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Is Adhd And Autism Connected

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  • 1Department of Neurosurgery, Cedars-Sinai Medical Center, Maxine Dunitz Neurosurgical Institute, Los Angeles, CA, United States
  • 2Department Biomedical & Translational Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, United States
  • 3StemVax Therapeutics, Chesterland, OH, United States
  • 4Department of Basic Medical Sciences, College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA, United States
  • 5Society for Brain Mapping & Therapeutics, Brain Mapping Foundation, Santa Monica, CA, United States
  • 6T-Neuro Pharma, Inc., Albuquerque, NM, United States

Direct Effect Of Genetic Liability To Adhd On Educational Attainment Independent Of Cognitive Ability

For the MVMR, the direct effect of genetic liability to ADHD on educational attainment was approximately 50% smaller than the total effect . There was evidence of heterogeneity among the effect estimates of the instruments as indicated by the Q statistic . Supplementary Table S4 contains the direct effect estimates of genetic liability to ADHD and cognitive ability on educational attainment, and the robust to weak instruments direct effect estimates and corresponding confidence intervals, as well as the conditional F statistics of the instruments.

Other Factors Contribute To Autism And Adhd

Manganese and Polycyclic Aromatic Hydrocarbons

Manganese is a natural trace element in soil, water and plants. Manganese metal is mainly used in steel production to improve hardness, stiffness and strength. Several studies have linked excessive manganese exposure to neurodevelopmental diseases in children. According to Zhang and Yan,29 most of manganese in the brain stays in the form of pancreatic phthalein amine synthetase, which is the excitatory neurotransmitter pancreatic phthalein amine metabolization key enzyme. This enzyme is important for nerve excitation, inhibition and balance. But excess amount of manganese can alter this balance, causing dopamine metabolism disorders in the nigra striatum after absorption into human cells, leading to neurologic symptoms of manganese toxicity. This could be associated with lower math scores, lower psychological functioning and ADHD.

Other Associated Factors

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Genetic Basis For Adhd And Anger Issues

From a genetics standpoint, it appears that emotional dysregulation is strongly associated with ADHD. Our recent findings suggest that genetic liability for ADHD is related directly to most traits under emotional dysregulation, like irritability, anger, tantrums, and overly exuberant sensation-seeking3. Whats more, irritability appears to have the biggest overlap with ADHD versus other traits, like excessive impulsivity and excitement, in children.

These findings refute the idea that mood problems in ADHD are necessarily part of an undetected depression even though they do indicate higher future risk for depression as well as higher possibility of depression being present.

Comparing Age At Diagnosis

Autism and ADHD

The CDC’s data for both disorders indicates autism is typically diagnosed a little earlier than ADHD, although this can depend on the severity of the disorder. The average age of diagnosis for ADHD is seven years, and the average age of diagnosis for high functioning autism is six years and two months. However, children with lower functioning levels show an average age of four years at diagnosis. In general, parents and caregivers tend to notice missed milestones with autism, but this is not always the case with ADHD.

Additionally, an earlier diagnosis of ADHD can mean a delayed autism diagnosis for children with both conditions. A 2015 study published in Pediatrics showed an initial diagnosis of ADHD could delay an autism diagnosis by an average of three years. This was not affected by the severity of the autism symptoms.

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Autism And Adhd: Beau’s Story

Beau had been a ball of fire all his life. “Ever since he was born, he was a very active, loud, hard-to-tame child,” recalled Baldassari, 39. She didn’t suspect anything was wrong until the family’s first big move, which took place in June 2011, while Beau was in kindergarten. He was upset before the move and didn’t settle down in the months following it, either. “He’d go his whole day angry and defiant, and yelling and upset,” she said. “It just seemed like he was so unhappy. I’d never see smiles out of him.”

