Is My Child with ADHD on the Autism Spectrum?
Behaviors associated with autism spectrum disorder can look a lot like ADHD. Here’s an overview of signs and symptoms, plus common reasons why parents miss ASD.
Some parents wonder whether their child with attention deficit disorder (ADHD or ADD) may have some form of autism. And they wonder for good reason: Most families of children with Asperger’s syndrome (AS), an autism spectrum disorder, receive an ADHD diagnosis — or misdiagnosis — before a pediatrician concludes that it’s Asperger’s and ADHD.
Is ADHD on the Autism Spectrum?
The symptoms of autism spectrum disorders and ADHD overlap. Most children on the autism spectrum have symptoms of ADHD — difficulty settling down, social awkwardness, the ability to focus only on things that interest them, and impulsivity. ADHD itself, however, is not part of the autism spectrum.
A mother I recently met with summed up her confusion and eventual enlightenment: “John is smart, and quick to learn something new, if he is interested,” she says. “But he has a terrible time focusing on things he isn’t interested in. When this happens, he starts rocking or pacing around the room. For years, we thought it was ADHD, but, at his last evaluation, his teachers suggested that he might have a form of autism. After seeing a pediatrician, he received a diagnosis of Asperger’s. Knowing he has it — and working to relieve the symptoms — is a relief.”
Asperger’s Syndrome Causes, Warning Signs, and Symptoms
Causes of Asperger’s Syndrome: Researchers don’t understand what causes Asperger’s syndrome, although there seems to be a strong genetic component. Although AS is on the autism spectrum, the symptoms are often milder than the symptoms of classic autism in younger children. Children with AS, like all individuals on the spectrum, have difficulties in three areas: communication, social interaction, and restricted interests.
Signs Your Child May Have Asperger’s Syndrome: More severe forms of autism are often diagnosed in the first two years of a child’s life, but AS is usually diagnosed at a later age. A major reason for that is that children with AS develop language skills more or less on time. While they may have moderate delays in the development of speech, the majority of such children communicate by age three.
Asperger’s Syndrome Symptoms Checklist
A child with AS might have some or all of the symptoms listed below. Symptoms are often less severe than in a child with autism.
Impaired communication – verbal and nonverbal
- Speech development may be normal or somewhat delayed, but difficulties arise in the functional and social use of language for communication
- Impaired use of nonverbal behaviors, including eye contact, body language, and social expressions
Restricted repertoire of activities and interests
- Narrow interests that are abnormal in intensity and focus (a single TV show, say, or an unusual object, like a vacuum cleaner)
- Rigid adherence to nonfunctional routines and rituals (following a strict protocol when leaving the house to go to school)
- Stereotyped repetitive motor mannerisms (pacing)
Poor Social Interaction
- Failure to develop age-appropriate peer relationships (inability to understand the social give-and-take of friendships)
- Failure to seek out others to share enjoyment, interest, and achievements (not sharing a good grade on a test or a just-finished painting with a family member)
- Lack of social and emotional reciprocity (not enjoying being with others just for the sake of being together)
Why Parents Miss Signs of Asperger’s Syndrome
Parents may be slow to pick up on AS in their child. Its subtle combination of symptoms leaves parents wondering if anything is wrong or if the symptoms are part of their child’s personality. A child with an unusual special interest, like the Titanic, may seem delightful to an adult, but odd to another 7-year-old. When a child goes to preschool, social difficulties become more evident. Typically, kids with AS are unable to make friends. They have a hard time reading other people or understanding humor.
Most children with AS want to make friends, but they don’t know how. Their poor conversation skills and difficulty reading social cues can lead to loneliness or a mood disorder as they go through middle school.
Asperger’s Diagnosis and Treatment
Getting Evaluated for Asperger’s Syndrome: Parents who suspect that their child has Asperger’s syndrome should consult with a developmental and behavioral pediatrician, a child psychiatrist, or a psychologist with expertise in the autism spectrum. The evaluation will likely involve observing your child and talking to you about his development. You may be asked about your child’s social interaction and communication skills. Your child may undergo several tests to determine her level of intellect and academic abilities, and to assess her abilities in the areas of speech, language, and visual-motor problem-solving.
Parents can assist the doctor’s evaluation. Write down any symptoms you have noticed, key personal information (any major stress or recent life changes), a list of medications, vitamins, and supplements your child takes, and questions you want to ask the doctor.
Treatment Plan for Children with Asperger’s Syndrome: Most children benefit from early, specialized interventions that focus on behavior management and social-skills training: learning how to interpret gestures, eye contact, tone of voice, humor, and sarcasm, for example. Cognitive behavior therapy may help them manage obsessive behavior and anxiety.
About half of children with AS will be treated with medication. While stimulant medications, like Ritalin, are among those most commonly prescribed, caution is advised. Stimulants are less likely to be effective than in children diagnosed with ADHD alone, and more likely to cause side effects.
Accommodations for Asperger’s at School
Schools are getting better at providing services for children with Asperger’s syndrome. Many schools offer pragmatic language therapy, which helps a child learn the basics of social interaction. Look for “friendship groups,” or a “lunch bunch.” Parents should make sure that social skills accommodations are part of their child’s individualized education program (IEP).
Because children with AS have a greater capacity to lead an independent life than children with more severe forms of autism, parents and their professionals who work together can help kids with Asperger’s learn to advocate for themselves as they approach adulthood.
Eileen Costello, M. D., is a member of the ADDitude ADHD Specialist Panel.