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Unraveling the Complexities of ADHD and Autism Spectrum Disorder (ASD)

ADHD and Autism Spectrum Disorder (ASD) can share overlapping symptoms, including difficulties with social situations, challenges in maintaining attention, and repetitive behaviors. However, while ADHD is characterized by hyperactivity and impulsivity, ASD is more defined by persistent challenges in social communication and restrictive, repetitive patterns of behavior. Distinguishing between them requires careful evaluation by healthcare professionals, as it's not uncommon for individuals to experience traits of both conditions.

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Tayler Hackett

TMAC Editorial Manager & Trainee Psychotherapist

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The Overlapping ADHD & Autism Experience

If you’ve been trying to understand ADHD symptoms and couldn’t help but notice how similar they are to ASD symptoms, there’s a reason for that; there’s a comorbidity between them. 

So how can you tell if it’s ADHD, ASD, or both? That overlap is exactly what we’re here to explore today, starting with:

  • What Autism Spectrum Disorder (ASD) and Attention Deficit Hyperactivity Disorder (ADHD) are.
  • The common overlapping symptoms between these two neurodevelopmental disorders (conditions that affect the growth and development of the brain).
  • Why symptoms of one are often mistaken for the other, confusing diagnosis, but also have different root causes to differentiate themselves.
  • How to navigate diagnosis and treatment for ADHD and ASD.
  • The importance of taking a neuro-affirmative approach to managing ADHD and autism, embracing and supporting them as an intrinsic part of identity, rather than seeking to 'correct' it.

Before we dive deeper, let’s look at ADHD and Autism Spectrum Disorder and the symptoms of both individually.

What is Autism Spectrum Disorder?

According to the National Institute for Mental Health, Autism Spectrum Disorders are part of the many neurodivergent disorders that affect “how people interact with others, communicate, learn, and behave.” 

With the introduction of the DSM-5 in 2013, the American Psychiatric Association updated the classification of autism. Previously distinct subtypes such as Asperger Syndrome, Pervasive Developmental Disorder- Not Otherwise Specified (PDD-NOS), and Classic Autism, are now unified under the single diagnosis of Autism Spectrum Disorder (ASD)

Rett Syndrome and Childhood Disintegrative Disorder, once considered part of the autism spectrum, are now recognized as separate conditions due to their distinct genetic factors and developmental patterns.

This change reflects a broader understanding of autism as a spectrum of conditions with varying degrees of severity, rather than a set of separate disorders.  Autism affects everyone differently; each autistic person has their own mix of strengths and needs. Some can speak, while others use different ways to communicate. Intellectual abilities vary, also - some autistic people have intellectual disabilities, while others do not. Support needs also widely vary; some need a lot of help with daily tasks, while others are more independent.

To receive an ASD diagnosis, individuals must meet specific diagnostic criteria, which include:

  • Persistent deficits in social communication and social interaction across multiple contexts
  • Restricted, repetitive patterns of behavior, interests, or activities. 

These symptoms must be present from early childhood and cause significant impairment in daily functioning.

The assessment also considers symptoms such as difficulties with language skills, avoiding eye contact, and challenges in nonverbal communication, which are indicative of ASD.

However, recent insights indicate that this can vary between genders. Symptoms in girls tend to be less obvious, with fewer social and communication difficulties and less repetitive behavior, which can result in their autism being overlooked, underdiagnosed, or misdiagnosed by healthcare professionals. 

Diagnosing autism in adults presents its challenges too, as many have learned to ‘mask’ their symptoms, unintentionally concealing their autism from others for years.

You Asked Us…

What do autistic adults struggle with?

Every autistic adult's journey is distinct, and while some might face social challenges or difficulties with focus, personalized support strategies can substantially elevate their overall quality of life, reflecting their unique needs and strengths.

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What is Attention Deficit Hyperactivity Disorder?

ADHD is characterized by a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development. These symptoms are divided into three presentations, based on the dominant characteristics in an individual:

  • Predominantly Hyperactive-Impulsive Type
  • Predominantly Inattentive Type
  • Combined Type

Diagnosis involves assessing how these traits manifest before the age of 12, their presence in at least two settings, and their impact on daily life, as per the DSM-5 criteria.

ADHD can impact impulse control, organizational skills, social interactions, focus, and learning abilities, presenting challenges similar to those faced by individuals with ASD.

So, if they share overlapping symptoms, how do we distinguish which is which?

What Does the Overlap of ADHD and Autism Symptoms Look Like?

Since both autism and ADHD are neurodevelopmental disorders, their symptom overlap isn't surprising, though they stem from different underlying causes. 

A common area of overlap is challenges in social skills. Many autistic folks often struggle to interpret social cues or body language, which can make forming and maintaining relationships difficult. They might struggle understanding others' perspectives or engaging in reciprocal social interactions.

