ADHD and Autism Spectrum Disorder

In a my last blog post I talked about how updates to autism diagnostic categories affected what terms are currently used to provide a diagnosis for a person with autism.

In addition to the changes in terms, there were some changes in what additional diagnoses were able to be included with autism, most notably, Attention Deifict-Hyperactivity Disorder or ADHD. In the prior diagnostic system, called DSM-IV, if a child or adult was given an autism diagnosis, they could not also receive a diagnosis of ADHD.

At the time, difficulties with impulsivity, attention, planning, organization, emotional regulation, and hyperactivity were viewed as an integral part of autism and its associated disorders such as PDD-NOS and Asperger's Disorder. Things changed when the mental health profession moved to updated criteria with DSM-5.

When using DSM-5, ADHD and Autism Spectrum Disorder (ASD) diagnoses are allowed to be made together. Further research and debate between thought leaders clarified that there are some people with ASD who have little to no problems with issues that are central to ADHD. As that became clear, the rules were changed for DSM-5 and ADHD is now allowed to be diagnosed along with ASD.

In fact, many children with ASD also qualify for an ADHD diagnosis. Researchers have estimated about 40-80% of people with autism as have ADHD. That range is so wide due to problems researching the two conditions together under the old DSM-IV rules. More research is ongoing now get better numbers on how many people with ASD also have ADHD.

Folks with autism generally benefit from the same types of treatments for ADHD as people who only have ADHD: medication, therapy, and ADHD coaching. Sometimes side effects of medications increase existing autism problems, like restricted eating, and have to be discontinued, but this is not common. Also, therapy or coaching is appropriate for people who are motivated and engaged and have the language skills needed to benefit.

In my own practice, issues with attention and impulsivity tend to be the things that get noticed by others. Children with autism and ADHD may have a very hard time focusing in a classroom where sensory issues can be an added distraction. Younger students may not catch on to the social cues of fellow students (everyone else is sitting and reading their text book) and do something impulsive that another student with only ADHD who is more socially aware might not.

I also see lots of kids, teens, and adult with ASD who really struggle with organization and planning. Backpacks are often described as looking like "a bomb went off in there" and poor grades may be related to homework not turned in that parents saw completed the night before. These effects of ADHD can be just as limiting as the more obvious impulsive behaviors, especially as the person gets older and schools and colleges expect more from students to organize themselves.

If you or your child was diagnosed more than 3-4 years ago with ASD and have very significant problems with impulsivity, attention, hyperactivity, planning and remembering at school, or poor organization then it might be a good idea to talk with the mental health professional managing their care to see if an added diagnosis of ADHD is appropriate. This additional diagnosis could open the doors to additional helpful treatments.

Todd Koser