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 previously associated with Asperger’s syndrome, plus common reasons why parents mistake ASD for ADHD — and vice versa.
Many children with traits associated with autism spectrum disorder receive an ADHD diagnosis — or misdiagnosis — before a pediatrician or developmental specialist con- cludes that it’s autism. Hallmarks of autism spectrum disorder and ADHD often overlap. Many autistic children also have symptoms of ADHD — difficulty settling down, social awkwardness, only focusing only on things of interest to them, and impulsivity.
What Causes Autism?
Researchers don’t understand what causes autism, though there seems to be a strong genetic component. Research suggests that autism may develop from a combination of genetic and environmental factors, though much further study is required to fully under- stand this interplay.
Is ADHD on the Autism Spectrum?
Characteristics of autism spectrum disorders and ADHD sometimes overlap. More than half of children on the autism spectrum have symptoms of ADD, according to CHADD — 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 previously met 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 doesn’t find interesting. 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 manage the symptoms — is a relief.”
What Happened to Asperger’s Syndrome?
In 1944, Hans Asperger first described Asperger’s syndrome (AS) in children who:
- Had strong vocabulary and language skills
- Had a distinct use of language and tone of voice
- Were socially isolated from their peers
- Performed repetitive behaviors
- Had strong interests in specific topics
- Preferred structure and routine
In 2000, the American Psychological Association (APA) included AS in the umbrella term of pervasive developmental disorders alongside autistic disorder associated with these three main difficulties: communication, social interaction, and restricted interests. AS was both related to and separate from autism at that time.
The newest version of the APA’s Diagnostic and Statistical Manual, published in 2013, does not include Asperger’s. Instead, it uses the term “autistic spectrum disorder (ASD),” which encompasses several distinct disorders, including AS. People previously diagnosed with AS received a new diagnosis of ASD. The APA believed this change could help those with AS more easily receive community and school services.
The clinical use of the term Asperger’s has mostly gone away; however, it is still frequently used by people previously diagnosed with AS and their families. Many believe it is a much better description for their condition than the general term autism. Many still call themselves “Aspies.” Today, many lay people still use the term Asperger’s, while medical professionals do not.
Signs Your Child May Have Qualified for an Asperger’s Syndrome Diagnosis
Children previously diagnosed with AS typically had moderate delays in speech development, but most communicated by age three.
Asperger’s Syndrome Checklist
- Speech development may be within the normal range 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
Poor Social Interaction
- Failure to develop age-appropriate peer relationships (inability to understand the social give-and-take of friendships). Most children with indicators formerly associated with Asperger’s syndrome want to make friends, but they don’t know how.
- Failure to seek out others to share enjoyment, interest, and achievements (such as sharing a good grade on a test)
- Lack of social and emotional reciprocity (not enjoying being with others just for the sake of being together)
- Narrow interests abnormal in intensity and focus (for example, a single TV show, the Titanic, or an unusual object such as 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, rocking, rubbing a blanket)
Why Parents Miss Signs of Asperger’s Syndrome
Parents may be slow to pick up the signs of autism enumerated above. A child with distinct special interests, like dinosaurs or cloud formations, 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 behaviors associated with AS find it difficult to make friends. They have a hard time reading other people or understanding humor.
Most children with autism want to make friends, but frequently 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 Autism. Parents who suspect that their child has autism should consult with a developmental and behavioral pediatrician, a child psychiatrist, or a psychologist with expertise in the autism spectrum. The evaluation typically involves observing your child and talking to you about their development, such as asking questions about your child’s social interaction and communication skills. Your child may undergo tests to determine their level of intellect and academic abilities and to assess their current level in speech, language, and visual-motor problem-solving.
Assist the Doctor’s Evaluation. Write down any behaviors you have noticed, vital personal information (any significant stress or recent life changes), a list of medications, vitamins, and supplements your child takes, and questions you want to ask the doctor.
Support Plan for Autistic Children. Most children benefit from early, specialized interventions that focus on behavior management and social skills training, such as learning how to interpret gestures, eye contact, tone of voice, humor, and sarcasm. Cognitive behavior therapy can help them manage obsessive behavior and anxiety.
Some doctors suggest medication for autistic children. Stimulant medications, like Ritalin, are among those commonly prescribed to address symptoms such as impulsivity, but you should exercise caution. Stimulants are less likely to be effective for children with autism. Some children develop tics or see a worsening of repetitive behaviors, according to Asperger/Autism Network (AANE).
Accommodations for Asperger’s at School
Schools are getting better at providing services for children diagnosed with autism. 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).
Many autistic children can lead independent lives; parents and professionals can help parents and professionals can work together to help children advocate for themselves as they approach adulthood.
Eileen Costello, M. D., is a member of the ADDitude ADHD Medical Review Panel.
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