Is it ADHD or Autism?

What?

Yes, it’s possible that ADHD can be misdiagnosed as autism and vise versa, particularly if the type of ADHD diagnosed is the inattentive type (click here for my ADHD blog). Oftentimes there are a lot of ADHD symptoms that are mistaken as autism symptoms and autism symptoms can be mistaken as ADHD.

Huh? Are you kidding?

Seriously, it can happen to a lot of neurodiverse children. This ADHD/autism overlap is a controversial topic. It often confuses both the medical and scientific fields especially ordinary people (like me, I can relate to this). First, let’s see why ADHD and autism are often interchanged.

ADHD is a neurodiversity condition where the person who has this has really short attention span, is hyperactive, impulsive, or inattentive and can easily loss track of concentration. Autism, on the other hand, is a neurodiverse condition characterised by lack of social skills, lack of communication skills, or is obsessive with repetitiveness.

Clearly different set of symptoms, right? But a lot of people with autism especially children are seen as hyperactive and impulsive, making them prone to be diagnosed as ADHD instead. At the same time, people with ADHD have no classic symptoms of hyperactivity and impulsive behaviour; instead they withdraw into their wide world of imagination and/or having hyperfocus on area of interest, thereby mistaken as autism (that really happened to me in my toddlerhood when I was without social interaction, poor communication and lack of eye contact, I was mistaken to have autism-like symptoms until I was diagnosed with ADHD in college). This could be really confusing…

Image courtesy of Patheos. ADHD and autism symptoms can be confusing to diagnose.

But really, how can you tell if it is ADHD or is it autism?

Both disorders may affect sufferers’ social interactions, their ability to follow directions, and to stay focused. But neither autism nor ADHD has one symptom that makes making a diagnosis easy. Both disorders display a combination of symptoms, and thus a professional evaluation is necessary to clarify whether someone suffers from autism or ADHD.[1]

But even professionals are confused with the ADHD autism diagnosis.

There may be a reason why symptoms of ADHD and autism can be difficult to parse. Both can occur at the same time. A doctor may decide only one of the disorders is primarily responsible for your child’s symptoms. Not every child can be so clearly diagnosed, however. In those cases, kids with either ADHD or autism may actually have both conditions.[2]

Unfortunately, many doctors were hesitant to diagnose one child with both ADHD and autism for many years. For that reason, very few medical studies have looked at the impact of the combination of conditions on children and adults.[2]

Doctors are either too afraid of diagnosing a person with two neurodiverse conditions or others have mindset that thinks that having both ADHD and autism is impossible. For many years, the American Psychiatric Association (APA) stated that the two conditions could not be diagnosed in the same person.

However, in 2013, the Association changed its stance. In the “Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition” (DSM-5), the APA states that the two conditions can co-occur. The APA notes that doctors should also consider the possibility of a separate disorder that might account for all of the behaviors.[2]

But what causes difficulty in the autism ADHD misdiagnosis?

There are many reasons for the two conditions being confused in young children. Many children with autism display signs of hyperactivity and inattention when they start school. However, experts are very clear that as the child becomes older the apparent similarities between the two conditions will separate out. The child with autism may become more withdrawn and given the right environment their hyperactivity should wane and their difficulties with social skills will emerge. Children with ADHD on the other hand are unlikely to become calmer with age unless they receive medication or high-quality therapeutic interventions.[3]

But there is a bottom line of comparing ADHD with autism: Children with ADHD still develop social and communication skills and are unlikely to have the anxiety levels of a child with autism[3], who are struggling more with social and communication difficulties. People with ADHD are more social and communicative than people on the autism spectrum. Communication and social skill levels are what sets ADHD from autism.

In a nutshell, ADHD and autism can share many characteristics as well as differences, yet they are still two different neurodiverse conditions.  They may or may not occur together.

Similarities between ADHD and autism[4]:

  • Inattention
  • Hyperactivity
  • Impulsivity
  • Sensory Processing Difficulties – people with ADHD and autism can have sensory processing disorder
  • Behavior Problems
  • Impaired Social Skills

Differences between autism and ADHD[4]:

  • Communication skills are usually more impaired with an autistic child
  • Children with autism or Asperger’s Syndrome may lack “theory of mind.” – theory of mind is the ability to attribute mental states — beliefs, intents, desires, pretending, knowledge, etc. — to oneself and others and to understand that others have beliefs, desires, intentions, and perspectives that are different from one’s own.[5] People with ADHD can have deficient theory of mind as well, but usually people on the autism spectrum have more severe deficit in theory of mind.
  • Children with ADHD are usually more capable of engaging and connecting with others.

But ADHD has some autistic-like traits like in this following research[6]:

Children with attention-deficit hyperactivity disorder (ADHD) often exhibit autistic traits, which can lead to even greater problems with socialization, according to new research presented at the 26th European College of Neuropsychopharmacology (ECNP) Congress.

Previous research has shown that children with autism spectrum disorder (ASD) often also have a diagnosis of ADHD. This new study suggests that the reverse may also be true.

“We showed that some children who do not fulfill the criteria for autism have a lot of similar social difficulties and interpersonal dysfunction. That might be something that’s important to recognize,” said lead researcher Joseph Biederman, M.D.

“We have been aware for a long time that some of those with ADHD have behaviors that look differently than what you would expect. They do not have a lot of social wisdom and have difficulties interacting, even though they do not fulfill criteria for autism,” said Biederman.

The ADHD-AT subgroup also had much higher rates of social dysfunction compared with the healthy control group and compared with the ADHD-only subgroup; and they had significantly higher rates of severe emotional problems.[6]

In addition, the ADHD-AT subgroup had significantly more disruptive behavior, mood, multiple anxiety, and language disorders than did either of the other groups.[6]

This is an ongoing research where there are a subgroup of children with combined autism-ADHD. This could be a milestone in neurodiversity as there are a lot of possibilities when it comes to the neurodiverse brain.

By properly identifying the similarities and differences in autism and ADHD, a professional, a teacher, a parent, or even you can identify who has ADHD and who has autism, or if a person has both ADHD and autism.

Image courtesy of Pinterest. Hmm.. still confused about ADHD autism overlap???

But it’s still difficult to have a proper diagnosis of ADHD and autism, though… what do you think?

Reference:

  1. http://www.rd.com/health/conditions/adhd-vs-autism/
  2. http://www.healthline.com/health/adhd/autism-and-adhd#Symptoms3
  3. http://www.autism.org.uk/about-autism/related-conditions/adhd.aspx
  4. http://www.healthcentral.com/adhd/c/849319/137070/spectrum-disorder/
  5. https://en.wikipedia.org/wiki/Theory_of_mind
  6. http://psychcentral.com/news/2013/10/18/adhd-kids-often-show-autistic-traits/60851.html
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