Autism vs. ADHD: A Parent’s Guide to Tricky Diagnoses
Social delays. Communication difficulties. Repetitive behaviors. What’s behind them: ADHD? Autism? Both? When conditions overlap, parents need an intimate understanding of each diagnosis to manage treatment – and everyday life.
What Is Autism?
Autism is a complex neurobiological disorder that affects boys four times as often as girls. Autistic spectrum disorders (ASD) are usually called Pervasive Developmental Disorders (PDD) by physicians. PDD is a group of three conditions — autistic disorder, Asperger syndrome, and Pervasive Development Disorder Not Otherwise Specified. The conditions are characterized by problems communicating and relating to others, and a need to follow rigid routines and to engage in repetitive behaviors or language.
Some pediatricians are knowledgeable enough to diagnose PDD, but the majority need the support of a specialist, especially if a child has already received an ADHD diagnosis.
Distinguishing autism vs. ADHD has confused many families. When a child can’t sit still for homework or a meal, or stay put in class, when he fidgets or talks too much and too insistently, most parents and educators, tutors, and coaches think, “This kid must have ADHD!”
The first explanation most doctors arrive at is also attention deficit disorder. The condition is familiar, it’s been around for a long time, and there are effective strategies to manage it. It is important to remember, however, that almost any psychological or developmental disorder of childhood can look like ADHD, with or without the hyperactivity. Kids under stress, due to learning disabilities, anxiety, depression, or sensory integration problems, may exhibit the same symptoms. It takes a skillful evaluation to tease out explanations for the behaviors.
Diagnosing ASD requires an evaluation by a developmental pediatrician, child psychiatrist, or pediatric neurologist. Most insurance companies, and virtually all public schools, require a written evaluation by a specialist before they provide, or pay for, the services autistic children need.
Because autism cannot be diagnosed by medical testing, screening and diagnosis involve interviews, observation, and evaluations. Even when a professional ventures an opinion, he will often hedge by saying, “Well, he is quirky and has some typical behaviors, and they are somewhat consistent with a diagnosis of a Pervasive Developmental Disorder.” This kind of talk is frustrating to the parents and the child, but it’s sometimes unavoidable. Another evaluation in a year often clarifies things, and sometimes a child doesn’t need a diagnosis, as long as he is getting the help he needs.
Usually a child who has been diagnosed with ASD is not given an additional diagnosis of ADHD. This is not to say, however, that children on the autism spectrum don’t benefit from the interventions that help children with ADHD even if they don’t have autism.
Most parents and pediatricians prefer to start with non-medical therapies to manage symptoms that hinder social and academic success and lead to a turbulent home life. The mainstay of treatment for ASD is behavioral therapy, which reinforces wanted behaviors and discourages unwanted ones. Posting lists, rules, and schedules to keep ASD kids organized can be helpful. Checking off checklists can give autistic kids a sense of accomplishment when they complete tasks.
Physical exercise is a good intervention for attention deficit children and children on the autism spectrum, all of whom seem to have boundless energy. Channeling excess energy into a physical activity, such as swimming or karate — which doesn’t require a lot of interaction with other kids — allows them to burn it off without the pressures of socializing.
If behavioral and educational interventions aren’t sufficient, medication may help. Because children with ASD have unpredictable reactions to stimulants, the most common class of medicines used for children with ADHD, they are less likely to be prescribed for autistic children. Most pediatricians, and virtually all child psychiatrists, feel competent in prescribing stimulants for ADHD. A pediatrician may refer a child with ASD to a psychiatrist or a psycho-pharmacologist as the dose is increased.
A class of medicines called atypical neuroleptics are often effective treatments for motor restlessness, repetitive behaviors, and sleep disturbance in children with autism. These include aripiprazole (Abilify), quetiapine fumarate (Seroquel), and risperidone (Risperdal, the only one of the three that is FDA-approved for treating behaviors associated with autism). A good response to an atypical neuroleptic may eliminate the need for a stimulant.
Every child with autism will benefit from the support of a developmental and behavioral pediatrician or a child psychiatrist with training in the autism spectrum. Having a specialist who understands what it’s like to live with an active autistic child (is there any other kind?) is a bonus for parents, as well.