"My son was originally diagnosed with ADD (age 4), but now they say he has 'high functioning' autism and ADD (age 6). What is the main difference between these two conditions, and is it possible to have both?"
Most kids don’t receive a diagnosis of High-Functioning Autism (HFA) or Asperger's (AS) until after age 5 or 6 (around the time they start public school). Usually, they are diagnosed with Attention Deficit Disorder as preschoolers. Part of the reason for this is that pediatricians routinely screen kids for ADD – but not for autism. Another reason is that an AS and HFA kid's social impairment becomes more evident once he or she starts school. Finally, pediatricians are reluctant to label a youngster as "autistic." It is okay - and even a badge of honor - to have a “hyperactive” youngster, but it is another thing entirely to have an “autistic” youngster.
Pediatricians make their diagnoses based on the kid's behaviors. Since kids with ADD and AS share similar behaviors, the two can appear to overlap. However, there is a fundamental difference between these two disorders. AS and HFA kids lack what pediatricians call "social reciprocity" or Theory of Mind. Theory of Mind is "the capacity to understand that other people have thoughts, feelings, motivations and desires that are different from our own." Kids with ADD have a Theory of Mind and understand other people's motives and expectations. They also make appropriate eye contact and understand social cues, body language and hidden agendas in social interactions. AS and HFA kids don’t!
Kids with ADD respond to behavioral modification. With AS and HFA, the syndrome is the behavior. Both kinds of kids can tantrum, talk too loud and too much, and have problems modulating their behaviors and making friends. Both are “social failures” to one degree or another – but for different reasons.
The youngster with ADD knows what to do – but forgets to do it. AS and HFA kids don’t know what to do. They don’t understand that relationships are two-sided. If an AS or HFA youngster talks on and on in an un-modulated voice about his particular interest, he simply doesn’t understand that he is boring his friend and showing disinterest in his friend's side of the conversation. On the other hand, the youngster with ADD can’t control himself from dominating the conversation.
An AS or HFA youngster can appear unfocused, forgetful and disorganized like a youngster with ADD, but there is a difference. The ADD youngster is easily distracted, whereas the AS and HFA kid has no "filter." The AS/HFA youngster sees everything in his environment as equally important (e.g., his teacher's dangling earring is as important as what she writes on the blackboard). The AS/HFA youngster doesn’t understand that he doesn’t have to memorize the entire textbook for the next test. He doesn’t "get" such rules. AS and HFA kids tend to get anxious and stuck about small things and can’t see the "big picture." On the other hand, kids with ADD are not detailed-oriented. The ADD youngster understands the rules – but lacks the self-control to follow them. The AS and HFA kid doesn’t understand the rules.
The unfocused ADD youngster is "nowhere," but the highly-focused or “fantasy" AS youngster is somewhere else. "Fantasy AS kids" retreat into a world of their own making, a world where everything goes the way they want it to. They play video games for hours or retreat into books and music. Their daydreaming and fantasizing resembles the behaviors of non-hyperactive kids with ADD.
Obsessive-compulsive AS and HFA kids live a world they create from rules and rituals. Like ADD kids, they appear preoccupied and distracted – but for different reasons. They appear distracted because they are always thinking about their "rules" (e.g., Did I tie my shoelaces right? Did I brush my teeth for 3 minutes?).
Some researchers estimate that 60% to 70% of AS and HFA kids also have ADD, which is considered a common comorbidity of AS and HFA. Other researchers say that the two disorders can’t exist together. Still others insist pediatricians have it all wrong - and that the two disorders are the same. The real problem is that there is no hard science. No one knows exactly how slight imperfections in brain structure and chemistry cause such problems.
For this reason, getting the right diagnosis for a youngster who exhibits behavior problems may take years of trial and error. Diagnosis is based on observation of behaviors that are similar for a myriad of disorders. The tragedy is that the youngster often doesn’t receive the correct medications, educational strategies, and behavioral modification techniques that could help him function on a higher level. He falls farther behind his peer group and loses ground when he could be getting appropriate treatments.
Psychiatry has made great strides in helping kids manage mental disorders, particularly moderate conditions, but the system of diagnosis is still years behind other branches of medicine. On an individual level, for many parents with children on the spectrum, the experience can be exhausting.
Pediatricians make their diagnoses based on the kid's behaviors. Since kids with ADD and AS share similar behaviors, the two can appear to overlap. However, there is a fundamental difference between these two disorders. AS and HFA kids lack what pediatricians call "social reciprocity" or Theory of Mind. Theory of Mind is "the capacity to understand that other people have thoughts, feelings, motivations and desires that are different from our own." Kids with ADD have a Theory of Mind and understand other people's motives and expectations. They also make appropriate eye contact and understand social cues, body language and hidden agendas in social interactions. AS and HFA kids don’t!