Baldassari took Beau to a psychiatrist at the new base, who diagnosed him with an unspecified mood disorder and put him on risperidone , an antispsychotic medication. “It lengthens his short fuse, I was told at the time,” she said. But problems persisted, and in March 2012, doctors finally diagnosed Beau with ADHD.

Beau seemed to do well on ADHD medications, but another move in the summer of 2012 exposed his dark side again. “It was even worse than the first. Just the most outrageously terrible behavior,” Baldassari said. “Three months without a smile he was just angry all day, explosively angry.”

It all came to a head at a meeting between Beau’s parents and school officials in March 2013. Even though the medication had helped reduce his hyperactivity and impulsiveness, Beau still continued to have meltdowns at school. School officials suggested he might have autism.

Here’s How To Understand The Diagnosis And Treatment Options

In recent years, there has been a move to diagnose some kids with both Autism Spectrum Disorder and Attention Deficit Hyperactivity Disorder at the same time.

In the United States, these disorders are defined by a psychiatric guide to diagnoses called the Diagnostic Statisticians Manual , which is currently in its fifth iteration . Is double diagnosis an accurate approach? Does it reflect biology in these kids? Lets look further into how this situation came about.

To make medical diagnoses, physicians traditionally rely on three things: the history given to them by patients, an office exam, and medical tests. Examples of medical tests doctors use to help make diagnoses include X-Rays, MRIs or CT scans , EKGs or EEGs , and bloodwork and tissue biopsies . Increasingly, doctors do DNA tests that contribute genetic information to the diagnostic process.

Tests are particularly useful for making a diagnosis when the underlying biology of a medical condition is well understood. When doctors are successful at reaching a diagnosis, they generally call the condition a disease. But this word doesnt apply very well to the vast majority of neuropsychiatric conditions including both ASD and ADHD. That is why these conditions are called disorders and not diseases.

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Limitations Of The Review

We have focused exclusively on EEG-imaging, but other imaging modalities such as fMRI or MEG, which are typically thought as having better spatial resolution, can also contribute to research into the neural basis of the ADHD-ASD overlap and distinction . The use of EEG-imaging and its recent mobile developments in large samples can serve as a foundation for more targeted analyses with other high-cost and less accessible methods .

Our review consists of a qualitative rather than a quantitative synthesis of the available evidence. While we have identified a relatively high number of studies in young adult samples , these were spread across neurocognitive domains and have employed heterogeneous cognitive paradigms precluding pooling of the data across studies at this stage, for instance, via meta-analyses. Here, we highlight the candidate neurocognitive processes and markers leveraging EEG-imaging, alongside established and novel cognitive paradigms, which could provide the foundation for the next phase of research in ADHD-ASD overlap. We also seek to galvanise joint collaborative efforts, such as data-sharing, so that a more formal quantitative reviews could be conducted in the near future. As the literature in this age group accumulates, further reviews could focus on specific age ranges and specific neurocognitive processes/tasks within this developmental period.

Total Effect Of Genetic Liability To Higher Educational Attainment On Risk Of Asd

ADHD vs. Autism | Differences & How Are ADHD and Autism Related?

In the univariable MR, the F statistic of the educational attainment instruments ranged from 30 to 240. There was evidence suggesting that genetic liability to higher educational attainment was associated with increased risk of ASD . The estimated effect was directionally consistent across the sensitivity analyses and there was limited evidence to indicate the presence of unbalanced horizontal pleiotropy . Steiger filtering suggested that 62 SNPs associated with educational attainment explained more variation in ASD and these were removed. The exclusion of these SNPs, despite attenuating the primary analysis effect estimate, was suggestive of an effect of genetic liability to higher educational attainment on ASD .

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Total Effect Of Genetic Liability To Asd On Educational Attainment

For the univariable MR, the F statistic of the ASD instruments ranged from 26 to 36. There was little evidence of an effect of genetic liability to ASD on educational attainment . The confidence intervals across primary and sensitivity analyses were largely overlapping. There was little evidence of directional horizontal pleiotropy . Steiger filtering suggested that the effect direction was correct for all the ASD SNPs. Supplementary Table S5 contains detailed information on the effect estimates, standard errors and P-values across primary and sensitivity analyses.

