic fatigue syndrome (CFS), are more prevalent among people with autism (Grant et al, 2022). Grant et al (2022) investigated the occurrence of CSS diagnoses and symptoms in autistic individuals using a Central Sensitization Inventory (CSI). They reported that in a large sample of 973 participants, about 4.5% of people with autism reported a co-occurring diagnosis of CFS. Although higher scores on the CSI appeared to be related to stronger autistic traits, the path analysis suggested that this relationship was mediated by sensory sensitivity and anxiety, implying that these two variables could increase the vulnerability to conditions like CFS, rather than autism per se (Grant et al, 2022).
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They are just reiterating what is said in the eight studies, above is the first one. This adds no value at all.
Limitations In terms of hierarchy of evidence, reviewed studies indicate low level of evidence (Melnyk et al, 2023) and are of not sufficient significance to make any recommendations or draw definite conclusions around association between ASD and CFS (see Table 1). The lack of randomized-controlled trials contributes to the uncertainty regarding the efficacy of emerging anti-inflammatory treatments for ASD and CFS
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I don't think there is any direct overlap in terms of pathology (and all the cited evidence in the study is very weak and speculative - generalised claims about neuroinflammation are meaningless), but of course there are always going to be patients whom the conditions co-occur (and they are more likely to seek help) and obviously this poses an additional challenge.

Individuals reporting that they were misdiagnosed with CFS instead of autism is curious and worrisome.

The study reported that children with ASD experienced excessive tiredness and intense day time fatigue which was more unusual than the general
population and significantly affected the children’s ability to function (Keville et al, 2021). They argued that the autistic fatigue was different from the fatigue seen in CFS and that individuals diagnosed with CFS (in the absence of a known medical explanation for fatigue) did not show autistic traits (Bileviciute-Ljungar et al,2018 and Keville et all, 2021).
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It should go without saying but this is an important point.

However, no differences in AQ scores were found between patients with CFS and healthy controls (Bileviciute-Ljungar et al, 2018).
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Likewise... ME/CFS is not ASD.

The title states "A Care Plan Perspective" but the evidence didn't really touch on this at all, there was little to inform about the unique needs of people with ME/CFS and ASD.
 
Jonathan Edwards said:
Somebody pointed out to me that some high level autistic people report difficulties tolerating sounds. Maybe different problems engage some common pathways.
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I'm pretty sure hypersensitivity to sensory stimulus occurs in both ASD and ADHD.

There's also people that identify as being a highly sensitive person (HSP) reporting issues with hypersensivity to sensory stimulus and sensory overload (among other things). Although there's not much research on that. If it's mild it might be more of a personality thing, if it's severe it could also be undiagnosed ASD/ADHD.
 
On the other hand, seeking out sensory stimulation is also a common thing in autism - repetitive movements, rocking, fiddling, making certain noises, etc - sometimes to the extent that it becomes injurious e.g. if people pick at their skin so much that it bleeds, or pull hair out, or headbang (pre-verbal children do this a lot). And with both autism and ADHD it's common for people to find that they can focus on a task more easily when they're getting a constant sensory stimulus from some kind of fidgeting or fiddling. There's nothing similar to that in ME/CFS that I can think of.
 
I've read that people with ASD, compared to the general population, have increased risk for a wide variety of other health problems. ASD tends to come with comorbidities. It wouldn't be surprising if there was an association between ASD and ME/CFS.

My limited experience with the high functioning ASD community suggests that fatigue which limits carrying out activities of daily living is a common problem in this group. I've not come across reports of PEM in ASD. The impression is that ASD and ME/CFS are distinct phenotypes with some overlap.

My suspicion is that fatigue in high functioning ASD is being underestimated and misunderstood. The disability is attributed primarily to difficulty with social skills, sensory sensitivity and autistic traits like mental rigidity.
 
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Hoopoe said:
I've read that people with ASD, compared to the general population, have increased risk for a wide variety of other health problems. ASD tends to come with comorbidities. It wouldn't be surprising if there was an association between ASD and ME/CFS.

My limited experience with the high functioning ASD community suggests that fatigue which limits carrying out activities of daily living is a common problem in this group. I've not come across reports of PEM in ASD. The impression is that ASD and ME/CFS are distinct phenotypes with some overlap.

My suspicion is that fatigue in high functioning ASD is being underestimated and misunderstood. The disability is attributed primarily to difficulty with social skills, sensory sensitivity and autistic traits like mental rigidity.
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I wonder how much of that fatigue is caused by having to adapt to a society that doesn’t suit them. Like, is it fatigue due to attrition, or is it caused by other processes? Maybe both?
 
Hoopoe said:
I've read that people with ASD, compared to the general population, have increased risk for a wide variety of other health problems. ASD tends to come with comorbidities. It wouldn't be surprising if there was an association between ASD and ME/CFS.

My limited experience with the high functioning ASD community suggests that fatigue which limits carrying out activities of daily living is a common problem in this group. I've not come across reports of PEM in ASD. The impression is that ASD and ME/CFS are distinct phenotypes with some overlap.

My suspicion is that fatigue in high functioning ASD is being underestimated and misunderstood. The disability is attributed primarily to difficulty with social skills, sensory sensitivity and autistic traits like mental rigidity.
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I’m now thinking about how when I got more severe I struggled to make eye contact or look anywhere normal when thinking or talking but particularly when I’m having to think hard on what to say due to word issues and just load

I’d often almost need to close my eyes and would be looking up etc.

Who knows how most would interpret that. Particularly if they aren’t keen on giving you the benefit of insight or listening so assumptions get made.

Its been drawn to my attention recently (even tho I knew it) of the term ASD meaning more than just putting what might have been separated with Asperger’s into a spectrum and getting rid of that name.

I’ve realised it was ‘syndrome’ but now has the term ‘disorder’ on the end and perhaps need to look up how the community felt and feel about that change in terminology and where it came from etc
 
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