All parents want their children to get along, play, and interact well with their peers. Usually, these social abilities develop intuitively. For children who struggle socially, the earlier the interventions start, the earlier the kids catch up. Since both ADHD and autism affect relationships, finding the “why” behind social difficulties is the first step in figuring out what to do.
Autism and Social Development
Autism is a disorder in which social skills do not develop as expected. More severe impairment affects children who barely interact with others around them, and have limited language. On the other end of the spectrum, there are fairly extroverted children who seek out others and get along with adults, but have a hard time getting along with other children. (The latest version of the DSM groups all autistic spectrum disorders under one diagnosis. Asperger’s syndrome is now called “high-functioning autism.”)
The ability to socialize and communicate progresses from infancy along predictable developmental paths. While autism presents other symptoms, what distinguishes it from ADHD and other developmental disorders are differences in social development. Autism is diagnosed by looking for social delays, along with communication differences and behavioral symptoms.
> SOCIAL CHALLENGES: Children with autism lag behind socially — according to some studies, starting as early as six weeks of age. By one year, without being taught, most children respond to their name, engage in back-and-forth interaction, and understand gesture language, such as pointing and waving. The ability to interpret facial expressions, humor, and empathy happen on their own during typical development, as does a desire to share interests, play with others, and to seek comfort when upset. The other red flags of autism are poor eye contact, limited facial affect, and delays in imaginative play and self-help skills. If your child’s development does not meet these milestones, see a professional for evaluation.
> COMMUNICATION CHALLENGES: Most children with autism have early delays in language, and speak later than their peers. A few never speak at all. Others develop large vocabularies and the ability to form sentences, but they lack the ability to understand the non-verbal aspects of communication. Their speaking may seem scripted, repetitive, or awkward. They can’t read facial expression, understand tone and humor, and initiate and follow a conversation.
> BEHAVIOR CHALLENGES: Autism is also characterized by quirks in behavior, including repetitive physical motions, such as hand flapping or spinning in place, obsessive interests, or overly rigid thinking. Many sufferers have sensory challenges as well. However, a diagnosis of autism is made based on social and communication differences, not on behavioral symptoms alone.
ADHD and the Social World
ADHD symptoms affect social interactions, cause communication differences, and may lead to behavior challenges. The best one-line description of ADHD comes from Russell Barkley, Ph.D., who said, “ADHD is not a disorder of not knowing what to do, it is a disorder of not doing what you know.” This concept also helps distinguish ADHD from autism: Children with ADHD typically know the social rules; they just don’t know how to follow them yet.
> SOCIAL CHALLENGES: Children with ADHD usually understand what they’re supposed to do socially, but they don’t yet have the ability to show it in everyday life. Being distracted, impulsive, and off-task affect interactions directly. ADHD kids miss social cues they would otherwise understand — if only they noticed them.
> COMMUNICATION CHALLENGES: One often-overlooked aspect of ADHD is the relatively high risk of language delays. Yet even in the absence of an actual delay, ADHD undermines communication. Children lose track of details, are overly talkative, interrupt, stray off topic, and have a hard time keeping track of information. They may speak and process information more slowly than peers, which is not a measure of intelligence but of pacing. Unlike kids with autism, children with ADHD typically understand the pragmatic part of language; ADHD itself gets in the way.
> BEHAVIOR CHALLENGES: Behavioral concerns frequently, but not always, occur with ADHD. They involve not following social rules, such as acting impulsively, being overly silly, or disrupting situations in other ways. When peers prefer sticking to one activity, a short attention span may be disruptive on its own. The chronic challenges with organization and planning related to executive function that occur with ADHD have not been as clearly linked to autism alone. If a child with autism struggles a lot with attention or executive function, ADHD may also be present.