A 16-year-old male with autism presents with worsening “anxiety” over the past year. They report panic attacks, migraines, difficulty attending school, and marked sensitivity to bright lights and loud sounds. Symptoms are especially triggered by hot showers and standing up quickly in the morning. Past medical history is notable for a concussion 8 months ago. Physical examination is otherwise unremarkable.
Which of the following underlying conditions should be most strongly considered as contributing to this patient’s symptoms?
Correct!
Wrong!
Explanation: Neurodivergent adolescents with anxiety-like symptoms may have underlying autonomic dysfunction rather than primary psychiatric disease alone. Clues in this case include symptom provocation with hot showers, positional changes, migraines, sensory sensitivity, and worsening after concussion. Dysautonomia and postural orthostatic tachycardia syndrome (POTS) are increasingly recognized in autistic and ADHD populations and may present with panic-like symptoms, fatigue, dizziness, headaches, and school avoidance. Neurodiversity-affirming care requires clinicians to broaden the differential diagnosis beyond primary anxiety disorders alone.