Autism vs ADHD (Dual diagnosis: a possibility?)

In this blog we would look at the difference between autism and ADHD. we will start by looking at what we mean by autism and ADHD separately, then move on to discussing what symptoms they share, the possibility of dual diagnosis, & the management of both. 

Autism vs ADHD

While there is a huge overlap between the two, they are both completely different disorders that may coexist as well. Autism is characterised by lack of social skills and social communication. On the other hand, ADHD which is attention deficit hyperactivity disorder is characterised by inability to pay attention, and experiencing hyperactivity or impulsivity. 

What is Autism?

Autism spectrum disorder impacts an individual’s social interaction and communication across various contexts. These are thus a range of neurodevelopmental disorders that impose challenges with social skills and communication, as well as social thinking. 

Another characteristic feature of autism is repetitive behaviours, and obsession with adherence to routine. 

The signs and symptoms that people suffering from autism spectrum disorder may generally exhibit include:

  • Delayed speech or sometimes even mutism
  • Avoiding physical or even eye contact
  • Likely to have meltdowns due to issues related to sensory processing & overload
  • Gets upset if the routine is interfered with
  • Has obsessive interests
  • Uses excessive body movements with the intention to self soothe
  • Is constantly fidgety, and in a state of movement
  • May struggle with nonverbal cues
  • Has trouble with empathetic expression

What do you mean by ADHD?

ADHD stands for Attention Deficit Hyperactivity Disorder. It is a neurodevelopmental that is four times more likely to be diagnosed in children as compared to adults. Those who suffer from ADHD may go through difficulties such as difficulties in attention, hyperactivity, impulse control. 

The common disturbances include difficulties in staying still, being able to concentrate, thinking before acting etcetera. The diagnosis is generally based upon the presentation of symptoms such that it gets classified into the following three categories:

  • Hyperactive- impulsive
  • Inattentive
  • Combined

Some signs of ADHD include:

  • Trouble following directions
  • Appears that they are not listening
  • Seems forgetful, or zoned out
  • Gets distracted easily
  • Often shows tantrums or has meltdowns
  • Inability to complete tasks
  • Lack of organisation skills
  • Struggles with social skills
  • Is not patient
  • Blurts out things
  • Unceremoniously interrupts people
  • Seems to act without much thinking
  • May be overwhelmed by sensory input

Similar symptoms

Some of the symptoms that seem to be similar for both attention deficit hyperactivity disorder as well as autism spectrum disorder are listed as follows:

  • Individuals being very active/ impulsive
  • Trouble focusing on social cues
  • Inability to properly interact with other people
  • Sensory information processing difficulties like overload
  • Having difficulty settling with peers

How ADHD and Autism are different

The most prominent difference between the two is the underlying mechanisms of the two conditions/ disorders. 

While Attention deficit hyperactivity disorder deals with issues related to inability to stay attentive, hyperactivity as well as impulse control, autism deals with something completely different. 

Autism, on the other hand, deals with issues related to social skills, including social interaction as ell as social communication. It deals with issues related to non verbal cues, as well as a strong adherence to routine, that borders obsessiveness. 

Even when the signs or symptoms of the two seem to overlap, what helps with the differential diagnosis, is outlining its underlying causes. Consider the following example:

Both individuals suffering from ADHD as well as autism may have trouble with social interactions, or have an inability to maintain a conversation. The difference, however, is that while with attention deficit hyperactivity disorder the cause may be issues related to self- esteem or inability to hold a conversation due to inattention and lack of concentration. 

On the other hand, the same problem of not being able to hold a conversation with someone may be attributed to a lack of social skills, or engage in speech for someone suffering from autism. 

Another very prominent difference between attention deficit hyperactivity disorder and autism is that while people suffering from attention deficit hyperactivity disorder may  be unable to keep paying attention to only one toy/ game/ thing. 

On the contrary, individuals suffering from autism usually have issues with change, and are over indulgent with one thing or often over focused on one toy/ game. They are fixated in both their routine as well as interests, and can not tolerate to see it being changed. 

When looking at the differential diagnosis between attention deficit hyperactivity disorder and autism spectrum disorder, it may help by looking at the following three aspects:

  • Attention span
  • Communication
  • Routine

Let us look at each of these facets one by one. 

In terms of attention span, 

  • While a person suffering from autism spectrum disorder may find it difficult to concentrate on something that doesn’t interest them, as they have very specific and fixated interests. However, when they find something that interests them, they get fully absorbed in it and it gets hard to stop them. 
  • In terms of a person suffering from attention deficit hyperactivity disorder, their attention span is short irrespective of their interest in or love for the activity that they are doing. 

The second distinction comes in terms of communication, 

  • An individual with autism spectrum disorder, may not be able to interact with those around them, or even respond appropriately to social cues. They lack the necessary skills for the same. 
  • On the other hand, a person suffering from attention deficit hyperactivity disorder is able to talk. They in fact, may end up talking non stop irrespective of how their words might be affecting or impacting others around them. 

