Autism & Technology Addiction: Common Co-Occurring Diagnoses

Written by
Tracy Markle, MA, LPC &
Dr. Brett Kennedy, Psy.D.

In This Article

Autism Spectrum Disorder (ASD) is a common co-occurring diagnosis for people who struggle with technology addiction or digital media overuse. Few therapists, however, are trained to recognize the wide array of characteristics that a person on the autism spectrum can present. Portrayals of autism in the media also contribute to a stereotyped or limited understanding of ASD. This has resulted in many autistic people going undiagnosed their entire lives while struggling to compensate for their unmet needs through sensory-seeking behaviors like digital media overuse. Read on to gain a better understanding of the wide array of ASD characteristics and why people on the autism spectrum are often drawn to digital media and the internet. As well as why they can be at elevated risk for digital media overuse or addiction.

What is Autism Spectrum Disorder or ASD?

Autism spectrum disorder (ASD) refers to a neurodevelopmental difference that causes persistent social communication and social interaction challenges as well as restricted, repetitive patterns of behavior, interests, or activities.

In some cases, ASD is noticed by parents or caretakers before a child is a year old and diagnosed by the time they’re two. But today autism experts know that many autistic people go undetected until later when social requirements exceed their capacity to cope. Many autistic people make it all the way to adulthood without anyone, including themselves, realizing they’re autistic.

This is concerning because a growing body of evidence shows that early diagnosis can lead to improved quality of life for those on the autism spectrum and their families.1 Children on the autism spectrum are at increased risk for bullying at school and more likely to refuse to go to school because of bullying. But research has shown that classroom aides can serve as protective factors against this.2 People diagnosed on the autism spectrum as adults are significantly more likely to report lifetime experience of suicidal ideation than are individuals from a general population sample.3 Recently, a study of people who died by suicide in the UK found that 41% were likely on the autism spectrum, but undiagnosed. Which is a rate 19 times higher than that of the general population.4

Autism used to be categorized under four different disorders in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). Those were autistic disorder, Asperger’s disorder, childhood disintegrative disorder, and pervasive developmental disorder not otherwise specified (PDD-NOS). But with the publication of the DSM-5 in 2013, these were all collapsed into the term autism spectrum disorder.

The DSM 5 also collapsed language delay into social communication difficulties, making it a possible manifestation of ASD criteria, but not necessary for diagnosis. In fact, some people on the autism spectrum are talented writers.5

The new changes are meant to provide clinicians with a better understanding that autism might present in different ways, but it’s all autism. The DSM-5 also sought to expand diagnostic criteria to include people on the autism spectrum that are often overlooked, such as females and minorities.6

What is Digital Media Overuse and Technology Addiction?

Digital media use occurs on a spectrum, with healthy use on one end and addiction on the other. In the middle, lies digital media overuse. The overwhelming majority of people who use the internet fall in the digital media overuse category, which is why we focus much of our work there.

A chart of digital media use shows percentage of users addicted to the internet.
The majority of internet users fall in the digital media overuse category.

Digital media addiction, sometimes called technology addiction or internet addiction, is an umbrella term that refers to an internet-based behavior disorder. There are five categories of digital media, internet, or technology addiction: video games, social media, online spending, pornography, and information overload. Autism and technology addiction are often co-occurring diagnoses.

Diagnostic criteria in the 11th edition of the World Health Organization (WHO) International Classification of Diseases (ICD-11) for internet-based behavior and impulse disorders include a persistent pattern of failure to control the behavior or impulse to the point that the individual is neglectful of health and personal care or other interests, activities, and responsibilities. The behavior must persist for at least 6 months and sometimes up to twelve months, despite numerous efforts to significantly reduce it and despite adverse consequences or deriving little or no satisfaction from it. You can read about technology addiction criteria in more detail here.

