Asperger's Syndrome and ADHD

Most kids with Aspergers do not receive that diagnosis until after age 6. Usually, they are diagnosed with Attention Deficit Disorder as toddlers. Part of the reason is that doctors routinely screen kids for ADD but not for autism. Another reason is that an Aspergers child's social impairment becomes more evident once he hits school. Finally, doctors are reluctant to label a youngster "autistic." It is okay and even a badge of honor to have a "hyperactive youngster," but it is another thing whatsoever to have an "autistic youngster."

Doctors make their diagnoses based on kid's behaviors. Since kids with Attention Deficit Disorder and Aspergers share similar behaviors, the two can appear to overlap. However, there is a fundamental difference between Attention Deficit Disorder and Aspergers. Aspergers children lack what doctors 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 make appropriate eye contact and understand social cues, body language and hidden agendas in social interactions. Aspergers children cannot.

One author put it this way: kids with Attention Deficit Disorder respond to behavioral modification. With Aspergers, 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 but for different reasons.

The youngster with Attention Deficit Disorder knows what to do, but forgets to do it. Aspergers children do not know what to do. They do not understand that relationships are two-sided. If an Aspergers child talks on and on in an unmodulated voice about his particular interest, he simply does not 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 cannot control himself from dominating the conversation.

An Aspergers child can appear unfocused, forgetful and disorganized like a youngster with Attention Deficit Disorder, but there is a difference. The ADD youngster is easily distracted; the Aspergers child has no "filter." The Aspergers child sees everything in her environment as equally important. Her teacher's dangling earring is as important as what she writes on the blackboard. The Aspergers child does not understand that she does not have to memorize the entire textbook for the next test. She does not "get" such rules. Aspergers children tend to get anxious and stuck about small things and cannot see the "big picture." Kids with Attention Deficit Disorder are not detailed-oriented. The ADD youngster understands the rules but lacks the self-control to follow them. The Aspergers child does not understand the rules.

If the unfocused Aspergers child is "nowhere," the obsessive-compulsive and "Fantasy" Aspergers children are somewhere else. "Fantasy Aspergers children" 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 Aspergers children 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." Did I tie my shoelaces right? Did I brush my teeth for 120 seconds?

Some authors estimate that 60% to 70% of Aspergers children also have Attention Deficit Disorder, which they consider a common comorbidity of Aspergers. Other authors say that the two cannot exist together. Still others insist doctors 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 does not 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 illness, particularly moderate conditions, but the system of diagnosis is still 200 to 300 years behind other branches of medicine," said Dr. E. Jane Costello, a professor of psychiatry and behavioral sciences at Duke University. "On an individual level, for many parents and families, the experience can be a disaster; we must say that."

My Aspergers Child