The total and direct effect estimates of genetic liability to higher educational attainment on risk of attention deficit hyperactivity disorder and autism spectrum disorder diagnosis

Exposure: genetic liability to higher educational attainment . Outcome: ADHD .

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.

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Sneaky Sensory Triggers In Adhd That No One Talks About

Children with ASD and ADHD both have high rates of depression and anxiety. Impulsive behavior and deficits in planning are common to both disorders. Both disorders include problems with pragmatic language, as well as with cognitive flexibility. Both disorders are more often found in the presence of intellectual disability or more specific learning disabilities such as in language, reading or motor skills. There may, in fact, be some underlying genetic or other biological factors common to both disorders: In many families where there is a child with ASD, there is a higher incidence of other family members who have ADHD .

Although we already mentioned that medical tests including brain MRIs are usually not that helpful in making psychiatric diagnosis, at a research level some interesting differences and similarities have been found in brain scans of people with these disorders. Note that these differences are not generally discernable on a single scan and so are not very useful when examining an individual patient at this time this is research data averaged over hundreds or thousands of test subjects.

Anger Issues And Adhd: Next Steps

Topic 7

The content for this webinar was derived from the ADDitude Expert Webinar Youre So Emotional: Why ADHD Brains Wrestle with Emotional Regulation by Joel Nigg, Ph.D., which was broadcast live on July 28, 2020.

SUPPORT ADDITUDEThank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

1 Beheshti, A., Chavanon, M. & Christiansen, H. . Emotion dysregulation in adults with attention deficit hyperactivity disorder: a meta-analysis. BMC Psychiatry 20, 120. https://doi.org/10.1186/s12888-020-2442-7

2 Karalunas, S. L., Gustafsson, H. C., Fair, D., Musser, E. D., & Nigg, J. T. . Do we need an irritable subtype of ADHD? Replication and extension of a promising temperament profile approach to ADHD subtyping. Psychological Assessment, 31, 236247. https://doi.org/10.1037/pas0000664

3 Nigg, J., et. al. . Evaluating chronic emotional dysregulation and irritability in relation to ADHD and depression genetic risk in children with ADHD. Journal of Child Psychology and Psychiatry 61, 2. https://doi.org/10.1111/jcpp.13132

7 Xue, J et. al. . A meta-analytic investigation of the impact of mindfulness-based interventions on ADHD symptoms. Medicine 98. 10.1097/MD.0000000000015957

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Is There A Difference Between Add And Adhd In Behavioral Therapy Treatment

No matter what you call them, all three presentations of ADHD are treatable through the standard techniques of applied behavior analysis. Since ADD is just a subset of what we call ADHD today, theres no real difference in treatments between the two.

In fact, ABA therapy for ADD and ADHD is one of the few scientifically proven treatments available. According to the Clinical Psychology Review, behavioral therapy should be the first choice for treatment in mild cases or in preschool age children. Catching the disorder early and applying consistent and effective behavioral therapies can keep cases from getting to the point where medication becomes necessary.

There are plenty of tools in the ABA toolbox to handle ADHD, but some of the more common therapies used are:

  • Discrete Trial Training DTT uses drills to model appropriate behaviors, breaking down troubling behaviors into a sequence of more manageable components and reinforcing them piece by piece.
  • Self-management Training Typically used with older ADHD patients, this emphasizes using self-praise and other internal feedback techniques to calm the impulses they experience and even out behaviors.
  • Cognitive Behavioral Therapy A hybrid of behavioral and psychotherapy techniques, this kind of treatment can be used one-on-one or in group settings to encourage patients to self-assess and self-regulate.