Conversely, those with ADHD might frequently interrupt conversations, struggle with taking turns speaking, or inadvertently intrude on others' personal space. Their difficulties in maintaining friendships are often attributed to impulsivity and inattention, which can affect social interactions and the perception of social cues.

Illustrated image showing examples of ADHD traits with text that reads, 'Here are some example of ADHD traits that can make us feel socially awkward... saying inappropriate things because of our impulsivity.' Features two characters, one speaking and the other reacting with surprise.

Both conditions can exhibit stimming or repetitive movements but for different reasons. People with ASD might engage in stimming to self-regulate and manage sensory input or emotions. In ADHD, similar behaviors, often seen as fidgeting, are typically a response to hyperactivity as an outlet for excess energy or a way of stimulating the nervous system when feeling restless or bored. To an observer, these behaviors appear similar but serve distinct functions for the individual.

Graphic explaining stimming in relation to ADHD with text, 'What is stimming? Stimming is a word used to refer to "self-stimulating behaviors." Stimming is generally associated with autism but people with ADHD can stim too!' Shows a cheerful character with pink hair.

Executive functioning challenges are present in both autism and ADHD. In ADHD, this often manifests as disorganization, difficulty with waiting, or emotional dysregulation. For autistic people, executive functioning difficulties can lead to a preference for routine, repetitive behaviors, or intense focus on specific interests.

Despite these similarities, it's crucial to recognize the distinctions between ADHD and ASD. Each affects individuals uniquely and requires a personalized approach to diagnosis and treatment.

You Asked Us…

Is stimming ADHD or autism?

Stimming can be associated with both autism and ADHD, manifesting as similar symptoms. Understanding the context in which a person responds helps in determining the correct diagnosis.

Coexisting Autism and ADHD: Diagnosis & Treatment

Did you know that more than half of autistic children and adults have comorbid ADHD diagnoses? Reports like this one suggest that those on the autism spectrum have a fifty to seventy percent increased risk of also meeting the criteria for an ADHD diagnosis.

There are several possible explanations for this high comorbidity rate. One is that research suggests there may be a genetic overlap between those who have both disorders and that they have shared effects on brain function.

Another reason for high comorbidity is the difficulty in diagnosing these disorders. When people have more symptoms for one condition than the other, it can be difficult to diagnose just one. The Diagnostic and Statistical Manual (DSM-5) recognizes that autism and ADHD can coexist.

The diagnosis process for either ADHD or autism begins with a clinical assessment where the professional will ask questions about the individual's development, social and language skills, and behavior patterns. 

As autism and ADHD can be mistaken for each other and coexist, it is essential to get an accurate diagnosis so you can understand and treat the underlying condition, not just the symptoms.

That’s why if you suspect your diagnosis may be wrong, it’s worth speaking to your mental health professional or seeking a second opinion. 

Treatment Options

The Centers for Disease Control and Prevention (CDC) outlines various therapies for autism and ADHD. 

For example, Cognitive Behavioral Therapy (CBT) is highlighted for its efficacy in managing ADHD symptoms, offering strategies that can significantly improve daily functioning and emotional regulation. Parents are encouraged to look into parent training programs, which can equip them with tools to support their children's social skill development, such as making friends and engaging in age-appropriate conversations. Role-playing various social scenarios can also be beneficial, preparing children for challenging social interactions.

However, as autism exists on such a broad spectrum, the efficacy and ethics of these treatments vary. For example, Applied Behavior Analysis (ABA) is one type of behavioral therapy that is often recommended for children diagnosed with autism. ABA therapy is designed to encourage 'desirable behaviors' through reinforcement. 

Although it has shown effectiveness in some areas, criticisms regarding its focus on compliance and repetition, potentially neglecting the child's emotional wellbeing and autonomy, can't be ignored. 

Although modern ABA has shifted towards more engaging methods, its emphasis is still on modifying autistic behaviors to fit neurotypical standards, possibly at the expense of the child's individuality.

Critics argue that ABA often fails to consider that children might be unable to perform certain tasks due to physical limitations or find them painful, such as making eye contact or being in overwhelming sensory environments. Unlike most therapies that are child-led, ABA's goals are typically set by therapists and parents, possibly encouraging autistic children to mask their pain and distress to 'fit in' with neurotypical norms. As masking is linked to poor mental health outcomes, including increased suicidality, this cannot be ignored.

Additionally, the effectiveness of ABA in improving the quality of life for autistic children has been questioned, with reports showing that more hours of ABA services do not necessarily correlate with better outcomes and may even lead to worsening scores in some regions. Many adults also report long-lasting negative psychological consequences of having ABA as children, too - and regardless of what the research tells us, it’s important to prioritize lived experiences of neurodiverse people.

