Is It Autism, ADHD, or Both? Expert Advice on Navigating Dual Diagnosis

A psychologist and an autism therapist overview the similarities between ASD and ADHD, as well as the many overlaps.

We don’t ask our pediatrician “what else” when we receive a diagnosis of attention-deficit/hyperactivity disorder (ADHD) or autism spectrum disorder (ASD) for our child. We tend to think there is enough we can focus on to support our child with the current diagnosis. But what if we find the support we are implementing is perhaps not helping our child, or we believe there is something else the professionals might have missed?

Parents are the true experts on their children. We know when people are over- or under-rating our child’s potential. We are fully aware of whether a support service makes a difference or just promises to do so. Sometimes, as parents, we feel we cannot be assertive about these instinctive parental observations or findings, but we should always listen to that intuitive superpower.

According to Mandell et al. (2005), ASD and ADHD diagnosis rates have rapidly increased since the 1980s. We have seen a trend of exclusively diagnosing one or the other of these conditions, with fewer comorbid diagnoses. Sometimes there may be potential for a more accurate evaluation to complement the profiles we see in practice.

When we think of a child recently diagnosed with ASD, who might be intensely active and impulsive, we can easily imagine the child might have a comorbid diagnosis of ADHD. We use the phrase “he or she is so hyper”, sometimes without wondering what the chances are of that child actually being diagnosed with ADHD.

Perhaps as parents and professionals, we don’t want to add to a diagnosis? Is one diagnosis sufficient, or should we determine each comorbid diagnosis to help our child effectively?

To be able to answer this, we should look at the actual challenges individuals face who are either autistic or have ADHD, as well as the support available for each of these populations.

ASD: a brief description of challenges and support needed

Pediatricians are usually contacted for an assessment if a parent notices their child has difficulty with vocal and nonverbal communication, behavioral peculiarities or challenges, social difficulties, and, more recently, sensory sensitivities. There are more subtle signs to look out for, especially with girls, as they tend to mask their challenges quite well by camouflaging with siblings or friends. Click here to watch an interview with Stephannie Bethany, an autistic adult who shares some of the more subtle signs parents can look out for.

Support strategies vary for each child diagnosed with autism, but the usual suggestion is 40 hours of Applied Behavioral Analysis (ABA) therapy. Recently, there has been some progress in therapeutic options, as autistic adults have spoken out about the rigidity of ABA therapy.

A more holistic approach, such as AIMS, Relationship Development Intervention (RDI), or Play Therapy, is now seen as the more appropriate route for supporting individuals diagnosed with ASD and related conditions. In general, therapy is focused on visual support, repetition (especially for our younger kids), and desensitization of sensory input.

Communication can be improved with a combination of visual strategies, pairing sounds and words with activities, and interest-based topics. Behavior can be managed and understood by focusing on clear explanations, such as creating personalized social stories together with the child, as well as generalization from one environment to others to practice developing skills.

Sensory sensitivities are usually improved by slowly introducing these types of input to a child, but ensure you are working on their self-awareness and self-regulation throughout. Each child’s emotional regulation should be a main focus, as they need to find appropriate coping skills

ADHD: a brief description of challenges and support needed

If we look at a brief description of ADHD and the challenges individuals face, it does differ slightly from those experienced by those on the autism spectrum. Individuals diagnosed with ADHD mainly struggle with the initiation of tasks, sustaining their attention to complete tasks, and constantly fighting their impulsive nature.

Support services for individuals diagnosed with ADHD tend to range from those in favor of medication and “getting on with it” to providers intent on finding solutions for the actual root of the issue or challenge. Many professionals would agree that a combination of these approaches could work well with individuals diagnosed with ADHD.

The use of Cognitive Behavioral Therapy (CBT) has been proven to be efficient for children, adolescents, and adults diagnosed with ADHD. This type of therapy challenges the thoughts of the individual to ensure their emotions and behaviors can be changed accordingly.

Although there are many overlapping characteristics of individuals diagnosed with ASD and ADHD, there are also core differences. Many individuals diagnosed with ADHD may be unable to concentrate on a task, whereas individuals diagnosed with autism can often hyper-fixate on interest-based activities or items.

Communication difficulties are usually not present with individuals diagnosed with ADHD, but are part of autism characteristics across the spectrum. With some autistic individuals, these communication difficulties may be masked by advanced verbal abilities; they may, however, experience challenges with things like nonverbal communication and understanding of social cues.

I was diagnosed with ADHD, and my partner is self-diagnosed as being on the autism spectrum. A major personal difference is that I seem to not only be able to integrate quite well into diverse social circles, but I enjoy it. My partner, on the other hand, seems unmotivated to fit into social circles.

What if ASD and ADHD overlap?

Dan Jones, an autistic YouTuber, has been diagnosed with ASD, ADHD, dyslexia, and obsessive-compulsive disorder (OCD). When asked what he feels he “identifies” with most—as his main diagnosis—he answered: “I’m a combination of all of this and so much more.”

The thing that helped Dan was to identify the difficulties he had and the reasons behind such difficulties. He feels that when he is unable to persevere to complete a task, he strives to understand the underlying reason and then attempts to find a coping skill appropriate for that specific situation. This comes with knowledge of each of his conditions. As they say, knowledge is power!

If you feel your child (or perhaps you!) has additional challenges that are not explained by one diagnosis, it is important to ask for a second opinion. A great strategy is to write down what you observe, experience, and feel in various environments (this applies equally to you or your child), and then share this with the professional—whether this is a pediatrician, speech therapist, occupational therapist, psychologist, or teacher.

There are other conditions that can also be present when someone is diagnosed with ASD, such as:

• epilepsy
• sleep disturbances
• gastrointestinal disorders
• feeding/eating disorders
• anxiety
• depression

This doesn’t mean that a person can’t have a diagnosis of ASD without any other condition, but it does show the importance of making sure your child is not being labeled incorrectly as “that’s because he is autistic” by teachers or family members. We want to ensure we are setting our children up for success, and by fully understanding the reasons for their behavior, reactions, or sensitivities, we can do this.

You are already going above and beyond by dedicating your precious time to reading this article. You are doing a phenomenal job, on top of the most difficult job in the world: raising a human being.

If there is one thing I would like for you to take from this article, it would be to ensure that you go with your intuition. If you feel a therapist is incorrect in their analysis of your child “being naughty” or seemingly “manipulating” you, question it.

You are most probably right; your child could be struggling with something in combination with their original diagnosis. You should get a second opinion and continue being your child’s most dedicated advocate. I take my hat off to you for your tenacity!

References:

​​Mandell DS, Thompson WW, Weintraub ES, Destefano F, Blank MB. Trends in diagnosis rates for autism and ADHD at hospital discharge in the context of other psychiatric diagnoses. Psychiatr Serv. 2005 Jan;56(1):56-62. doi: 10.1176/appi.ps.56.1.56. PMID: 15637193..

The post Is It Autism, ADHD, or Both? Expert Advice on Navigating Dual Diagnosis appeared first on Autism Parenting Magazine.

Get a FREE issue of Autism Parenting Magazine at https://www.autismparentingmagazine.com/freegift/

Trending Products

.