The Similarities of ADHD and Autism

It's no secret that ADHD and autism share many similar traits and that some symptoms from each neurodevelopmental disorder overlap. Yet, they are two distinct conditions. Until the fifth edition of the Diagnostic and Statistical Manual of Mental Health (DSM-V) was released recently, clinicians were advised to diagnose ADHD or autism, but never both. Now that the DSM-V tells clinicians that an individual can have both ADHD and autism, this dual diagnosis is on the rise. Now, clinicians must carefully consider if the profile they are seeing is ADHD, autism, or both.

It can certainly still be a challenge to get both diagnoses for one child. My son, Ricochet, is living, breathing proof — I had to push and get multiple opinions for two years before finally finding a psychologist willing to dig deep and keep her mind open to the possibility of both ADHD and autism. A new study released in Pediatrics last month confirms that it's more of a challenge to get an autism diagnosis once a child is diagnosed with ADHD. The study's authors found that it is a three-year delay on average, in fact.

Why does this happen?

In our case, Ricochet's hyperactivity is noticed first by everyone. He also doesn't have any of the overt symptoms of autism, like poor eye contact and repetitive behaviors. On the surface, he's a classic case of pretty significant ADHD, but not a classic case of autism. I never even considered the possibility that autism was part of his alphabet soup of neurodevelopmental disorders until four years after his ADHD diagnosis.

You see, when Ricochet was young, the gap between he and his peers wasn't too large, because all kids are socially awkward and struggle with attention when they are five, six, or seven years old. As Ricochet got older though, the gap seemed to multiple in width each year, instead of follow the same trajectory. As his peers learned more adept and nuanced social skills, he did not. As his peers became good at interpreting pragmatic language, he did not. As his peers learned to be more flexible and control their emotions, he did not.

It wasn't just the Ricochet-to-peers gap that started me thinking about the possibility of autism. Kids with ADHD tend to improve on lagging skills and maturity, with the right support, as they enter adolescence. In areas I expected Ricochet to improve — such as reading nonverbal language, frustration tolerance, and flexibility — he was not improving at all. At the same time, he began down a path of severe school avoidance and refusal. It was as if it was literally painful for him to go to school. When I put all those unanswered questions (clues) together, a picture of high-functioning autism or Asperger's emerged.

I finally saw autism in him at that point (about age ten), but it took me two years of diligent pursuit before I encountered a clinician willing to look past the typical symptoms of autism and see it in Ricochet too. I say “willing,” because the first few clinicians I approached about the possibility of autism refused to look past the absence of typical autism symptoms and dig deeper.

How do you know if your child with ADHD could have autism too?

In my experience, there were still struggles that were atypical of or not explained by ADHD. I felt like there was still a missing piece of the puzzle. Ricochet could not understand intention. He was constantly upset by social interactions. His thinking was still overly literal and he was severely inflexible. He seemed constantly “uncomfortable,” almost pained, in many environments, especially at school. There were so many little things that just weren't explained by ADHD, but fit with autism.

One of the biggest ah-ha's for me was watching a particular episode of  the TV show, Parenthood, where Max decided to go on a overnight field trip with school. He ended up getting bullied and had a meltdown because he didn't understand why the kids would do those things to him. I saw so much of Ricochet in that scene. That felt true to us.

If your child with ADHD has symptoms that seem outside the sphere of ADHD, consider the possibility of co-existing autism. Talk with your doctor about a new evaluation to dig deeper. Listen to your gut and keep pressing forward if you know there are still unexplained pieces of your child's puzzle.