April 18, 2019

At first glance autism and ADHD share many traits: impulse control challenges, trouble with emotional regulation, difficulty reading social cues, and struggles with executive function are just a few.

Some researchers are searching for connections between the two, looking at possible genetic roots that ADHD and autism may share. But so far, while there is consensus that the two conditions have many similarities, there’s not conclusive evidence that they are both conditions that are part of the same continuum.

Can Someone Have Both ADHD and Autism?

For many years, doctors held that one individual could not have both ADHD and autism, but in 2013 the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) allowed for the possibility of a dual diagnosis. The two conditions coincide frequently. According to the National Institutes of Health (NHI), about 30 to 80 percent of children with autism also meet the criteria for ADHD. About 20 to 50 percent of children diagnosed with ADHD similarly meet the criteria for autism.

It is possible to have both ADHD and autism. Finding a doctor that can give distinct diagnoses can help families and individuals seek the best treatments and therapies, something that’s important to address at an early age for both conditions.

“Rather than hoping entry to preschool or school will magically mitigate troubles, and rather than ascribing challenging or worrisome behaviors to autism alone or even to ADHD and autism together, we can support referral to appropriate psychological help,” writes Lydia Furman, MD, Assistant Editor, for Pediatrics in a blog aimed at other pediatricians that discussed patients with both ADHD and autism.

How Are ADHD and Autism Different?

ADHD is a neurodevelopmental condition whose hallmark signs include hyperactivity, impulsivity, and inattention. Autism is also a neurodevelopmental condition, but one characterized by social skills challenges like social interactions, communications, and repetitive behaviors. Autism can also occur on a very broad spectrum that can affect individuals in a number of ways, from cognitive disabilities or outstanding abilities to varying sensory issues.

While there may be an overlap in symptoms between the two conditions, the underlying causes may be very different. For example, social struggles might be due to the impulsivity ADHD causes or stem from sensory overloads common with autism.

Individuals with ADHD might be prone to tantrums and meltdowns due to low frustration tolerance and high impulsivity; may struggle with staying on task for non-preferred activities; have excessive “fidgety” movement; act without thinking; and take physical risks.

Common signs in people with autism might include avoiding eye contact; delayed or no speech; struggles with social cues; a use of excessive body movements (“stimming”) to self-soothe; being prone to meltdowns caused by sensory issues, anxiety, or communication struggles; and intense interest in certain preferred topics.

What Treatment Options Exist for Both?

While medication can make a big difference in managing ADHD symptoms, there are no medications that are targeted toward addressing autism as a whole – although there are medications that may help address specific symptoms common with autism, such as anxiety.

For some individuals on the autism spectrum common ADHD medications like stimulants may cause an adverse effect. There’s no clear cut way to treat patients with dual ADHD and autism diagnoses, which is why it’s important to have a doctor who can understand the nuances of both and work with individuals and families to find the best protocol.

Beyond medication, accommodations in school and work environments can also have a huge, positive impact. Both conditions may make students eligible for individual education plans (IEP), which can include mandated accommodations like a seat that’s closer to the teacher and farther away from auditory and visual distractions; visual prompts to help the student stay on task; movement breaks; and breaking assignments into smaller chunks.

Occupational therapy can provide a sensory diet that can help children with ADHD and autism self-regulate. Some individuals with autism may also benefit from speech therapy, whether it’s to help them verbalize or to help with pragmatic (social skills) communication.

Applied behavior analysis (ABA) and other forms of behavior therapy are also effective for both conditions and can help teach children to manage their actions and learn cues for appropriate social interactions. Throughout their lifetime, people with both diagnoses may also benefit from seeing psychiatrists for emotional support.

 

Sources:
https://www.aappublications.org/news/2018/03/30/children-with-both-autism-spectrum-disorder-and-attention-deficit-disorder-new-insights-pediatrics-3-30-18

https://www.scientificamerican.com/article/decoding-the-overlap-between-autism-and-adhd/

https://www.additudemag.com/is-it-adhd-or-asd/

https://www.understood.org/en/learning-attention-issues/child-learning-disabilities/add-adhd/the-difference-between-adhd-and-autism

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