The last distinction comes in terms of routine,

  • Children or individuals suffering from autism spectrum disorder feel the  most comfortable in a routine or structured environment. They feel safe and familiar in such settings. Changes in routine cause them immense anxiety and lead them to being upset.
  • When it comes to individuals suffering from attention deficit hyperactivity disorder, they do not like structure or routine. They in fact start getting bored when such things happen, and start to act impulsively, which often leads to behavioural issues in structures environments (like that of a school).

Dual Diagnosis: a possibility?

The diagnosis of either of the two- autism spectrum disorder, or attention deficit hyperactivity disorder- can not be given without consulting a mental health expert or general physician. If you feel that your child  might be suffering, it is advised to consult your pediatrician, who might guide you to a specialist in the field. 

To diagnose autism spectrum disorder, behavioural checklists, surveys, interviews and observation of activities are seen. To diagnose attention deficit hyperactivity disorder, pattern of forgetfulness, distracted behaviour, restless and impulsive behaviour, etc are seen. 

In this case too, checklists, interviews, questionnaire tools, consultation with peers, adults and teachers are used to support the diagnosis. 

Both autism and ADHD may end up sharing some symptoms like inability to sustain social communication, and they may occur at the same time. While till the year 2013 American psychiatric association held the stance that Autism and ADHD can not be comorbid disorders; This stance was however changed by them after the publishing of the diagnostic and statistical manual of mental disorders- 5th  edition in 2013. 

In this manual they claimed that autism spectrum disorder and attention deficit hyperactivity disorder may in fact be comorbid, or occur together in the same person. 

Management of Autism

Autism spectrum disorder is often treated through non-pharmacological therapies, in order to manage behaviours associated with ASD that hinder academic and interpersonal success. 

One of the most well known, and effective treatment strategies for autism spectrum disorder is behavioural therapy. Applied Behavioural Analysis is used to reinforce a person’s strengths, and to manage or overcome the behaviours that are seen to be maladaptive. 

Children / individuals with ASD prefer routine, structure as well as fixed schedules. Thus, using such schedules or rules to help organise their days/ tasks/ life can be a helpful strategy. Checklists give them a sense of accomplishment. 

Management of ADHD

One of the key features of attention deficit hyperactivity disorder is in fact, hyperactivity. The restlessness or impulsivity that stems from abundance of energy can be managed by means of physical exercise. 

Keeping them active or making them indulge in exercise can be very beneficial as it channels their excess energy in an adaptive and socially acceptable way. It can be helpful to choose activities that do not require a lot of routine or structure, or social interaction as they may end up getting bored. Sports like karate, swimming are good options. 

Conclusion

In this blog we discussed autism vs ADHD. We started by looking at what autism and ADHD are, then discussing if dual diagnosis is in fact a possibility, and in the end looking at the management of both separately. We discussed the similarities as well as the differences between Autism and ADHD. 

Frequently asked questions (FAQs): Autism v/s ADHD

Can autism be mistaken for ADHD?

Autism and ADHD do share a few common symptoms like being socially awkward, unable to sustain attention in a few tasks etc. Sometimes, the inability to sustain attention in tasks that seem uninteresting to those with ASD may seem like ADHD’s lack of ability to pay attention. 

Can ADHD mask Autism?

The symptoms of ADHD are more readily visible, and thus, when ADHD and ASD are comorbid, the symptoms of autism may end up being masked by that of ADHD. even when looking at the treatment for the two, ADHD symptoms are often given the priority to treat, and the individual is helped to learn to live with autism. 

Can ADHD be mistaken for Aspergers?

ADHD is often misdiagnosed with the formerly known Asperger’s syndrome. It is often misdiagnosed as autism as well. The similar symptoms may be the social awkwardness, inability to pay attention to certain tasks.
 
It is important to know the underlying causes behind the symptoms to understand what the diagnosis really is. 

Can you be slightly autistic?

The answer is no. While we might have feelings or behaviour that have similar pattern to autism spectrum disorder, they are however not to be considered autism spectrum disorder if they do not cause clinically significant distress and issues in the person’s interpersonal or occupational life. 

Autism is a serious mental condition and is in fact very distressing. 

Can autism go away?

Autism is a chronic disorder, and there is no cure for the same. While behavioural therapies have been seen to be effective, they are used to manage the symptoms and not completely treat the same. 

Does autism worsen with age?

It is actually quite the contrary, autism seems to get a little more manageable with age. As the person grows older, their symptoms seem to get better, or maybe they just learn to live with the symptoms better. 

References

Bhandari S., (2019) ADHD or Autism? WebMD. https://www.webmd.com/add-adhd/childhood-adhd/adhd-or-autism

Leonard J., Legg T.J., (2019) What is the difference between autism and ADHD? Medical News Today. https://www.medicalnewstoday.com/articles/325618

Morin A., (n.d.) The Difference between ADHD and Autism. Understood. https://www.understood.org/en/learning-thinking-differences/child-learning-disabilities/add-adhd/the-difference-between-adhd-and-autism

Autism vs ADHD: explaining the difference between the two. (n.d.) Scope making it happen. https://www.scopeaust.org.au/blog/disability-advice/autism-and-adhd-explaining-the-difference-between-the-two/

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