Autism and ADHD: Overlaps and Differences
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Kim attempted to open the door to her algebra class only to drop half of what was in her hands. Frustrated, she picked up her belongings, pushed her glasses back to her forehead, and tried again. School was a place where she could pour herself into her studies. She liked that, but she wished she didn’t have to go from place to place making conversation with people and trying to make sure all her books were the correct match for whichever class she was attending.
Her autism made her day complicated enough, sometimes she wondered though, could there be something else at play? When she talked to her mom about it, her mom said, “I wonder if you might have autism and ADHD.”
“At the same time?” Kim inquired. “Also, what is ADHD?”
Her mom answered: “It’s attention deficit hyperactivity disorder.”
They soon decided to call Kim’s doctor and find out if Kim did indeed have both conditions.
Like Kim and her mom, you may be wondering if someone can have autism and attention deficit hyperactivity disorder (ADHD) together. Let’s explore this topic.
Can you be autistic with ADHD?
According to the study Overlaps and distinctions between attention deficit/hyperactivity disorder and autism spectrum disorder in young adulthood: Systematic review and guiding framework for EEG-imaging research, these two disorders frequently co-occur (Russell et al., 2014), with ADHD presenting in 30–80% of individuals with ASD, and ASD presenting in 20–50% of individuals with ADHD (van der Meer et al., 2012). Below-threshold cross-disorder symptoms are also common, that is, having symptoms of the other disorder despite not having the diagnosis.
So,the answer is a resounding “Yes”! You can have both ADHD and autism together.
Among comorbid conditions occurring with autism, ADHD is king. An ADHD diagnosis happens more with autism, than almost any other condition (comorbid sleep issues are very common as well). Here are some of the top comorbid conditions with autism.
- ADHD: 30-80%
- sleep disorders 40-80%
- Anxiety: 27-42%
- Depression: 23-37%
- GI problems: 9-91%
- Epilepsy: 3-5%
Diagnosis of autism and ADHD
Correct diagnosis of ADHD and autism together has come a long way. However, more research is needed. The diagnostic and statistical manual (DSM-5) allows for dual diagnosis.
If your child has an autism and ADHD diagnosis you may be wondering what problems they will face specifically, and what to do to help them. You are not alone, many parents have the same questions. Let’s look at the two conditions, and brainstorm some ideas that could be of help to you and your child.
What happens if you have autism and ADHD?
With all that autism spectrum disorders bring on their own, the addition of an ADHD diagnosis can be worrying. One thing to remember is: a diagnosis doesn’t change your kid or their symptoms, it just explains them. It also gives you access to the help you need.
Shared symptoms of autism and ADHD
Both autism and ADHD share similar symptoms, although the symptoms have different reasons behind them. Many children experience symptoms such as:
- Social communication impairments
- Difficulty focusing/intense focus
- Language skills challenges
- Executive functioning issues
- Sensory overload
- Hyperactivity/impulsivity
- Lack of eye contact
Like many of the above symptoms: “Social problems are not part of the core diagnostic criteria for ADHD, but children with ADHD experience significant social difficulties (Cantwell, 1996; Friedman et al., 2003). ADHD children are more often rejected by their peers, and have fewer friends (Hoza et al., 2005; Mikami, 2010). In many cases, these difficulties are viewed as a direct result of the ADHD core symptoms. Inattentive behaviors may lead a child to miss social cues, impulsiveness may result in upsetting peers, and hyperactivity hinders participation in organized activities and leads to avoidance of peers.
We know that there are cases where ADHD and autism mimic each other in their symptoms, but what are some other similarities?
The similarities between autism and ADHD
Both ADHD and autism share traits and symptoms. Like autism, ADHD is a common neurodevelopmental disorder. They both carry a genetic risk.
