I’ve read some upsetting statistics in the past that point to a shortened average lifespan for autistic people compared to neurotypical sex-matched ones. I haven’t actually read much of the research that might delineate whythis discrepancy exists, but I hypothesize that there are three primary reasons for this ten-plus year truncated life expectancy in the autistic population. The first is due to a reluctance to see doctors and seek the appropriate medical care. The second is due to a potentially real increased risk of comorbid health conditions that lower one’s overall quality of health. The final major reason I imagine underlies this shortened life expectancy is due to a propensity for unhealthy behaviors, which are routinized, leading to aspects of the lifestyle that are chronically detrimental to an autistic person’s health and wellbeing.
It’s no secret that I hate going to doctor’s appointments. They stress me out, throw kinks in my daily routine (which I hate), and almost always seem unproductive because I either find myself succumbing to unintentional selective mutism and thus don’t communicate openly and thoroughly about my symptoms and don’t advocate aggressively for my needs (which you need to do in this age of super busy doctors who drop the ball on following up), or otherwise get brushed off and told to “hang in there” and “come back in for a follow-up appointment in 6 months” and we will gauge how I’m doing then. (In the latter case, the six-month visit yields the same, despite a report of continuing or worsening of symptoms.) Hours are wasted in waiting rooms, hundreds of dollars lost in copays and missed wages for the time off, and feelings of frustration and hopelessness mount with every unproductive appointment. This cycle leads to greater reluctance to schedule future appointments when new issues arise, or to follow-up with the dismissive or intimidating provider. As someone who is normally verbal, it’s anxiety-riddling, frightening in its unfamiliarity, and embarrassing when suddenly, I am completely unable to will yourself to make a sole utterance of a word, let alone explain the complicated problems I am experiencing, which I was fully able to talk at length about at home. It’s not just a matter of being “tongue-tied;” rather, I truly cannot speak a single word (even a hello or my name!) no matter how much I want to. Selective mutism can be so upsetting because it puts you in what feels like a dangerously vulnerable position—one where it feels like you couldn’t stand up for your needs even if push came to shove. As someone with a major trauma in my history, this fear is all-encompassing enough that experiencing selective mutism with one doctor, which typically occurs if they have a disposition, mannerisms, or tone of voice that frightens me, may preclude me from willingly seeing them again because doing so might land me back in that terribly uncomfortable emotional place.\
I also believe, and I think peer-reviewed research will back me up, that autism tends to predispose the affected individual to medical conditions, particularly digestive diseases, epilepsy, and fragile X syndrome, and certainly mental health disorders, such as depression, bipolar disorder, OCD, and anxiety. These latter conditions can increase the risk of suicide, which will certain reduce one’s lifespan, and there is also evidence that certain conditions, like depression, may lower life expectancy even in the absence of suicide.
Lastly, autistic people tend to be very habitual and wedded to their routines. When these include unhealthy behaviors, such as the regular consumption of processed foods or a lack of physical activity, these patterns can be detrimental to one’s health. Avoidant Restrictive Feeding Disorder (ARFD)—in which someone follows a severely limited diet (likely devoid of necessary nutrients)—and more classic eating disorders like anorexia are very common in autistic children and adults. The former is especially likely in autistic people with sensory processing disorder of the defensive/avoidant type. Certain food textures, smells, and tastes can be completely offensive to the person, wiping out entire classes of foods. For example, some autistic people hate crunchy food because it’s too “loud” or “hard,” while others won’t eat anything mushy or soft like yogurt, cooked vegetables, rice, or beans. If the same limited diet is followed day in and day out, the body can easily miss out on the variety and balance of nutrients needed to maintain growth (in a child) or health (in an adult) and develop major deficiencies. On the opposite end of the spectrum, some autistic people are sensory seekers and may soothe themselves with eating as a stimming behavior (a repetitive behavior used to help regulate and relax the person (classic examples are hand flapping and rocking)). Constantly munching on crunchy foods, almost as a tic, can lead to excessive calorie consumption and weight gain. This, in turn, can also be problematic for health. Excessive exercise can also be a self-soothing, stimming behavior, and while potentially less problematic for a healthy lifestyle, it’s often counterproductive in its excessiveness over time. Injuries, chronic fatigue, hormonal imbalances, and physiologic stress can all ensue.
I have suffered from various components of all three of these factors myself, which is probably partially why they’ve made it on my short list of probable reasons for a reduced life expectancy in autistic people. This topic has piqued my interest though, so I hope to get my hands on the actual scientific research and inform myself as to the evidence-based rationale.