What Is Comorbidity In Asd
The co-occurrence of two or more diagnosed conditions in the same person is called comorbidity. An estimated 75% of children and young adults on the spectrum are diagnosed with at least one comorbid condition in their lifetime.1,2 In fact, in a 2010 comparative study, researchers found that 95% of youth on the spectrum had at least three comorbid disorders and 75% had at least five.3 It is apparent that individuals on the spectrum have higher levels of comorbidity, especially psychiatric and physical conditions, compared to their neurotypical peers.4,5 However, scientists have yet to discover exactly why this is the case as research on co-occurring conditions specific to ASD is a relatively new discipline.6,2 Continued research in the field is necessary because these conditions often exacerbate ASD traits, influence the timing and accuracy of autism diagnosis or misdiagnosis, and affect quality of life.
The most diagnosed comorbid conditions in autistic individuals are anxiety, depression, attention deficit/hyperactivity disorder , gastrointestinal issues and epilepsy.7,8,5 Comorbid conditions vary widely in severity and manifestation but are most often included in one of the following groups:
Classic medical/physical problems, which include sleeping disorders, epilepsy and gastrointestinal issues
Psychiatric disorders like anxiety, attention deficit/hyperactivity disorder , depression, obsessive-compulsive disorder , and bi-polar disorder
Further Education Career Advice And Occupational Skills Training
A summary of the consensus reached regarding educational and occupational interventions for adults with comorbid ADHD and ASD is presented in Table .
Table 8 Practice recommendations for adults with comorbid ADHD and ASD: educational and occupational interventions
The educational approach for young people in further education is not dissimilar to that outlined in the previous section focused on the education of children. Across the contexts of both further education and occupation, each area of disability may magnify the other and multiply the number of potential educational and occupational challenges for a person with both ADHD and ASD. Other additional comorbidities and specific learning difficulties are also likely to contribute to poorer outcomes.
Transition planning should occur at least 1 year before a young person moves from adolescent to adult services so that appropriate supports may be identified, and a range of potential positive destinations recognised . It is important to consider the strategies and person-centered planning services that can be applied to support transitions . A successful transition should involve everyone in the persons circle of support. Significant life-path transitions should also trigger enhanced planning, as should geographical re-location or major relationship changes.
Table 9 Supplementary information: educational and occupational interventions for adults with comorbid ADHD and ASD
Depression And Adhd: Chicken And Egg
For many individuals, depression and ADHD go hand in hand. Their dual symptoms include a persistent, sad, or irritable mood, loss of interest in previously enjoyable activities, changes in appetite or weight, sleep problems , low energy, feelings of worthlessness, or inappropriate guilt. Some clients experience thoughts or acts of self-harm.
As with anxiety, there are three ways ADHD-depression present together. Most commonly, depression follows the ADHD. Managing ADHD symptoms is tough, so a person with ADHD may feel hopeless and ineffective, leading to diagnosable depression. Even with a good evaluation, the only way to test this is to address the ADHD with stimulants and cognitive behavioral therapy, and see if the depressive symptoms lessen. Frequently, they will.
In other cases, clients respond favorably to stimulants at first, only to have a quick drop-off in their impact. Stimulants raise energy and alertness, and increase productivity, which helps people feel better. However, that improvement may mask underlying depressive symptoms that exist in tandem with ADHD, and may last only as long as the stimulant is working, usually eight to 12 hours. Fortunately, these clients tend to be good candidates for adding an SNRI. Treating co-occurring depression and ADHD in this way allows the prescriber to try lower stimulant doses while maintaining treatment satisfaction.
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Overlap Of Adhd And Asd
Although their core diagnostic criteria do not explicitly overlap, lately, an increasing number of studies provide evidence for an elevated degree of corbidity between ADHD and ASD, with different levels of symptom severity. In DSM-5, the diagnoses of AD and ADHD will not be mutually exclusive any longer. This provides the basis for more differentiated studies on overlap and distinction between both disorders. .