“The phenotypic overlap between ADHD and ASD appears to be explained by aetiological overlap, at least partly, in terms of shared genetic influences between traits of both disorders. For example, individuals with ADHD and their siblings display more ASD symptoms than non-sibling controls, suggesting shared familiality.” Neurosci Biobehav Rev. 2019
The differences between autism and ADHD
As neurodevelopmental disorders, both ASD and ADHD share some phenotypic similarities, but are characterized by distinct diagnostic criteria.
“ADHD is characterized by severe deficits in attention, hyperactivity and impulsivity, whereas ASD is associated with impaired communication and social interaction skills, in addition to repetitive and restricted behavior and interests.” (American Psychiatric Association or APA, 2013).
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DSM-5 criteria for ADHD
People with ADHD show a persistent pattern of inattention and/or hyperactivity–impulsivity that interferes with functioning or development:
- Inattention: Six or more symptoms of inattention for children up to age 16 years, or five or more for adolescents age 17 years and older and adults; symptoms of inattention have been present for at least six months, and they are inappropriate for developmental level:
- Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or with other activities
- Often has trouble holding attention on tasks or play activities
- Often does not seem to listen when spoken to directly
- Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., loses focus, side-tracked)
- Often has trouble organizing tasks and activities
- Often avoids, dislikes, or is reluctant to do tasks that require mental effort over a long period of time (such as schoolwork or homework)
- Often loses things necessary for tasks and activities (e.g. school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones)
- Is often easily distracted
- Is often forgetful in daily activities
- Hyperactivity and Impulsivity: Six or more symptoms of hyperactivity-impulsivity for children up to age 16 years, or five or more for adolescents age 17 years and older and adults; symptoms of hyperactivity-impulsivity have been present for at least six months to an extent that is disruptive and inappropriate for the person’s developmental level:
- Often fidgets with or taps hands or feet, or squirms in seat
- Often leaves seat in situations when remaining seated is expected
- Often runs about or climbs in situations where it is not appropriate (adolescents or adults may be limited to feeling restless)
- Often unable to play or take part in leisure activities quietly
- Is often “on the go” acting as if “driven by a motor”
- Often talks excessively
- Often blurts out an answer before a question has been completed
- Often has trouble waiting their turn
- Often interrupts or intrudes on others (e.g., butts into conversations or games)
In addition, the following conditions must be met:
- Several inattentive or hyperactive-impulsive symptoms were present before age 12 years
- Several symptoms are present in two or more settings, (such as at home, school or work; with friends or relatives; in other activities)
- There is clear evidence that the symptoms interfere with, or reduce the quality of, social, school, or work functioning
- The symptoms are not better explained by another mental disorder (such as a mood disorder, anxiety disorder, dissociative disorder, or a personality disorder). The symptoms do not happen only during the course of schizophrenia or another psychotic disorder
Based on the types of symptoms, three kinds (presentations) of ADHD can occur:
- Combined Presentation: if enough symptoms of both criteria inattention and hyperactivity-impulsivity were present for the past six months
- Predominantly Inattentive Presentation: if enough symptoms of inattention, but not hyperactivity-impulsivity, were present for the past six months
- Predominantly Hyperactive-Impulsive Presentation: if enough symptoms of hyperactivity-impulsivity, but not inattention, were present for the past six months.
Because symptoms can change over time, the presentation may change over time as well.
DSM-5 criteria for autism spectrum disorder
According to the CDC, the criteria for autism under the DSM-5 is:
To meet diagnostic criteria for ASD according to DSM-5, a child must have persistent deficits in each of three areas of social communication and interaction (see A.1. through A.3. below) plus at least two of four types of restricted, repetitive behaviors (see B.1. through B.4. below).
- Persistent deficits in social communication and social interaction across multiple contexts, as manifested by the following, currently or by history (examples are illustrative, not exhaustive; see text):
- Deficits in social-emotional reciprocity, ranging, for example, from abnormal social approach and failure of normal back-and-forth conversation; to reduced sharing of interests, emotions, or affect; to failure to initiate or respond to social interactions
- Deficits in nonverbal communicative behaviors used for social interaction, ranging, for example, from poorly integrated verbal and nonverbal communication; to abnormalities in eye contact and body language or deficits in understanding and use of gestures; to a total lack of facial expressions and nonverbal communication
- Deficits in developing, maintaining, and understanding relationships, ranging, for example, from difficulties adjusting behavior to suit various social contexts; to difficulties in sharing imaginative play or in making friends; to absence of interest in peers
How do you treat ADHD in someone with autism?
