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 .
Restrictive / Repetitive Behaviors May Include:
- Repeating certain behaviors or having unusual behaviors. For example, repeating words or phrases, a behavior called echolalia
- Having a lasting intense interest in certain topics, such as numbers, details, or facts
- Having overly focused interests, such as with moving objects or parts of objects
- Getting upset by slight changes in a routine
- Being more or less sensitive than other people to sensory input, such as light, noise, clothing, or temperature
People with ASD may also experience sleep problems and irritability. Although people with ASD experience many challenges, they may also have many strengths, including:
- Being able to learn things in detail and remember information for long periods of time
- Being strong visual and auditory learners
- Excelling in math, science, music, or art
Autism And Adhd Share A Common Genetic Burden
Autism spectrum disorder and attention deficit hyperactivity disorder are both known to be heritable, but the details of the genes involved remain unclear. Researchers now report the analysis of exome sequences of approximately 8,000 children with ASD and/or ADHD and 5,000 controls. The researchers discovered that the similarities between the two diagnoses can be linked to changes in the same genes. The new study is the largest study to date of rare mutations in the genome of people with ADHD and autism.
The work is published in Nature Neuroscience in a paper entitled, Autism spectrum disorder and attention deficit hyperactivity disorder have a similar burden of rare protein-truncating variants.
The researchers from iPSYCH, Denmarks largest research project in the field of psychiatry, found that individuals with ASD and individuals with ADHD had a similar burden of rare protein-truncating variants in evolutionarily constrained genes, contributing to the biological causes of the two child psychiatric disorders.
The very fact that mutations are found to the same extent and in the same genes in children with autism and in children with ADHD, points towards the same biological mechanisms being involved, said Anders Børglum, PhD, who is a professor at Aarhus University and one of the leading researchers behind the study.
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Common Risk Factors Susceptibility In Adhd/asds
The etiopathogenesis of NDDs appears to be the result of the combined actions of both environmental and genetic risk factors on the developmental process. NDDs display highly complex pathophysiological processes as well as considerable genetic heterogeneity. However, NDDs present some phenotypic overlapping in their traits, show a substantial comorbidity and share a number of environmental and genetic risk factors. The current heritability estimates of ASD and ADHD also imply the relevance of common environmental and disorder-specific risk factors for one or both disorders .
4.2.1. Genetic risk factors
In recent years, numerous scientific and technical advances have been developed on the human genome. This has allowed an exponential progress in understanding the molecular pathways of genetic expression, which has revealed the pathogenesis of many diseases. In NDD such as ASD and ADHD, these genetic and epigenetic risk factors are very wide, which makes it difficult to give simple answers at the present time. Up to now, genome-wide association studies association studies and genome-wide copy number variants studies), assessments of chromosomal variations, as well as candidate-gene and linkage analyses have revealed an ample spectrum of genes presenting polymorphisms and susceptibility mutations related to ADHD and ASD.
ADHD and its candidate genes.
Adhd In Autistic Adults: Outcomes
Greater functional impairments exist in autistic adults as more ADHD symptoms are present. Thats according to a recent study involving 724 autistic adults who were asked about the frequency and severity of behaviors associated with autism and ADHD, their quality of life, and other aspects of living. In all cases, comorbid ADHD explained measurable variances in adaptive behaviors compared to controls.3
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Autism Symptoms And Criteria
Autism is broadly characterized by persistent challenges in social communication and social interaction, as well as the presence of repetitive behaviors. Full diagnostic criteria for autism spectrum disorder are outlined in the Diagnostic and Statistical Manual of Mental Disorder . During an evaluation, clinicians look for significant challenges in the following domains to determine whether an adult is on the autism spectrum. These behaviors must be present during development, and they must cause significant impairment in functioning to warrant a diagnosis:
1. Deficits in Social Communication and Social Interaction
Social emotional reciprocity refers to the back-and-forth interaction that takes place with another person during social interactions and conversations. Naturally, clinicians evaluate different behaviors in adults and children.
Non-verbal communication is another way of saying body language. Clinicians evaluate the use and integration of gestures, facial expression, and other body parts in communication. Lack of eye contact while communicating is one common behavior observed in individuals on the autism spectrum. Clinicians also evaluate a persons ability to understand non-verbal communication in others.