Kids with ADD respond to behavioral modification. With AS and HFA, the syndrome is the behavior. Both kinds of kids can tantrum, talk too loud and too much, and have problems modulating their behaviors and making friends. Both are “social failures” to one degree or another – but for different reasons.
The youngster with ADD knows what to do – but forgets to do it. AS and HFA kids don’t know what to do. They don’t understand that relationships are two-sided. If an AS or HFA youngster talks on and on in an un-modulated voice about his particular interest, he simply doesn’t understand that he is boring his friend and showing disinterest in his friend's side of the conversation. On the other hand, the youngster with ADD can’t control himself from dominating the conversation.
An AS or HFA youngster can appear unfocused, forgetful and disorganized like a youngster with ADD, but there is a difference. The ADD youngster is easily distracted, whereas the AS and HFA kid has no "filter." The AS/HFA youngster sees everything in his environment as equally important (e.g., his teacher's dangling earring is as important as what she writes on the blackboard). The AS/HFA youngster doesn’t understand that he doesn’t have to memorize the entire textbook for the next test. He doesn’t "get" such rules. AS and HFA kids tend to get anxious and stuck about small things and can’t see the "big picture." On the other hand, kids with ADD are not detailed-oriented. The ADD youngster understands the rules – but lacks the self-control to follow them. The AS and HFA kid doesn’t understand the rules.
The unfocused ADD youngster is "nowhere," but the highly-focused or “fantasy" AS youngster is somewhere else. "Fantasy AS kids" retreat into a world of their own making, a world where everything goes the way they want it to. They play video games for hours or retreat into books and music. Their daydreaming and fantasizing resembles the behaviors of non-hyperactive kids with ADD.
Obsessive-compulsive AS and HFA kids live a world they create from rules and rituals. Like ADD kids, they appear preoccupied and distracted – but for different reasons. They appear distracted because they are always thinking about their "rules" (e.g., Did I tie my shoelaces right? Did I brush my teeth for 3 minutes?).
Some researchers estimate that 60% to 70% of AS and HFA kids also have ADD, which is considered a common comorbidity of AS and HFA. Other researchers say that the two disorders can’t exist together. Still others insist pediatricians have it all wrong - and that the two disorders are the same. The real problem is that there is no hard science. No one knows exactly how slight imperfections in brain structure and chemistry cause such problems.
For this reason, getting the right diagnosis for a youngster who exhibits behavior problems may take years of trial and error. Diagnosis is based on observation of behaviors that are similar for a myriad of disorders. The tragedy is that the youngster often doesn’t receive the correct medications, educational strategies, and behavioral modification techniques that could help him function on a higher level. He falls farther behind his peer group and loses ground when he could be getting appropriate treatments.
Psychiatry has made great strides in helping kids manage mental disorders, particularly moderate conditions, but the system of diagnosis is still years behind other branches of medicine. On an individual level, for many parents with children on the spectrum, the experience can be exhausting.
The Aspergers Comprehensive Handbook
COMMENTS:
• Anonymous said... Add is part of asd. That's why so many kids are diagnosed w add before they get an actual diagnosis of high functioning or aspergers (my daughter was finally diagnosed w aspergers after about 3 years of an add diagnosis)
• Anonymous said... ADD/ADHD and ASD are not the same. They are each mutually exclusive disorders, yet they can also be comorbid. I have two with ASD, yet neither of them have ADD/ADHD.
• Anonymous said... I fought for my son to not have the ADD label because when I saw the test a lot of the questions they asked where his asd. My paediatrician said I had to take out the asd and answer the questions but it is not that black and white. I agree with Michelle if they can sit and concentrate they are not ADD.
• Anonymous said... I personally believe that ADD/ADHD has been overdiagnosed for many years and now it seems that many PCP's/Pediatricians are diagnosing Asperger's without doing any Psychological testing leading to it now being overdiagnosed as well. These are not even Developmental Pediatricians who do not have the credentials and training to diagnose ASD.
• Anonymous said... In kinder the school said my son was autistic. Since he was very verbal, I thought he was just ADHD. Now, I know he is aspergers and so much more of his sensory issues make sense now.
• Anonymous said... My 11 yr old had adhd first and now aspergers
• Anonymous said... My 4 (almost 5) year old dr says he is hyperactive disorder but does not have the attention defecit. His preschool is suspecting aspergers but his dr doesn't want to do any testing for that until after we start medicating him. He too will snap right to attention if the subject interest or benefits him.
