Is it ASD, ADHD, or Both?

"My 6-year-old son was diagnosed with ADHD at age 5. But now we are seeing signs that he may have 'high functioning' autism. What percentage of ADHD children also have autism? Is a dual diagnosis common?"

Most kids with ASD level 1 (high functioning autism) don’t receive that diagnosis until after age 6. Usually, they are diagnosed with ADHD as toddlers. Part of the reason is that physicians routinely screen kids for ADHD but not for autism. 
 
Another reason is that an ASD child's social impairment becomes more evident once he starts school. Finally, physicians 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 entirely to have an autistic youngster.

Physicians make their diagnoses based on the youngster’s behaviors. Since kids with ADHD and ASD share similar behaviors, the two can appear to overlap. However, there is a fundamental difference between the two. For example:
  • An autistic child can appear unfocused, forgetful and disorganized like a youngster with ADHD, but there is a difference. The ADD youngster is easily distracted. The ASD child has no "filter."
  • Autistic children don’t understand that relationships are two-sided. If an ASD 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 ADHD can’t control himself from dominating the conversation.
  • Autistic children lack what physicians 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 ADHD 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. ASD children can’t.
  • Autistic children tend to get anxious and stuck about small things and can’t see the "big picture." Kids with ADHD are not detailed-oriented.
  • Both have social difficulties, but for different reasons.
  • Both kinds of kids can tantrum, talk too loud and too much and have problems modulating their behaviors and making friends.
  • If the unfocused autistic child is "nowhere," the obsessive-compulsive and "fantasy" autistic  child is somewhere else. "Fantasy 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 ADHD.
  • Kids with ADHD respond to behavioral modification. With ASD, the disorder is the behavior.
  • Obsessive-compulsive ASD children live a world they create from rules and rituals. Like ADHD 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 120 seconds?).
  • The ADHD youngster understands the rules but lacks the self-control to follow them. The autistic child does not understand the rules.
  • The autistic child views everything in her environment as equally important. Her teacher's dangling earring is as important as what she writes on the blackboard. The ASD child does not understand that she does not have to memorize the entire textbook for the next test. She does not "get" such rules.
  • The youngster with ADHD knows what to do, but forgets to do it. ASD children don’t know what to do.

Some researchers estimate that 60% to 70% of ASD-Level 1 children also have ADHD, which they consider a common comorbidity of ASD. Other researchers say that the two can’t exist together. Still others insist physicians 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.


Resources for parents of children and teens on the autism spectrum:
 

==> Videos for Parents of Children and Teens with ASD
 
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COMMENTS:

•    Anonymous said… fabulous info! thank you....
•    Anonymous said… Great article, thanks!
•    Anonymous said… My son haznt got any speech delays but shows every sympton of aspie but they wont diagnose him they wana diagnose him wid adhd an attachment disorder cus he waz poorly when a babie im still thinkin aspergers thow
•    Anonymous said… My son is 11 and still officially 'undiagnosed'!!!
•    Anonymous said… my son was diagnosed smack bang on the age of 6 ... no speech delay for this man . cant shut him up since the age of one !!! but other things make sense now . hes nearly seven :)
•    Anonymous said… My son was diagnosed with autism at 3. He is now 11 and presents as a child with Aspergers but at 3 there was speech delay.
•    Anonymous said… My son was just diagnosed at 7... at three he was diagnosed with speech delay anxeity disorder and ocd....
•    Anonymous said… the doctor that diagnosed my daughter said the only difference between asperger's and high functioning autism is the speech delays in the early years 
•    Anonymous said... Adhd n add will never be on the spectrum. Add n adhd are commonly diagnosed with Aspergers because some of the "symptoms" are in both. Sensory issues are in almost every child with an ASD.
•    Anonymous said... I have 2 with adhd and one with asd. While a few of the symptoms are the same, and a child can have both, I could not imagine add or adhd being on the spectrum in any way ever.
•    Anonymous said... My son has asbergers adhd ocd and generalized anxiety disorder
•    Anonymous said... They are talking about putting ADD and ADHD on the spectrum, so your question is yes. Going to share your page.
•    Anonymous said... yes my son was diagnosed with adhd when he started school but he always had the aspergers tendencies. he has been re diagnosed as adhd-asd-aspergers syndrome.
•    Anonymous said… I agree. My 15 year old son was diagnosed with ADHD at 5 but wasn't given a formal diagnosis of Aspergers till he was 9. One of the reasons for the delay was other cases where the disability was evident took precedent. Unfortunately, in cases such as Autism or FASD where the disability is "invisible" or intangible, individuals are more often than not last priority in psychological assessments in school.
•    Anonymous said… I've had a lot of anger towards the specialists who were a part of diagnosing my son with ADHD when he was 5. I always knew it wasn't the answer, and sought help from different sources (pediatrician, school special education team, therapists...) only to feel like I was going crazy because I was the only one who didn't want to medicate him for ADD. Four (long and tough) years later, we're in the process of an autism assessment. The more I read about the spectrum, the more I feel that it's so blatantly obvious that autism symptoms are what have been ailing him and causing his issues at school for so long; and it has made me angry that those specialists (who should be familiar enough with those symptoms) didn't see it or suggest it 4 years ago. This article helped me come to peace with that a little bit. I still find it strange that doctors routinely screen for ADHD over autism, and I think it's because there is medication for ADHD, a quick fix, where ASD takes a lot more time/resources/intervention.
•    Anonymous said… Very common to have both diagnosis. Actually, having only Aspergers is more rare. Aspies usually have a second diagnosis of ADHD, depression, or OCD according to what I have read and seen. My son was diagnosed ADHD at 3 1/2. At that time he was also tested for ASD, but not diagnosed. Within 2 years, he had changed quite a bit, and it then became evident that he also had Aspergers.
•    Anonymous said… Yes, there can be a dual diagnoses. I have a triple one. In our case, it is all evident and true. Asperger's and ADHD. The third one is a attachment/ bonding disorder. All are clearly right on point 100%. Some do not like to diagnose so quick. It is a process that may require a couple of opinions.

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