2. Repetitive Behaviors
Clinicians look for restrictive, repetitive patterns of behavior, interests, or activities that are maintained across the following four categories only two categories need to be present for a diagnosis:
Demographic Data And Head Motion
Gender was not significantly related to diagnosis and groups did not differ on age . IQ was significantly higher in the TD group compared with the ADHD , which is typical in this population. Groups differed significantly on the ADHD-RS-IV scores . The ADHD group total score was significantly higher compared with that of ASD and TD children scores. The total score was also significantly higher for the ASD group compared with that of the TD group , due to the presence of ADHD comorbidity in nine participants . The inattention score in the TD group was significantly lower compared with that of both the ADHD and the ASD groups . The hyperactivity score was significantly higher in the ADHD group compared with that of the TD group . Finally, there were no significant differences between groups regarding head motion. Additional analyses including non-comorbid ASD and ASD with ADHD comorbidity separately are reported in the .
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Dimensional Relationship Between Sensory Symptoms And Ifc
Consistent with the results of prior studies, the current study showed that individuals with ASD and those with ADHD obtained similar AASP scores in four domains . By combining all of the individuals from the three diagnostic groups, the current study revealed that the neural correlates of each of the four sensory symptom domains were distinct. Notably, in all four domains, the scatter plots of sensory symptoms and iFC relationships showed substantial overlap of individuals across diagnostic groups , suggesting transdiagnostic homogeneity of neural correlates of sensory symptoms. The similarities in the slopes of sensory symptom-iFC relationships between people with ASD and those with ADHD support future examinations of the relationship between iFC and AQ and/or ADHD symptoms, regardless of diagnoses.
What Are The Major Differences
There are several distinct factors that are pretty clear lines between autism and ADHD, although there are some people that can have both ADHD and autism, so parents and guardians need to recognize the key differences to help professionals with their diagnosis. While both might struggle with attention, people with ADHD have a hard time when asked to concentrate on a single task, so they tend to avoid tasks that require concentration. Meanwhile, a child with autism might stay hyper focused on a topic that interests them, while demonstrate trouble concentrating or even show signs of discomfort when asked to concentrate on things theyre not interested in. Kids with ADHD might talk quickly and loudly, wanting to have the last word or the first word in a conversation, while kids with autism may have difficulty expressing emotion or thoughts verbally. In addition, they may avoid eye contact and misunderstand social interactions.
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Whats The Difference Between Adhd And Autism
The most notable symptoms of ADHD include inattention, hyperactivity, and impulsivity. It is primarily a disorder of self-regulation and executive function skills that act as the brain manager in everyday life, says Mark Bertin, M.D., a developmental-behavioral pediatrician and the author of The Family ADHD Solution.
Autism typically includes problems with social interactions, communication, and repetitive or ritualistic behaviors.
Children with autism do not intuitively understand some aspects of the social world, Bertin says. They have specific behaviors, such as limited imaginative play or lack of gesture language. They often find it challenging to manage social interactions and emotions.
While the primary components of ADHD and ASD are different, some overlap exists be- tween the two. The trick to differentiating between them is to determine the reason behind the behavior. For example, both can cause social challenges. For children with ADHD, the root causes may include inattention and inability to organize their thoughts, or impulsivity.
For autistic children, the reasons are often different such as not understanding nonverbal communication or delays in language skills.
Kids with ADHD may not be able to stick to turn-taking play, but they understand it. They may not respond when called because of attention problems, but they are socially engaged and recognize their name and what it means, Bertin says.
Is My Child With Adhd On The Autism Spectrum
A child with autism can have ADHD or not a diagnosis of ADHD is separate from an autism diagnosis and having ADHD does not necessarily mean that your child is autistic or vice versa. ADHD and autism can co-occur but, like any other condition, each needs to be evaluated separately to provide an accurate diagnosis.
As always, it is important to visit your childs medical practitioner and schedule an evaluation to determine whether your child has one or both conditions. This is especially important given that the two conditions have overlapping symptoms that may be perceived as one or the other, or both.
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Diagnosis In Young Children
Diagnosis in young children is often a two-stage process.
Stage 1: General Developmental Screening During Well-Child Checkups
Every child should receive well-child check-ups with a pediatrician or an early childhood health care provider. The American Academy of Pediatrics recommends that all children be screened for developmental delays at their 9-, 18-, and 24- or 30-month well-child visits and specifically for autism at their 18- and 24-month well-child visits. Additional screening might be needed if a child is at high risk for ASD or developmental problems. Those at high risk include children who have a family member with ASD, have some ASD behaviors, have older parents, have certain genetic conditions, or who were born at a very low birth weight.
Parents experiences and concerns are very important in the screening process for young children. Sometimes the doctor will ask parents questions about the childs behaviors and combine those answers with information from ASD screening tools, and with his or her observations of the child. Read more about screening instruments on the Centers for Disease Control and Prevention website.