Explaining Adhd And Anger Via Emotional Profiles

Emotional dysregulation remains a constant in ADHD even when analyzing personality traits, making the case for emotional profiles or subtypes around ADHD.

Our own study of children with ADHD that used computational methods to identify consistent temperament profiles found that about 30 percent of kids with ADHD clearly fit a profile strongly characterized by irritability and anger2. These children have very high levels of anger, and low levels of rebound back to baseline when they get angry, they cant get over it.

Another 40% had extreme dysregulation around so-called positive affect or hyperactive traits like excitability and sensation-seeking. Children with this profile also had above-average levels of anger, but not as high as those with the irritable profile.

Thinking of ADHD in terms of temperament profiles also becomes meaningful when considering the role of brain imaging in diagnosing ADHD. Brain scans and other physiological measures are not diagnostic for ADHD because of wide variation in results among individuals with ADHD. However, if we consider brain scans based on temperament profiles, the situation may become clearer. Data from brainwave recordings makes the case that there is distinct brain functioning among children who fall under our proposed irritable and exuberant ADHD profiles2.

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Interventions For Children With Anger Issues

1. Behavioral Therapy4

  • Cognitive Behavioral Therapy : Some children with anger issues have a tendency to over-perceive threat they over-react to an unclear or ambiguous situation when no threat is actually present. For these children, CBT can help the child with understanding that something ambiguous isnt necessarily threatening.
  • Counseling: Anger problems can also be caused by difficulties with tolerating frustration. Counseling can help children learn how to tolerate normal frustrations and develop better coping mechanisms.
  • Parent Counseling: Parents have a role in how a childs anger manifests. A parents angry reaction can lead to negative and mutual escalation, such that parents and kids both start to lose their balance. This can form a negative loop. With counseling, parents can learn to react differently to their childs tantrums, which can help reduce them over time.

2. Medication:

How Are Autism And Adhd Similar

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While the two disorders are not the same, there are some similarities. According to a 2012 study published in Research in Autism Spectrum Disorders, the majority of children with ADHD did not display key characteristics of autism, which can include communication challenges, repetitive behaviors, and problems with social interaction. However, many children diagnosed with autism also displayed some of the core characteristics of ADHD, including the following:

  • Inattention – A fundamental requirement for ADHD diagnosis is an impaired ability to pay attention in many situations. Frequently, people with autism also struggle with paying attention, although this is sometimes related to sensory overstimulaton.
  • Hyperactivity – Again, this symptom of some types of ADHD also shows up in some people with autism. The need to move and fidget constantly appears in both populations, although it is not a requirement for diagnosis of either disorder.
  • Impulsivity – Another major aspect of ADHD involves acting impulsively, or before fully considering the situation at hand. People with autism may also act on impulse.

In addition, there’s significant overlap in one specific area of impulse control, called executive functioning, according to a 2009 study published in Psychiatry Research. Both children with ADHD and children with autism show significant impairments in their ability to plan and organize.

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Different Neurotoxins Contribute To Autism And Adhd

Data collected from a rather accurate survey shown in Figure 11 of long-term data in 10 different US states suggest and provide a possible link between environmental toxins such as lead, mercury, PCBs, and autism rates as well as a graph of the percentage of children diagnosed with ADHD. As can be seen from the statistical data in Table 1,1 the incidence of autism and ADHD in the United States from 1992 to 2003 was accompanied by an increase in the content of toxic substances such as heavy metals in the environment, and the number of children with the disease also showed a general trend of increasing year by year.

Table 1 Comparison of Trends in Neurodevelopmental Disorders and Neurotoxins in the General Environment in the United States Between 1992 and 20031

Figure 1 Comprehensive diagram of prevalence of Autism & ADHD and the amount of different kinds of neurotoxins in the United States between 1990 and 2007. Reproduced from Smith EE, Charest JM, Bedrosian KR, DeVault VL Neurotoxic chemicals in the environment. 2008.1

Lead and Mercury

PCBs and PVC

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