Autism disorder commonly coexists with ADHD with 20-50% of children with ADHD meeting the diagnostic criteria for Autism Spectrum Disorder, (ASD). Even when symptom levels do not meet the criteria for a diagnosis of Autism, we often see common symptoms of Autism present in children with ADHD. ADHD on the other hand is the most common coexisting disorder in children with Autism, 30-80% of ASD children meet the criteria for ADHD.
Research on this significant co-existence led the American Academy of Psychiatrists to revise their guidelines. Prior to 2013 physicians were not allowed to diagnose both disorders in the same child, however the new DSM 5 guidelines now allow for the dual diagnose ADHD and Autism.
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Some researchers have been pondering whether these two disorders might possibly be the same disorder with different presentations, but research to-date has been inconclusive. Genetic studies show some similarities, but brain imaging indicates both differences and similarities. Researchers are also questioning whether similar appearing impairments seen in the two disorders, such as attention dysregulation, may actually be caused for two different reasons.
At the same time, other researchers are pondering if we should be looking at a different way to think about mental and neurological disorders altogether. Rather then looking at the disorders through their diagnostic labels, we should be conducting joint studies looking at ways to categorize under common traits. An example is a study by the POND Network in Ontario, which looked at the inability of study participants with Autism, ADHD and OCD to read other people’s emotions by looking at their eyes. This has generally been thought to be an Autism trait, but researchers found the same inability in participants with ADHD. Therefore, children with ADHD would also struggle with impaired social functioning. Knowing this would greatly assist in initiating appropriate supports.
One of the most important things we need to understand as parents of children with ADHD is our child’s unique profile. When we understand their individual set of strengths and impairments, rather than just a generalized list of ADHD symptoms, we can put appropriate supports and accommodations in place and make knowledgeable decisions about appropriate treatments. With the overlap of these two disorders many children with ADHD will also present with traits seen in Autism, even when they do not meet diagnostic criteria. Only after my grandson was diagnosed with dual ADHD and Autism, did I delve into the world of Autism literature more deeply. I was surprised how much this also assisted me in understanding some of those “more unique” traits of two of my three sons with ADHD.
Another reason to understand the interplay of these two disorders is for the purpose of school advocacy. Although many of the learning and self-regulation impairments that students with ADHD experience are very similar to those of students with Autism, ADHD is not included in the categories of exceptionality in Ontario, British Columbia or Quebec. Ministries of Education use these categories to define students with special learning needs and approve additional resources. Therefore, students with ADHD although also impaired do not qualify due to their specific diagnosis. In a past blog post CADDAC summarized a recent Ontario Human Right Commission’s paper addressing this issue.
The situation has become so bad that physicians report parents coming to them asking for a diagnosis of Autism rather than ADHD because they know that this will get their child access to learning resources that these kids desperately need. Of course, this is not a discretionary choice on a physician’s part, but how sad that it has come to this.
Perhaps we all need to do a better job of educating our elected officials and Ministries of Education on the research and how greatly these two disorders actually overlap.
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