• Anonymous said... My son can concentrate but only to a certain point before he gets unfocused. It's hard for him. He was initially dx AHDD and later ASD with AHDD. AHDD came at age of 5 and ASD at age of 12 after multiple problems with school, bullying and behaviors which interfered with his school and life. He still takes meds for concentration and mood stabilizers for some of the mood swings. I have to say it has been a challenging road. But once you figure out what to do for them it gets a little easier. My son is now 17 and soon graduating high school. In some parts he acts his age and in others he acts like he is 12. I try to focus his attention on becoming an adult and college, but he needs a lot of hand holding. I do believe the two disorders exists amongst themselves. He is no longer hyper but surely very forgetful and unorganized.
• Anonymous said... My son has a duel diagnosis of ADHD and Aspergers.
• Anonymous said... My son has Asperger's and ADD diagnoses but I don't agree with the ADD. He is definitely able to concentrate for hours if it's something he likes to do and we have tried medicines in the past for attention problems and they made little to no difference for him.
• Anonymous said... my son has been diagnosed as adhd at about 5. around 8 years old Aspergers was noted and he was officially diagnosed as having both.
• Anonymous said... My son the same Maria. He has adhd and aspergers.
• Anonymous said... My son was diagnosed with high functioning Aspergers when he was 4. This year, now he is five, they said he also has ADD. I was told ADD typically always comes with AS. I don't exactly know what my opinion on that is. Yes, my son has trouble consentrating and likes to move around a lot. And that is something I work with him on. I don't know if he really needs that extra label and I do know I am not going to medicate him just to do so.....listen to your intuition. Unfortunately, you will have to do the research as the medical field is highly uninformed (IMO).
• Anonymous said... Personally I think they over diagnose add. But the 2 are very similar. Except those with add, cannot concentrate on anything, whereas those with Aspergers can concentrate on something they are interested in.
• Anonymous said... Since our children are around the same age, mine will be six soon, and they have the same diagnosis, feel free to message me and we can talk more.
• Anonymous said... The two are very different, very very different. The best person to ask is someone who specializes in this. Your child's doctor or specialist will be able to explain to you what the differences are in relation to your child. All aspergers/autism is different so it's impossible to guess what your child is like in that respect. It's possible to have both and my son has many friends who have both. ADD doesn't usually have social issues, sensory issues, and so many other typical ASD issues.
• Anonymous said... Without sounding like I'm accusing anyone, because I'm not, I think many ASD kids get misdiagnosed with ADD because they are so hard to discipline that they can sometimes just be wild little things. ASD kids don't pay social penalties for anything so they lack a lot of self discipline that NT people learn very early. And traditional discipline doesn't always work. I know if I send my son to the corner he just makes up stories and reads them to the floor and he loves doing that.
• Anonymous said… My son was diagnosed with ADHD at 7. Typical ADHD meds only made his problems worse, and it wasn't until I saw a checklist of Asperger traits that it clicked "that is him!" Now, at 10, he finally has an "accurate" diagnosis. Beth Ann, I understand where you're coming from. My son is very high functioning and can appear neurotypical in many settings. He even fools me sometimes, until something happens to remind me that no, I'm not dealing with a "typical" child here. That is THE hardest thing for me as his mom.
• Anonymous said… My oldest wasn't dx'd till 3rd grade but he also has add. We just thought he was immature and a little eccentric as an only child. He hit all the normal milestones. We realized it was something more but bounced a lot of letters around. After some research by his psych and us we all agreed on aspergers. But what do I do with a kid who appears neurotypical and not the full blown vs of autism?
• Anonymous said… After it took myself, 2 nurses and the doctor to pin my 3 year old son down for a strep test and him coming up with a bloody mouth would she finally have a consultation with me about aspergers. He has major sensory issues. at his last dental cleaning it took 5 of us to hold him down. after his diagnosis, he is in pt, ot and speech. it has only been a month but am starting to see a little improvement.
Post your comment below…
COMMENTS:
• Anonymous said... Add is part of asd. That's why so many kids are diagnosed w add before they get an actual diagnosis of high functioning or aspergers (my daughter was finally diagnosed w aspergers after about 3 years of an add diagnosis)
• Anonymous said... ADD/ADHD and ASD are not the same. They are each mutually exclusive disorders, yet they can also be comorbid. I have two with ASD, yet neither of them have ADD/ADHD.
• Anonymous said... I fought for my son to not have the ADD label because when I saw the test a lot of the questions they asked where his asd. My paediatrician said I had to take out the asd and answer the questions but it is not that black and white. I agree with Michelle if they can sit and concentrate they are not ADD.