In a study titled The Co-Occurrence of Autism and Attention Deficit Hyperactivity Disorder in Children – What Do We Know?, we learn some of the current options for treatment of ADHD in people with autism and ADHD, which includes:
ADHD medications
- Stimulant medications
- Non-stimulant medications
The aforementioned study indicated that, with stimulant medications, “The National Institute of Mental Health Collaborative Multisite Multimodal Treatment Study of Children with ADHD (MTA) (MTA Cooperative Group, 2004) reported response rates of 70–80% as compared to the 49% reported in the Research Units of Pediatric Psychopharmacology (RUPP) Autism Network trial of methylphenidate (Arnold et al., 2012). In terms of tolerability, 18% of subjects in the RUPP trial withdrew, yet discontinuation rates were quite low in the MTA study (1.4%). While methylphenidate may improve irritability in ADHD without ASD, it appears to worsen irritability in some patients with ASD.”
Psychosocial interventions
A study titled Treatment for Co-Occurring Attention Deficit/Hyperactivity Disorder and Autism Spectrum Disorder states: “An up to date literature survey on psychosocial interventions in children with both ADHD and ASD has not revealed any results. In a comprehensive review on the treatment of these co-occurring conditions Davis and Kollins (2012) mention that there are similarities across approaches to treat both disorders.
“In both, treatment uses conditioning procedures, which have evolved in time to draw on a social learning theory (Brookman-Frazee et al., 2006). Whereas both ADHD and ASD include behaviorally oriented parental intervention, the role of the family is conceptualized in a different way; for ADHD ‘parent training’ involves teaching parents to manage the behaviors of their children, in ASD ‘parent education’ places more emphasis on individualized treatments that provide parents with tools to promote their child’s (social) skill development. Davis and Kollins suggest that bridging between these two strategies might benefit those with comorbid disorders.”
As will all treatments, each individual will react differently to each measure taken to improve their symptoms. Seeking the help of medical professionals is the first line of defense when helping your child with ADHD and autism.
Summary
While ADHD and autism are two distinct conditions, they share many similarities. The presence of one increases the likelihood of both.
There is help available. Ask your child’s doctor about their options including behavioral therapy with a child behavior disorder specialist, a child psychiatrist, and an occupational therapist. All of these medical professionals can help your child improve their symptoms.
References:
Lau-Zhu, A., Fritz, A., & McLoughlin, G. (2019). Overlaps and distinctions between attention deficit/hyperactivity disorder and autism spectrum disorder in young adulthood: Systematic review and guiding framework for EEG-imaging research. Neuroscience and biobehavioral reviews, 96, 93–115. https://doi.org/10.1016/j.neubiorev.2018.10.009
Guo, J., Luo, X., Wang, E., Li, B., Chang, Q., Sun, L., & Song, Y. (2019). Abnormal alpha modulation in response to human eye gaze predicts inattention severity in children with ADHD. Developmental cognitive neuroscience, 38, 100671. https://doi.org/10.1016/j.dcn.2019.100671NLM
Leitner Y. (2014). The co-occurrence of autism and attention deficit hyperactivity disorder in children – what do we know?. Frontiers in human neuroscience, 8, 268. https://doi.org/10.3389/fnhum.2014.00268
Davis, N. O., & Kollins, S. H. (2012). Treatment for co-occurring attention deficit/hyperactivity disorder and autism spectrum disorder. Neurotherapeutics : the journal of the American Society for Experimental NeuroTherapeutics, 9(3), 518–530. https://doi.org/10.1007/s13311-012-0126-9
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