Diagnosing Overlapping Autism and ADHD
Individuals with traits stretching across autism and ADHD diagnoses can face more challenges than those with a single diagnosis. They can have greater impairments in adaptive functioning and more severe social and cognitive difficulties, and because of this, it is crucial to understand the key differences and indicators of both conditions.
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Understanding the Overlap and Differences Between Autism and ADHD: Importance of Accurate Diagnosis and Treatment
- Up to 80% of individuals with autism demonstrate diagnostic symptoms of ADHD, and 20-50% of children with ADHD reflect symptoms of autism.
- It can be challenging to differentiate between the two conditions, but an accurate diagnosis is essential to ensure proper treatment.
Functional Impacts
- Both autism and ADHD present similar day-to-day challenges, such as affecting social interaction, delaying language development, causing oppositional or defiant behavior, interfering with attention, and limiting emotion regulation.
- Sensory processing differences, difficulty in making or maintaining friendships, a hard time paying attention, and motor-skill impairments are also common challenges.
How do Autism and ADHD Compare?
- Sensory Processing Differences
- Autistic individuals have greater differences in auditory processing than children with ADHD or typical development.
- Children with ADHD score higher than those with ASD or typical development on tests measuring visual processing.
- Difficulty Making and Maintaining Friendships
- Social communication style may be the driver in autism, whereas impulsivity can be at the root of the problem with ADHD.
- Attention Difficulties
- With autism, difficulty paying attention may be linked to an intense focus on something else, while with ADHD, it is often due to distraction.
- Motor-Skill Differences
- Repetitive movement and speech patterns are considered autistic traits.
- ADHD can cause restless movements.
Early Signs and Diagnosis
- Early diagnosis of Autism occurs when parents of infants or toddlers raise concerns about developmental milestones, while ADHD can go undiagnosed until behavior issues arise in school.
- Either condition can raise concerns about excessive crying, sleep problems, eating issues, motor delays, and difficulty interacting with others.
Camouflaging and Masking
- Individuals with autism, ADHD, and those with comorbidity often work to disguise or compensate for their differences to escape ridicule, protect family and friends, and fit into work or school.
- These compensatory strategies are linked to a higher risk for depression, anxiety, and suicidal thoughts or actions.
Disparities in Diagnosis and Treatment
- Autism and ADHD occur in all racial, ethnic, and socioeconomic groups. Sex, gender, race, and other factors can play a role in delaying identification and intervention.
What Clinicians Can Do
- Screen for both conditions when either condition is present.
- Conduct a comprehensive evaluation, gathering data from different environments, sources, and assessments.
- Avoid “double-counting” symptoms for both autism and ADHD.
- If possible, observe functioning over time since characteristics can change.
- Use visual tools in addition to those requiring spoken responses.
- Be aware of how culture can impact criteria such as eye contact.
- Keep an eye out for camouflaging and compensatory strategies.
- Consider assessing mental health and sensory processing.
- Work to counteract bias and other sources of disparity.
There are some key differences between autism and ADHD, but there is also a complicated interplay between the two that requires an in-depth evaluation to determine if an individual has one or both conditions.