• Anonymous said... I personally believe that ADD/ADHD has been overdiagnosed for many years and now it seems that many PCP's/Pediatricians are diagnosing Asperger's without doing any Psychological testing leading to it now being overdiagnosed as well. These are not even Developmental Pediatricians who do not have the credentials and training to diagnose ASD.
• Anonymous said... In kinder the school said my son was autistic. Since he was very verbal, I thought he was just ADHD. Now, I know he is aspergers and so much more of his sensory issues make sense now.
• Anonymous said... My 11 yr old had adhd first and now aspergers
• Anonymous said... My 4 (almost 5) year old dr says he is hyperactive disorder but does not have the attention defecit. His preschool is suspecting aspergers but his dr doesn't want to do any testing for that until after we start medicating him. He too will snap right to attention if the subject interest or benefits him.
• Anonymous said... My son can concentrate but only to a certain point before he gets unfocused. It's hard for him. He was initially dx AHDD and later ASD with AHDD. AHDD came at age of 5 and ASD at age of 12 after multiple problems with school, bullying and behaviors which interfered with his school and life. He still takes meds for concentration and mood stabilizers for some of the mood swings. I have to say it has been a challenging road. But once you figure out what to do for them it gets a little easier. My son is now 17 and soon graduating high school. In some parts he acts his age and in others he acts like he is 12. I try to focus his attention on becoming an adult and college, but he needs a lot of hand holding. I do believe the two disorders exists amongst themselves. He is no longer hyper but surely very forgetful and unorganized.
• Anonymous said... My son has a duel diagnosis of ADHD and Aspergers.
• Anonymous said... My son has Asperger's and ADD diagnoses but I don't agree with the ADD. He is definitely able to concentrate for hours if it's something he likes to do and we have tried medicines in the past for attention problems and they made little to no difference for him.
• Anonymous said... my son has been diagnosed as adhd at about 5. around 8 years old Aspergers was noted and he was officially diagnosed as having both.
• Anonymous said... My son the same Maria. He has adhd and aspergers.
• Anonymous said... My son was diagnosed with high functioning Aspergers when he was 4. This year, now he is five, they said he also has ADD. I was told ADD typically always comes with AS. I don't exactly know what my opinion on that is. Yes, my son has trouble consentrating and likes to move around a lot. And that is something I work with him on. I don't know if he really needs that extra label and I do know I am not going to medicate him just to do so.....listen to your intuition. Unfortunately, you will have to do the research as the medical field is highly uninformed (IMO).
• Anonymous said... Personally I think they over diagnose add. But the 2 are very similar. Except those with add, cannot concentrate on anything, whereas those with Aspergers can concentrate on something they are interested in.
• Anonymous said... Since our children are around the same age, mine will be six soon, and they have the same diagnosis, feel free to message me and we can talk more.
• Anonymous said... The two are very different, very very different. The best person to ask is someone who specializes in this. Your child's doctor or specialist will be able to explain to you what the differences are in relation to your child. All aspergers/autism is different so it's impossible to guess what your child is like in that respect. It's possible to have both and my son has many friends who have both. ADD doesn't usually have social issues, sensory issues, and so many other typical ASD issues.
• Anonymous said... Without sounding like I'm accusing anyone, because I'm not, I think many ASD kids get misdiagnosed with ADD because they are so hard to discipline that they can sometimes just be wild little things. ASD kids don't pay social penalties for anything so they lack a lot of self discipline that NT people learn very early. And traditional discipline doesn't always work. I know if I send my son to the corner he just makes up stories and reads them to the floor and he loves doing that.
• Anonymous said… My son was diagnosed with ADHD at 7. Typical ADHD meds only made his problems worse, and it wasn't until I saw a checklist of Asperger traits that it clicked "that is him!" Now, at 10, he finally has an "accurate" diagnosis. Beth Ann, I understand where you're coming from. My son is very high functioning and can appear neurotypical in many settings. He even fools me sometimes, until something happens to remind me that no, I'm not dealing with a "typical" child here. That is THE hardest thing for me as his mom.
• Anonymous said… My oldest wasn't dx'd till 3rd grade but he also has add. We just thought he was immature and a little eccentric as an only child. He hit all the normal milestones. We realized it was something more but bounced a lot of letters around. After some research by his psych and us we all agreed on aspergers. But what do I do with a kid who appears neurotypical and not the full blown vs of autism?
• Anonymous said… After it took myself, 2 nurses and the doctor to pin my 3 year old son down for a strep test and him coming up with a bloody mouth would she finally have a consultation with me about aspergers. He has major sensory issues. at his last dental cleaning it took 5 of us to hold him down. after his diagnosis, he is in pt, ot and speech. it has only been a month but am starting to see a little improvement.
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