ADHD and ASD are more frequent in boys than in girls, and both emerge, at least to a certain degree, at preschool age. Research on the co-occurrence of ASD and ADHD has focused on older children despite the fact that characteristic ADHD and autistic behaviors appear already in early childhood. Clinicians have been able to recognize behavioral characteristics, such as social deficits, in children with ADHD hyperactivity among children with ASD for a long time. However, it is only in recent years that research investigating their comorbidity has burgeoned .
Predictors Of Adaptive Functioning
An additional five-step hierarchical linear regression analysis using the VABS composite scores as the dependent variable was applied to identify variables that contributed to the variance in the child’s adaptive behavior. Independent variables included age and sex in the first step, maternal education in the second step, cognitive scores in the third step, ADI-R SI, Communication and RRB subdomain scores in the fourth step, and CPRS Inattentive, HI and Anxiety scores in the fifth step. As presented in Table 9, the total model explained 44.0% of the variance. In the final step, when all predictors were entered together, age, IQ scores, ADIR SI and Communication scores, and CPRS inattention scores were significant independent predictors over and above all the other variables entered.
Table 9. Linear regression model for the VABS composite scores.
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Parents’ And Teachers’ Reports
Differences in informant reports of clinically elevated ADHD and anxiety symptoms were also of interest. Parents reported more severe ADHD symptoms, while teachers reported more severe anxiety symptoms. This can be explained as almost one third of the study participants received medication for ADHD, which decreased symptom severity in the structured school setting. In contrast, the school environment provides more stressful social situations, which may lead to more noticeable anxiety symptoms. Therefore, we chose to use only the parental reports for the assessment of comorbidities .
Llanes et al. compared parents’ and teachers’ reports on ADHD and anxiety symptoms in preschool and school-aged children, and found a low concordance between these informers, with teachers reporting fewer problems overall.
Autism Spectrum Disorder: Closely Correlated With Adhd
Autism exists on a broad spectrum from oddly helpful to debilitating making it hard to compare one case to another. However, what these cases have in common, in varying degrees of severity, is difficulty with communication and interaction with others. Clients have restricted interests and repetitive behaviors, and impairment in the clients functioning in school, at work, and in areas of life that involve human interplay.
Rarely is ASD a differential diagnosis to ADHD because the two are so closely correlated. When a person has both, the diagnoses are especially tricky to treat. Stimulants can help people with ASD-ADD learn social rules and pay attention to the details that underlie them, but no medication can make them more socially adroit or disengage them from their interior worlds. Some patients with ASD-ADD have significant mood fluctuation and emotional breakdowns, particularly when external events overwhelm them. Some providers mistake mood swings for anxiety, and treat them as such, which serves to increase, rather than decrease, irritability.
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Whats The Difference Between Adhd And Autism
While there are several similarities that are shared between ADHD and autism, there are many distinctions. One significant difference is that ASD is more variable than ADHD. There are three different types of ADHD and each person may have their own set of symptoms, but autism is a spectrum that can include a wide variety of different experiences. Even if a symptom looks the same for ADHD and autism on the outside, the causes of that symptom may be different. For instance, inattention is a common trait for children with both disorders. But the child with ADHD may understand a task and why they should complete it and be unable to focus on it. A child with ASD may not be able to understand the task, how to do it, or why they need to do it. They may also be extremely focused on another thought or stimulus.
Here are some other common differences:
Clinical Presentation Of Asd With And Without Clinically Elevated Adhd And Anxiety Symptoms
We compared the four defined groups based on the CPRS ADHD index scores and the anxious-shy scores. The male:female ratio did not differ significantly among the groups in a non-parametric chi-square analysis . As presented in Table 2, parental ages at pregnancy and educational attainment in the four examined groups were not significantly different using one-way MANOVAs. Only the ANOVA for the child’s age yielded a significant main effect, however post-hoc Scheffe analysis did not reveal any significant difference between each pair of the groups.
Table 2. Mean scores and standard deviation of demographic variables in the ASD alone, ASD+ADHD, ASD+anxiety, and ASD+ADHD+anxiety groups.
Cognitive Ability
Regarding cognitive ability, using a one-way ANOVA, no group main effect was found .
Table 3. Mean scores and standard deviation of IQ and VABS domains in the ASD alone, ASD+ADHD, ASD+anxiety, and ASD+ADHD+anxiety groups.
Adaptive Skills
Regarding adaptive behavior skills, using a one-way MANOVA, a group effect was found . When examining each subdomain separately, the daily living skills and the socialization subdomains yielded a significant group main effect with medium effect size . For the DLS subdomain, the ASD alone group had significantly higher scores than the ASD+ADHD+anxiety group for the socialization subdomain, the ASD alone group had significantly higher scores than the ASD+ADHD group and the ASD+ADHD+anxiety group .
Autism Severity
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Restricted And Repetitive Patterns Of Behaviors/activities
- Repetitive motor movements like hand-flapping.
- Abnormal speech patterns like echoing and repeating words.
- Adherence to strict routine or structure.
- Hyper or hypo-sensitivity to sensory stimuli indifference to pain/temperature, excessive touching and smelling of objects, etc.
Graphic: Shrestha Jolly
Symptoms of ASD and ADHD often co-occur together. Both share similar symptoms like inattention, communication impairment, impulsivity, and hyperactivity. The co-occurrence of both disorders can worsen psychosocial problems. However, a comorbid diagnosis is manageable.
Adhd Vs Autism: Misdiagnosis Comorbidity Similarities
Attention-Deficit Hyperactivity Disorder and autism spectrum disorder are both issues that begin in early childhood and affect the way a childs brain develops. Both can be difficult to diagnose, and they share some of the same characteristics. A closer look reveals that each of these neurodevelopmental conditions is distinct. But is there a link between the two? Is it possible to have both ADHD and autism at the same time? Learn more about these two disorders and their connection.
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When They Occur Together
There may be a reason why symptoms of ADHD and ASD can be difficult to distinguish from one another. Both can occur at the same time.
Not every child can be clearly diagnosed. A doctor may decide only one of the disorders is responsible for your childs symptoms. In other cases, children may have both conditions.
According to the Centers for Disease Control and Prevention , 14 percent of children with ADHD also have ASD. In one study from 2013, children with both conditions had more debilitating symptoms than children who didnt exhibit ASD traits.
In other words, children with ADHD and ASD symptoms were more likely to have learning difficulties and impaired social skills than children who only had one of the conditions.
Compliance With Ethical Standards
All procedures performed in this study were approved by the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The Helsinki committee of the medical center waived the need for informed consent, as the study was retrospective and all the data were derived from the clinical charts.
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Comorbid Autism And Adhd
Comorbidity is the presence of one or more additional conditions coexisting with a primary condition. Roughly two thirds of children with ADHD have another coexisting difference in mental health, and one of which that is common is being on the Autism Spectrum.
Autism spectrum disorder and ADHD are both neurodevelopmental disorders with symptoms showing from early childhood. Often children with ASD show similar symptoms to those with ADHD. It is important to not diagnose one or the other too quickly, to make the correct decisions with medication, therapy and other forms of external support. Those with both will need a more attentive and intensive support for social integration to achieve better and more effective outcomes. Identifying symptoms of ADHD in children with ASD can therefore be difficult, and professionals who specialise in child mental health may take a while to properly diagnose your child.
Treatment for both ADHD and autism can start from at home and in school, and so notifying your childs school of any diagnoses made will hopefully see changes in their environment. Asking for structured play or outlining different forms of disciplinary action for the school to take may seem like an overbearing task, or pushy as a parent, so perhaps it is best to speak with a representative at the school who deals with mental health, or a school nurse first.
