Relationship between Autism and ADHD
Parents are often puzzled by their child’s lack of interaction with others in social situations. Their child does not make or sustain eye contact, has a delay in language development, and engages in repetitive movements. The child is unresponsive to common stimuli and is withdrawn. The pediatrician or psychologist labels the child with a diagnosis of Autism Spectrum Disorder (ASD).
A child who has not been diagnosed with any disorder may start school and become disruptive, and initially, the child may be viewed as an undisciplined child. He or she has difficulty concentrating and may get up and wander around the classroom, interfering with the work of others. Finally, the child is diagnosed with attention deficit hyperactivity disorder (ADHD), and medication is prescribed. Either the behavior improves, or a future is embarked upon in which medication dosages are adjusted, and behaviorists work with the child with a goal of achieving behavior modification.
These scenarios frequently occur. A diagnosis is made, and all interventions focus on that one diagnosis. Prior to the publication of the 2013 Diagnostic and Statistical Manual of Mental Disorders (DSM-5), psychiatrists stated that a child could be diagnosed with either ASD or ADHD, but not both. In the DSM-5, the American Psychiatric Association (ASA) changed its collective mind and now states that a child may have both conditions. This is still a controversial theory, and many diagnosticians will diagnose a child with either one or the other disorder, but not with both. A troubling aspect of diagnosing is that children with one disorder or the other may be misdiagnosed. The correct diagnosis is important, so the proper interventions can be implemented.
Distinguishing Similarities and Differences in ADHD and Autism
Children with ADHD and Autism engage in some similar behaviors. They both have difficulty interacting socially and have trouble understanding or responding to directions. Some ways the symptoms may be distinguished include:
• Children with ADHD have trouble coming to attention, but, unlike autistic children, they know they should and will respond even though they may have trouble sustaining attention and are easily distracted. They may not respond when they are playing and their name is called, because they are engaged and do not want to be interrupted. They do know their names and know they should respond, but choose not to. Their facial expressions are appropriate; they understand humor and can laugh at jokes. They may find it difficult to take turns when participating in an activity with other children, but they understand the concept. They are hyperactive and impulsive.
• Children with ASD have major trouble coming to attention. They may not even be able to do so, and they may not respond at all. They do not respond to their name being called because they may not associate that name with themselves. They do not take turns and do not understand the concept. They do not understand humor, do not express emotion and do not have appropriate facial expressions.
ASD, ADHD or Both: Does It Matter?
Author and developmental behavior pediatrician, Mark Bertin, M.D., believes there are times when trying to make the right diagnosis needs to be set aside; instead, the focus should be “on a plan to address whatever is going on with the child.” The diagnosis is not as important as just trying different interventions to discover which ones are effective. Bertin states, “In fact, the interventions themselves may help determine the most accurate diagnosis.”
Bertin notes that many of the interventions are the same. For example, a child with ongoing problems with social skills, whether because of ADHD or ASD, may respond to behavioral therapy. Other interventions, such as speech therapy, educational interventions and other therapies should be implemented no matter which disorder is the ultimate diagnosis. On the other hand, medications that help ADHD children improve their behavioral problems do not help children with autism.
When a Child Has Both Autism and ADHD
Since it has only been since 2013 that the APA concluded that a person could have both autism and ADHD, very few medical studies exist that consider the impact of both diagnoses on children or adults. One example of a male child with both ASD and ADHD inspired his mother, Cassie Zupke, to write a book about her experiences as the mother of an autistic child. The book is titled, ”We Said, They Said: 50 Things Parents and Teachers of Students With Autism Want Each Other to Know.”
Clark Zupke was diagnosed with autism when he was 3 years old primarily due to delays in his speech development. He had no real problems in special education during preschool and kindergarten, but in first grade, he entered a regular classroom and absolutely could not function. He had no impulse control and would run under the teacher’s desk or hide in the janitor’s closet. He refused to interact with other children and had poor communication skills. He was diagnosed with ADHD in addition to mild autism. Medication was prescribed, and his behavior improved dramatically.
As a teenager, Clark continues to take ADHD medication, and he is considered to still have autism based on his symptoms. He responds to behavioral interventions. He understands his condition and strives to bridge the gaps between his behavior and that of others.
As one would expect, children with both disorders struggle more than those with just one. A correct diagnosis is vitally important for the child to receive the proper interventions. Having the correct diagnosis and therapy can make a tremendous difference in the future of a child who has ADHD, ASD or both.