In light of these insights, it is crucial for parents and caregivers to critically assess and consider a wide range of perspectives and research findings on different therapies. Embracing approaches that respect the individuality, preferences, and wellbeing of autistic children with ADHD is essential, ensuring interventions support their growth and integration into society in a manner that affirms their dignity and unique identities.

Healthcare professionals that share this perspective can provide valuable guidance and referrals, even if they don't have all the answers immediately available. As children with ADHD or autism transition into adolescence, specialists in adolescent psychiatry or psychology become crucial resources, offering expertise in navigating the complexities of emotional regulation and the impacts of puberty on symptoms and medication, particularly when ADHD is involved.

Beyond The Categories of ADHD & ASD

Autism and ADHD, as part of the broad spectrum of neurodiversity, defy simple categorization. Individuals with these conditions often exhibit a rich tapestry of traits that don't always align neatly with textbook definitions. 

For example, a person with ADHD might have several special interests or engage in stimming behaviors due to sensory sensitivities, traits typically associated with autism. Conversely, they might navigate social situations with ease or have a nuanced understanding of others' perspectives, challenging the common perceptions of ADHD and ASD.

Cartoon image with text explaining sensory issues associated with ADHD, 'Many people with ADHD are very sensitive to sensory stimuli. When these stimuli are too intense, it can lead to a sensory overload.' Depicts a smiling character with pink hair.

This variability shows how complex neurodivergent conditions are; neurodiversity encompasses a wide range of neurological variations, meaning individuals can exhibit a diverse blend of characteristics, sometimes demonstrating the same symptoms of both autism and ADHD, which is sometimes referred to in the neurodiverse community as AuDHD. 

This doesn't always require separate diagnoses for each condition. Many with ADHD, for instance, may recognize autistic traits within themselves but choose not to pursue an autism diagnosis, finding sufficient insight and acceptance in understanding their ADHD.

The key lies in self-understanding and acceptance. Recognizing and embracing one's unique neurodivergent traits allows a more personalized approach to managing daily life and challenges. It's essential to remember that neurodiversity means there's no one-size-fits-all definition or experience of autism and ADHD. 

You Asked Us…

Can you live a normal life with autism and ADHD?

Absolutely, individuals with Autism Spectrum Disorder and Attention Deficit Hyperactivity Disorder have the potential to lead rich and fulfilling lives. A correct diagnosis and tailored behavioral therapy can empower them to navigate their symptoms and embrace their unique strengths, enhancing their ability to thrive in diverse environments.

Key Takeaways

  • Both ADHD and ASD exhibit overlapping symptoms, including difficulties with social situations, executive functioning, and repetitive behaviors.
  • Despite sharing common symptoms, ADHD and ASD have distinct root causes and presentations.
  • ADHD is characterized by difficulties with attention, hyperactivity, and impulsivity, while ASD involves challenges with social communication and repetitive behaviors.
  • Seeking a professional diagnosis is crucial for accurate assessment and personalized treatment planning.
  • Therapeutic interventions can help address symptoms associated with ADHD and ASD, but it's vital to prioritize methods that respect the child's individuality, opposed to those that may prioritize masking and conformity to neurotypical standards.
  • AuDHD highlights the overlap between ADHD and autism, showing that individuals can have traits of both without fitting into a single diagnosis. This encourages tailored support and self-acceptance, moving beyond strict labels.

A dual diagnosis of ADHD and ASD may seem daunting, but understanding your symptoms enables you to manage them effectively, leading to a more fulfilling neurodiverse life. 💕

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Frequently Asked Questions (FAQs)

Can you have ADHD and autism?

Yes, it is possible to have both Attention Deficit Hyperactivity Disorder (ADHD) and autism. Studies show a significant co-occurrence rate, with some individuals meeting the diagnostic criteria for both conditions. Understanding the specific symptoms and risk factors of each can help in managing the unique challenges they present.

What does ADHD and autism look like together?

When ADHD and autism occur together, individuals may exhibit a combination of symptoms from both developmental disorders. This can include trouble paying attention, difficulty focusing, repetitive behaviors, and social challenges. The blend of symptoms varies widely among individuals, making personalized treatment plans essential.

How do I know if I have autism or just ADHD?

Determining whether you have autism, ADHD, or both involves a careful evaluation of your or your child's symptoms by a professional, such as a child psychiatrist or a specialist in mental disorders. They will consider your communication skills, behavioral patterns, and how you respond to various situations. A correct diagnosis is crucial as it guides the development of an effective treatment plan, which may include behavioral therapies, among other interventions. If you experience symptoms common to both conditions, such as difficulty in social situations or a tendency towards repetitive behaviors, seeking a comprehensive assessment is a vital step toward understanding your neurodivergent profile. Remember, the co-occurrence of ADHD and autism underscores the need for more research into these distinct conditions and how they can manifest in the same person. Each individual's experience with these attention disorders is unique, influencing how they navigate social difficulties and what interventions are most effective.

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