Only a small percentage of the population meets criteria for technology addiction with the most vulnerable age groups being college age followed by adolescents. This includes 13%-18% of US college students and 8.5% of US children ages 8-18.7,8 Studies show that autistic people are also at elevated risk for digital media overuse and addiction.9 In order to understand why, it’s important to understand the widespread lack of autism detection and why autistic people might engage in sensation seeking behaviors through various forms of internet-based media.

How Prevalent is Autism in the US?

At the time of this writing, the Centers for Disease Control and Prevention (CDC) estimates that 1 in 44—or 23 per 1000—US 8-year-olds have been identified on the autism spectrum.10 This is up from 1 in 54 8-year-olds in 2016 and continues an upward trend of diagnoses estimated by the CDC since they began tracking autism in 8-year-olds in 2000 through the Autism and Developmental Disabilities Monitoring network (ADDM). The CDC began monitoring autism diagnoses in 8-year-olds because they believed at the time that most autistic children are identified by that age. But in 2019, a CDC study found that approximately 25% of elementary school children with ASD indicators are going undiagnosed.11 Despite this, the rate of diagnosis in the United States has progressively gone up over the past two decades.

Why Are Autism Rates Increasing?

Children born in 2014 were 50% more likely to receive an ASD diagnosis or ASD special education classification by 48 months than were children born in 2010.12 Theories abound about why diagnoses are increasing, but many autism experts agree it’s largely due to a better understanding of how autism can present.

Autism wasn’t officially established as its own separate diagnosis by the American Psychiatric Association until the publication of the DSM-III in 1980. Which explains why many autistic adults have never been identified as such.

In 2006, the American Academy of Pediatrics also began recommending that all children get screened for developmental disabilities like autism at 9, 18 and 24 months.13 This likely contributed to much of the growth in identification over the last 15 years.

Finally, changes to diagnostic criteria for autism in the DSM-5, (published in 2013), have expanded understanding of how autism can present in the medical and mental health industries, as well as among the general public.

Factors Contributing to Increase
in Autism Rates Include:

Understanding What Autism Looks Like

People on the Autism Spectrum Who Are Female, Genderqueer, and Racial or Ethnic Minorities Recognized

One reason that autism numbers are growing is that our understanding of how autism can present is growing. Since the beginning of autism research, boys of European descent have been at the center.14,15,16 This meant that autistic traits exhibited by adults, non-males or people raised in other cultural contexts weren’t included in the diagnostic criteria.

Today, greater awareness beyond that first narrow sample is helping to identify more people on the autism spectrum. Still, in the US, boys are 4 times as likely to be identified autistic as girls and in some states, Whites are more likely to be identified than racial or ethnic minorities despite the fact that the prevalence of autism across the US is the same for all racial and ethnic groups.17

According to the 2019 CDC study that found 25% of kids on the autism spectrum are being missed, factors associated with missed clinical diagnosis of ASD were non-White race, no intellectual disability, older age at first developmental concern, older age at first developmental evaluation, special education eligibility other than ASD, and need for fewer supports. This, write the study’s authors, highlights the importance of reducing disparities in the diagnosis of children with ASD characteristics so that appropriate interventions can be promoted across communities.

Factors Associated with Missing Clinical Diagnosis of Autism Spectrum Disorder

Wiggins, L. D., Durkin, M., Esler, A., Lee, L., Zahorodny, W., Rice, C., Yeargin‐Allsopp, M., Dowling, N. F., Hall‐Lande, J., Morrier, M. J., Christensen, D., Shenouda, J., & Baio, J. (2019). Disparities in Documented Diagnoses of Autism Spectrum Disorder Based on Demographic, Individual, and Service Factors. Autism Research, 13(3), 464–473. https://doi.org/10.1002/aur.2255

Socio-Cultural Factors Delay Autism Diagnoses

Research has also found a gender bias in the general public when it comes to drawing professional attention to potential autism. In one study of 385 laypeople, participants worried more about how their hypothetical son’s autistic behavior might affect him socially during adolescence than they did about their hypothetical daughter’s autistic behavior.18 Given that parents and caregivers are key to drawing professional attention to a child’s developmental issues, this could be one explanation for the delay in diagnoses for autistic girls.

Female Protective Effect Theory

Another prevailing theory for why boys are four times as likely to be diagnosed on the autism spectrum as girls is the so-called female protective effect theory.19 The female protective effect theory says that, biologically, females are more protected against autism than males. Support for this theory is largely indirect. And a study published in 2020 analyzing a decade of data from more than 800,000 children in the Swedish National Patient Register and their relatives in the Multi-Generation Register, found that brothers of autistic people are just as likely as sisters of autistic people to have an autistic child.20 The results, researchers say, do not suggest female protective factors as the principal mechanism underlying the male sex bias in ASD.

Autism in the Media: A Limited Depiction

Today, Autism awareness among the general public is probably at an all-time high and that can largely be attributed to movies and television. Many of the portrayals of autism in the media, however, still rely on a narrow scope of possible characteristics.

Depending on their age, many Americans will call to mind one of three characters when they think of an autistic person. Raymond Babbitt, played by Dustin Hoffman in the 1988 movie Rain Man. Sheldon Cooper, played by Jim Parsons in the 2007-2019 television series, The Big Bang Theory. Or Sam Gardner played by Keir Gilchrist in the 2017-2021 Netflix series Atypical.

limited depictions of autism in the media - Atypical Netflix

Caption: 1988’s Rain Man brought autism to the public consciousness. But almost 35 years later, Hollywood depictions of autism still closely resemble autism case studies from 1940’s Europe. From left to right, Raymond Babbit in Rain Man (1988), Sheldon Cooper in The Big Bang Theory, Season 2 (2008), and Sam Gardner in Atypical, Season 1 (2017).

Although these characters span more than thirty years and two centuries, they are surprisingly similar to the children in pioneering autism researcher Hans Asperger’s case histories conducted in Austria in the 1940’s.

All three characters are White males. All three speak with a stilted affect making their social communication challenges fairly obvious to neurotypical viewers. And all three possess a special talent for memorization as when Raymond Babbitt is able to rattle off the phone number of a waitress he’s never met before simply by reading her name tag because he memorized part of the phone book the previous evening. Or when Sam Gardner has the location of every item of inventory at his new job memorized on his first day. Or Sheldon Cooper who’s a theoretical physicist at Cal-State University with an eidetic memory and an IQ of 187.

These characters may be based on real autistic people, but they also represent persistent stereotypes about autism that cause many autistic people to go unidentified and undiagnosed.

Contrary to what the media tells us, not all autistic people are white males with a genius IQ or intellectual disability and savant syndrome.

Autism is a neurological disorder. Neurological behaviors and intelligence occur through different pathways in the brain. Which means that a person can land anywhere on the intelligence spectrum and have ASD—or not.

Groups That Overlap with Autism

To help dispel some of the common stereotypes about who has autism and how it presents, here are a couple of groups you may not realize have a well-documented overlap with autism spectrum disorder.

Autism and Gender Diversity

There is a well-documented overlap between autism and gender diversity. According to a 2020 study of over 600,000 people, transgender and gender-diverse individuals were 3.03 to 6.36 times as likely to be autistic as cisgender individuals, after controlling for age and educational attainment.21 The authors of the study use the terms “transgender and gender-diverse” to collectively refer to a diversity of gender identities used by individuals whose gender does not always correspond to the sex they were assigned at birth such as transgender, non-binary, genderfluid, agender, genderqueer, two-spirit, bigender and others. They use the term “cisgender” to refer to individuals whose gender corresponds to their sex assigned at birth.

Autism and Inmate Populations

Researchers conservatively estimate the rate of U.S. prison inmates on the autism spectrum disorder is 4 times higher than that of the general population.22 Autism isn’t related to criminal behavior. Rather, autistic people are more likely than neurotypical people to suffer from social interaction issues that can result in their arrest. The US Bureau of Justice Statistics (BJS) on contacts between police and the public show that less than 2% of young people ages 16 to 24 were involved in street stops by the police in 2015.23 But a 2015 study by Drexel University in Philadelphia found that 20% of young, autistic adults ages 21-25 had ever been stopped and questioned by police.24 This is especially troubling when you consider that racial minorities are overrepresented in US prisons and one of the leading factors for missing clinical diagnosis of ASD is Non-White race.25,26

Conditions or Diagnoses that Commonly Co-Occur with Autism

Autism experts estimate that about 70% of autistic children have a co-existing diagnosis.27 Because of the many criteria necessary for an autism diagnosis, many people with undiagnosed autism will tend to collect a series of other diagnoses throughout the lifespan that represent either a small piece of their ASD presentation or a misdiagnosis. For this reason, it’s important that providers understand the conditions that commonly co-exist in people with ASD. The following are some, but not all of those conditions.

Suicidality

Multiple studies have established an increased risk for suicidality and death by suicide in people on the autism spectrum. The aforementioned British study found a sample of people who died by suicide were 19 times more likely to have undiagnosed autism spectrum disorder than the general UK population. And a nationwide retrospective cohort study in Denmark found that individuals with ASD were over three times more likely to attempt suicide than those without ASD.28 In the study, females with ASD were over 8 times as likely to attempt suicide as females without ASD. Males with ASD were 1.93 times more likely to attempt suicide than males without ASD. Individuals with ASD were also four times more likely than others to die by suicide. Of crucial importance in the Danish study was the finding that factors such as being married, living with someone, or being employed did not appear to act as protective factors to people with ASD. Suicide risk also increased with level of education.

Anorexia, Compulsive Exercise, and Disordered Eating

According to multiple studies, people with anorexia are more likely to be autistic than people who aren’t anorexic.29 Researchers place the prevalence anywhere from 4% to 52% of anorexia patients having autism or autistic traits.30 A 2020 study also reported that greater autistic social traits in childhood could represent a risk factor for the development of disordered eating in adolescence.31 Some researchers believe that food restriction can be a presentation of the restrictive and repetitive behavior criteria required for an autism diagnosis. And that excessive exercise, calorie counting, and obsession with body image could be a presentation of intense special interest commonly found in autistic people. Others believe that restricting calories and over-exercising is a sensation seeking behavior that helps autistic people (often undiagnosed) to cope with overwhelmingly difficult feelings brought on by their differences and by how they are treated by others.

ADHD

ADHD shows high concurrent comorbidity with other neurodevelopmental disorders including autism spectrum disorder.32 But diagnostic criteria for co-occurring ADHD and ASD didn’t happen until the publication of the DSM-5. So many providers still lack awareness and understanding of what it looks like when they co-occur. There’s also less guidance in the literature for how to treat those who have both disorders.

Depression

Studies show that autistic people are four times as likely to develop depression as typically developing people.33 And that key indicators for autistic people with clinical depression are insomnia/sleep problems and restlessness which differs from neurotypical people with depression.34 Researchers say developing treatments that address these issues could be key to helping people with ASD and depression.

Gaming Disorder and Internet Addiction

Research has shown that children and adolescents on the autism spectrum are an especially vulnerable subpopulation for gaming disorder.35 In one study, adults with ASD endorsed more symptoms of video game pathology than did typically developing adults.36 In another, autistic traits predicted the severity of internet gaming disorder in adults that had an ASD diagnosis.37

Why are ASD and Technology Addiction commonly co-occurring diagnoses?

Sensation Seeking

People with ASD are often hyper- or hyporeactive to sensory input.

That means they can be hypersensitive to some kinds of light, sound, touch, texture, or smell to the point that they have an adverse response. Or they can be under responsive to some kinds of light, sound, touch, texture, or smell. Or they can be both.

When a person on the autism spectrum is exposed to sensory inputs that trigger an adverse response, it can be quite taxing. In some cases, it can lead them to shut down, flee, or act out in ways that look like willful disobedience, but are actually just attempts to regulate their nervous system.

On the other hand, a person on the autism spectrum who is hyporeactive doesn’t register enough sensory input to feel alert or engaged. They require either a greater amount of sensory input or a different kind of sensory input that they find more stimulating.

What’s more, the same autistic person can be hyperreactive to one sensory input and hyporeactive to another.

To cope with any of these scenarios, an autistic person may engage in sensory-seeking behaviors that they find to have a positive effect. This is what is meant in the DSM-5 when it says that autism spectrum disorder may cause a person to present with “unusual interest in sensory aspects of the environment”.

Video games and other digital media are created using something called persuasive design. Designers use rewarding cues and prompts like exciting sounds, animation, and messages, as well as a variable reward schedule —the most addictive reward schedule known to man—to keep users on the platform. Sensation seekers, like those on the autism spectrum, are particularly vulnerable to the lure of persuasive design. You can read about persuasive design in more detail here.

“Unusual interest in sensory aspects of the environment” appears under “repetitive and restrictive behavior” in the DSM-5. Because once an autistic person experiences a positive, stimulating, or soothing sensation, the likelihood they engage in that behavior repeatedly, to the exclusion of other activities, is high.

Social Challenges Make the Internet a Refuge

People on the autism spectrum often demonstrate a preference for solitary play as children and solitary leisure time as adults. Sometimes that’s because of difficulties regulating their nervous system around others. It can also be because of previous rejection from peers.

Many autistic people struggle to interpret non-verbal facial expression during in-person interactions. This makes the likelihood of feeling they don’t fit in high.

Often young autistic people who also self-identify as gamers report that the virtual world, such as in video games, is less nuanced and confusing than the offline world. It has a set of rules that make sense to them. They don’t have to worry about reading another person’s facial expressions and they can engage in logical thinking and visual skills. Both of which are strengths in many people on the spectrum.

Research shows that children diagnosed with ASD spend more time playing video games than their typically developing siblings.38 And that children on the autism spectrum are more sedentary than their typically developing cohorts, often because of their engagement in screen-based activities.39

Restricted Interests Make the Internet Seductive

People on the autism spectrum display restricted, repetitive patterns of behavior, interests, or activities. One way this presents is that many autistic people have one or more special topics about which they show intense interest. Often to the point that it’s all they want to talk about or spend their time doing. The internet can provide endless content around any topic and, through persuasive design, platforms continually serve up targeted content to keep users logged in. This can be especially difficult for autistic people to resist.

Weaker Executive Functioning

Many people diagnosed on the autism spectrum have difficulty recognizing when persuasive design is being used to lure them into continued digital media use. Many also have difficulty perceiving the passage of time. Both of which can put them at greater risk for technology addiction or digital media overuse.

College, Autism, and Technology Addiction

Studies show that autistic students are more likely to drop out of college than neurotypical students.40 The transition to college is especially challenging for students with autism because it’s at this time that family and special education supports fall away. Many autistic students aren’t prepared for the social demands, and they find it difficult to make friends. They also aren’t prepared for the amount of self-advocacy required as most universities lack adequate supports for students with disabilities.

As a result, many autistic students retreat into gaming and the internet. This can lead to long hours online that negatively affect their sleep patterns. Before they know it, their academic work is suffering, too. Universities are beginning to wake up to this issue but parents are advised to begin planning with their autistic student well before their junior year of high school about how they will transition to adult life. This can include focusing on the skills they’ll need to succeed and finding a post-secondary school with the proper supports.

Resources to Learn More

Learn How Persuasive Design Is Used to Create Habit Forming Digital Media

Online Addiction:
Everything You Need to Know
Sources

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39. (Lane, 2019)

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