Exploring Co-occurring Conditions in Iraqi Children with Autism Spectrum Disorder: Prevalence, Characteristics, and Potential Risk Factors

Ahmed Kamil Toman^1,2,3Hulla Raoof Abdulrasool^1,2Faris Lami^4,5Shatha Mohammed Jasim^1,4Osamah Abbas Jaber^1,4Nahid Dehghan Nayeri^4,6Mahdi Shafiee Sabet^4,7Ghaith Al-gburi^4,8*

• ¹Al-Subtain Academy for Autism and Neurodevelopmental Disorders, Karbala, Karbala, Iraq
• ²Baghdad Teaching Hospital, Baghdad,, Iraq
• ³Imam Hussein Center for Autism, Babil, Iraq
• ⁴Al-Subtain University of Medical Sciences, International Branch of Tehran University for Medical Sciences, Karbala, Karbala, Iraq
• ⁵College of Medicine, University of Baghdad, Baghdad, Baghdad, Iraq
• ⁶School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Alborz, Iran
• ⁷Department of Family Medicine, School of Medicine, Tehran University of Medical Sciences, Tehran, Alborz, Iran
• ⁸School of Biosciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, England, United Kingdom

Introduction: Co-occurring conditions are common in children with autism spectrum disorder (ASD) and have important negative impacts on the children and their families. For Iraqi children, local healthcare systems tend to place more emphasis on the management of ASD itself while neglecting co-occurring conditions.Objectives: This study aims to investigate the prevalence, characteristics, and potential risk factors of co-occurring epilepsy, sleep, and weight issues among Iraqi children with ASD.Methods: A multicenter cross-sectional study was conducted from January 24 to August 7, 2024, including children from Imam Hussein Centre, Al-Subtain Academy for Autism and Neurodevelopmental Disorders, and Baghdad's National Centre for Autism and Child Psychiatry.A structured questionnaire was used, including 35 items for demographic information, epilepsy, sleep problems, and weight issues.Our sample included 240 children, of whom 34 (14.2%) had co-occurring epilepsy, 178 (74.2%) had at least one sleep problem, and 104 (43.3%) were obese. Among children with epilepsy, 18 (52.9%) received their diagnosis before ASD. The most prescribed anticonvulsant, sodium valproate, was noted in 18 (52.9%) cases. Difficulty falling asleep was the most common sleep problem, affecting 97 (40.4%), while sleepwalking was reported in only 26 (10.8%).Significant differences in the body-mass index were observed based on risperidone use (adjusted p-value = 0.036, R-value = 0.163, 95% CI: 0.031, 0.288), sleep duration (r = -0.166, adjusted pvalue = 0.036), and diet (adjusted p-value = 0.036, ε 2 = 0.038, 95% CI: 0.005, 0.087). However, no significant association was demonstrated between BMI and screen time (adjusted p-value = 0.264).Co-occurring conditions are common among children with ASD and should be assessed simultaneously. Additionally, since some of the children might be diagnosed with epilepsy first, it is important to consider co-occurring ASD in their diagnosis.