Specialised Therapy:
Medication:
Recap:
This is common, and research has shown a link between autism and ADHD.
Differences Between Adhd And Asd
Despite both conditions sharing similar symptoms, they are two different disorders.
Ability to focus
While those with autism may lose concentration when doing tasks they dont particularly like, they can show intense focus and fixate on special interests they have. Those with ADHD are easily distracted and generally dislike any task that requires attention to detail.
Communication
Autistic individuals tend to be socially awkward with the inability to put thoughts and feelings together to communicate effectively and rarely make eye contact. Though on occasion, some with ASD can talk in great lengths but only about their particular interests.
In contrast, those with ADHD may have the gift of the gab, disrupting others mid-conversation and leading their own confidently.
Repetition
Individuals with ASD generally prefer order, doing the same things repeatedly and dislike unpredictable changes. They find comfort in having the same daily routine, eating the same food or being severely attached to only one particular favorite toy. In comparison, those with ADHD can be disorganized, dislike repetition and often get bored fairly quickly.
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Whats The Relationship Between Adhd & Autism
Autism usually falls under the umbrella term Autistic spectrum disorder . Both ADHD and ASD are neurodevelopmental disorders, affecting brain development and the central nervous system, responsible for movement, language, memory, social and focusing skills.
Although both conditions can affect adults, diagnosis is most common during childhood. According to the CDC, 1 in 10 children aged between 5 and 17 years is diagnosed with ADHD, making it one of the most common childhood neurodevelopmental conditions in the U.S. Of these children with ADHD, 14% also suffer from ASD.
Studies show ADHD and ASD can occur together simultaneously, making it difficult to distinguish between the two. Not every child is diagnosed clearly with either ADHD or ASD or both.
How Is Autism Diagnosed
Like ADHD, Autism cant be diagnosed with a medical test like a blood test or physical exam. Instead, its diagnosed with psychological exams and other observational signs. The DSM-5 changed the way autism is diagnosed significantly. Before the revisions, autism was broken up into different categories based on severity and specific symptoms. However, autism is so variable many clinicians believed the categories werent able to accurately describe autism as a whole. Instead, its now defined as an autism spectrum disorder, which encompasses the full range of possible symptoms and severities.
Its important to note, the criteria for an autism diagnosis looks at deficiencies and uses words like deficit. This language is debated because of the way it may impact people to learn they have a chronic condition that causes deficits. However, being diagnosed with a disorder doesnt mean you are doomed to be deficient, and you may learn to cope with autism on your own or with help in a way that allows you to live a productive and meaningful life.
Heres a breakdown of the diagnostic criteria in the DSM-5:
You must experience persistent deficits in three areas of social communication and interaction. These issues arent just specific to one context, like school or home. Instead, you will struggle with social norms in multiple settings. Social communication and social interaction include:
You must also experience two of the four types of restricted, repetitive behaviors.
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Autism And Adhd: Do You Know How To Help With Co
Among school-age children, an estimated 11 percent are diagnosed with attention deficit hyperactivity disorder . What most parents, teachers, and school counselors may not realize is that children with ADHD may also manifest symptoms of autism spectrum disorder .
Having two or more co-occurring diseases or disorders is defined as being comorbid or having comorbidities. A 2014 review of studies looking at comorbidity found that between 30 and 50% of individuals with ASD manifest ADHD symptoms , and similarly, estimates suggest two-thirds of individuals with ADHD show features of ASD. Researchers also determined that children with this comorbidity often had more severe levels of dysfunctionwhich is why early and accurate diagnosis and effective treatment are so important for parents to help these students succeed.
The good news is that many of the treatments for one disorder can be helpful for the other which is highlighted in Strategies for ADHD: How School Counselors Can Help Todays Students Succeed, a recent post by Counseling@NYU, which offers an online masters in school counseling from NYU Steinhardt. Here, well look at strategies, like behavioral therapy, as well as the similarities and differences of both diagnoses and how they often overlap.