Children who show developmental problems during this screening process will be referred for a second stage of evaluation.
Stage 2: Additional Evaluation
This second evaluation is with a team of doctors and other health professionals who are experienced in diagnosing ASD.
This team may include:
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How Are They Different
Keep an eye on how your child pays attention. Those with autism struggle to focus on things that they don’t like, such as reading a book or doing a puzzle. And they may fixate on things that they do like, such as playing with a particular toy. Kids with ADHD often dislike and avoid things they’ll have to concentrate on.
You should also study how your child is learning to communicate. Although kids with either condition may struggle to interact with others, those with autism can have less social awareness of others around them. They often have a hard time putting words to their thoughts and feelings, and they may not be able to point to an object to give meaning to their speech. They find it hard to make eye contact.
A child with ADHD, on the other hand, may talk nonstop. They’re more likely to interrupt when someone else is speaking or butt in and try to monopolize a conversation. Also, consider the subject. Some kids with autism can talk for hours about a topic that they’re interested in.
An autistic child usually loves order and repetition, but one with ADHD may not, even if it helps them. A child with autism might want the same type of food at a favorite restaurant, for instance, or become overly attached to one toy or shirt. They can become upset when routines change. A child with ADHD doesn’t like doing the same thing again or for long times.
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What Is Bipolar Disorder
Bipolar disorder is a serious mental illness that is characterized by extreme mood swings, abrupt changes in energy levels, and distorted decision making. In most cases, it develops in the late teens or early adulthood though more and more experts now accept the existence of pediatric bipolar disorder and it is estimated to affect about 5.7 million Americans. Bipolar disorder affects men and women at virtually equal rates, and the disorder is found among patients of all races, social classes, and ethnic groups.
Bipolar disorder is characterized by high, euphoric, or irritable periods called mania and low periods of depression. The mania stage is sometimes mistaken for hyperactivity and the low states manifest themselves as inattention and lack of motivation, which are common in individuals with ADHD.
Adaptive Behaviours And Quality Of Life
Adaptive behaviour and quality of life are measured in all children through parent-report questionnaires.
Language profiles in ASD are heterogeneous, ranging from non-verbal to superior linguistic abilities . Although language impairments are not a hallmark diagnostic criteria for ADHD, both linguistic and pragmatic deficits are commonly part of the symptom presentation . Recent empirical records on the co-occurrence of language impairments in ASD and ADHD have identified impairments in structural and pragmatic aspects of language in both the groups . Despite the presence of language difficulties in ASD and ADHD, and indeed, in a number of other neurodevelopmental disorders and psychopathology, language constructs are not currently included in RDoC or HiTOP frameworks. Thus, the inclusion of language assessments in the MAGNET Project protocol will provide a novel and unique contribution to these nosologies.
Getting The Proper Treatment
The first step in helping your child get the proper treatment is getting a correct diagnosis. You may need to seek out a child behavior disorder specialist.
A lot of pediatricians and general practitioners dont have the specialized training to understand the combination of symptoms. Pediatricians and general practitioners may also miss another underlying condition that complicates treatment plans.
Managing the symptoms of ADHD can help your child manage the symptoms of ASD, too. The behavioral techniques your child will learn may help lessen the symptoms of ASD. Thats why getting the proper diagnosis and adequate treatment is so vital.
Behavioral therapy is a possible treatment for ADHD, and recommended as the first line of treatment for children under the age of 6. For children over the age of 6, behavioral therapy is recommended with medication.
Some medications commonly used to treat ADHD include:
- mixed amphetamine salts
The Relationship Between Adhd And Autism
When a school-aged child cant focus on tasks or in school, parents may think their child has attention deficit hyperactivity disorder . Difficulty concentrating on homework? Fidgeting and difficulty sitting still? An inability to make or maintain eye contact?
All of these are symptoms of ADHD.
These symptoms do match what most people understand about the common neurodevelopmental disorder. Even many doctors might gravitate toward that diagnosis. Yet, ADHD might not be the only answer.
Before an ADHD diagnosis is made, its worth understanding how ADHD and autism can be confused, and understand when they overlap.
There are three types of ADHD:
- predominantly hyperactive-impulsive
- predominantly inattentive
The combined type of ADHD, where you experience both inattentive and hyperactive-impulsive symptoms, is the most common.
Autism spectrum disorder , another childhood condition, also affects an increasing number of children.
ASD is a group of complex disorders. These disorders affect behavior, development, and communication. About 1 in 68 U.S. children has been diagnosed with ASD. Boys are four-and-a-half times more likely to be diagnosed with autism than girls.
Heres a comparison of the two conditions and their symptoms: