Autism Spectrum Disorder

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There can be overlap, but experts warn against rushing to determine a concrete diagnosis.

It’s no secret that a child with attention deficit hyperactivity disorder may have coexisting conditions such as depression and anxiety. However, each person’s situation varies – from genetic factors to environmental issues and everything in between – which can potentially muddy the waters for parents seeking a clear diagnosis.

ADHD and autism spectrum disorder present one such example. Maybe your child just has ADHD. Perhaps it’s ASD instead. Then again, it could be that he or she exhibits traits from both.

Russell A. Barkley, clinical professor of psychiatry at the Virginia Treatment Center for Children at the Virginia Commonwealth University Medical Center, says that “autism overlaps with ADHD about 25 percent of the time.” He explains key differences between the two, saying that with ADHD, other co-morbid, or coexisting, disorders are typically learning disabilities, conduct problems, anxiety, depression and oppositional defiant disorder, which include behaving in an argumentative manner that may become hostile and disruptive on a regular basis. Autism’s co-morbid disorders involve ADHD, anxiety disorders such as panic attacks and obsessive compulsive disorder. Additionally, Barkley says that “if a child starts showing bizarre use of language” such as referring to an object by a name that isn’t remotely close to what it actually is, that’s a clear indication that autism is at hand. Children with autism may also stop using language altogether or start engaging in poor grammar such as referring to themselves in the third person.

Barkley suggests a good first step for parents is to start speaking with a pediatrician, who may refer you to other professionals as he or she feels appropriate.

Differences Between Autism and ADHD

“In developmental pediatrics, there’s a lot of overlap,” says Dr. Mark Bertin, a developmental pediatrician in Pleasantville, New York, and the author of “Mindful Parenting for ADHD.” He explains that with autism, whether severe or mild, there’s an aspect of social intuition and understanding that “hasn’t fully developed.”

Indeed, Barkley says that with autism, there’s a “failure to develop sociability.” People with the disorder often lack the ability to interact with others, he explains, adding that research shows such a social deficiency doesn’t stem from anxiety, as many tend to think, but is rather due to disinterest. He says that these individuals often have an inability to copy or mimic other kids’ behaviors, watch and interact, often demonstrating a preference for repetition and sameness.

On the other hand, “ADHD has nothing to do with those behaviors,” Barkley says, explaining it as a “disorder of self-control.” People with ADHD often can’t manage their behavior, so they’re impulsive, inattentive, emotionally disregulated and lack willpower. “But they don’t have loss of language, repetitive behaviors such as hand flapping or toe walking or severe language deficits,” Barkley says.

With ADHD, Bertin says, there are often executive functioning delays which involve behavior, attention, organization and planning. These executive functioning issues, he explains, may affect a child’s social world – one example of how a parent may mistake one condition for the other. Bertin notes that autism involves not understanding social cues while ADHD involves not seeing or paying attention to them.

Focus on Support Systems, Not a Quick Diagnosis

“Up to half of kids with autism also have ADHD,” Bertin says. He explains that since ADHD affects social interactions, it may be difficult to initially gauge a child’s actual social abilities. This is yet another example of possible overlap that may be displayed and make diagnosis challenging. While it may be natural for parents to want a clear answer sooner than later, Bertin stresses that that’s not always possible, adding that it’s common for children to have symptoms of both ADHD and ASD. He says that the ultimate goal is to move away from focusing on a cut-and-dry diagnosis, at least at the onset. “It’s more important to define what help can be offered without having to fully separate everything out,” he says.

Bertin explains that while comprehensive evaluations upfront are helpful, it’s “far more important from a child’s point of view” to get a support system in place. This may include a range of behavioral interventions, including, but not limited to, speech-language groups (ideal for autism in particular), behavioral therapy, educational supports such as an IEP or 504 plan and parent training interventions.

An IEP, or Individualized Education Program, helps ensure that children in elementary or secondary schools who have a disability obtain specialized instruction and services. A 504 plan pertains to children in the same circumstance as those with an IEP, but it focuses on offering certain accommodations such as visual aids or preferential seating.

Once social support has been in place, Bertin suggests parents work with a professional and begin to clarify – over time – whether their child has two different conditions. “Getting support systems in place early is an important step for a child that’s fallen behind developmentally,” he says. In time, a child’s developmental differences can be “teased out – helping them feel more successful is the larger goal from the start.”

Changing Circumstances May Mean Changing Behaviors

Manju Banerjee, vice president of educational research and innovation at Landmark College in Vermont, which places an emphasis on students who learn differently, including those with learning disabilities such as dyslexia, ADHD and ASD, agrees. “Don’t go for a diagnosis as a first step in this process,” she says. “ADHD and ASD are situational.” Banerjee notes that circumstance and context need to be considered, adding that they may change over time, which might make manifestations vary. Along the way, she says that cognitive behavioral therapy, ADHD medication, coaching and various social supports may be beneficial treatments. Proactive parents, she explains, should discuss any concerns about these disorders with a pediatrician and school counselors. Still, Banerjee reminds parents not to get hung up on immediately identifying a concrete diagnosis, and especially warns against parents attempting to make a diagnosis on their own.

Banerjee also advises parents to “be aware and familiar with current research about neurodiversity,” saying that there are many developmental manifestations that lie along a trajectory. Some of these develop later than others, but whenever they do, she says it’s best not to jump to conclusions. For example, someone who is experiencing communication challenges may in fact actually be extremely shy or different in various environments; “it could be a personality issue and not ASD,” she says. “It’s really important to consider the gestalt of the situation and adopt a 360-degree view rather than jumping to one diagnosis or another.”

“None of this is definitive,” Banerjee says. “There aren’t blood tests for any of this.” She notes that research pertaining to these disorders is typically self-reported or self-observed, which leaves plenty of room for subjectivity. “Parents need to think along a developmental trajectory as opposed to strictly DSM categories.”

DSM-5, or the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, is the American Psychiatric Association’s classification and diagnosis standard.