ASD vs ADHD - wrong diagnosis?

[hellohome]

Hello,

My son (nearly 7) was recently assessed for ASD & ADHD and diagnosed with one of them. Before assessment everyone involved with him thought he showed the signs of the OTHER one. I just wondered if I could get some opinions? As I'm thinking of asking for a second opinion... however they said he will get extra help in school on the back of this (which he desperately needs) so I'm scared to rock the boat.

Speech - He had delayed speech. First spoke at 3. First talking properly at 4. Now he talks but struggles to say what he wants to say, stops and starts a lot, lots of 'ums'. Gets certain words confused like he/she/her etc, tenses, plurals. Random words like he might say chair when he means table etc? He copies peoples speech too i.e. a teacher said the other day 'you're fully prepared for the downpour!' as he had his raincoat on and it was about to rain. So now when he puts his coat on he says it, but i'm not 100% sure he understands what he's saying. Both the SALT and the people at his assessment said that he takes things literally but I feel this is quite a hard concept to grasp anyway (sarcasm, metaphors etc) and he is quite immature for his age so it could be down to that. The SALT said he had an expressive language delay and has recommended twice weekly speech and language sessions. She also said he had trouble recalling long sentences but ok with short ones... so there could be something wrong with his working memory. However he has an excellent memory for certain things, like the other day I was talking about a wedding we went to a couple of years ago and he said 'you were wearing a heart necklace' and i looked at the pictures and I was!

Eye contact - has always made eye contact since he was a baby. However you have to say his name repeatedly to get his focus on you, and then continually get his attention back to you when talking etc. He seems to zone out or just isn't interested in what you're saying most of the time. That SALT and also during his assessment both said he made good eye contact but it was fleeting. He has a teaching assistant help him to try and stay focused on his work at school otherwise he will write a word or two and then get distracted.

Behaviour - has always had massive tantrums, when younger it was directed towards himself - hitting himself, headbutting etc but now it's directed towards others - hitting, punching, biting, spitting, kicking, pinching, throwing things etc. He always seems so frustrated. And it just gets worse as he gets older. Last year he only had 3 lunch time detentions for hurting other children, this year he's already had 2 and they've only been back 3 weeks. We've noticed so many reasons for them, but some we still don't know why?! At school it's because other children won't play with him or play something he doesn't want to. SALT recommended a social skills group which I'm hoping will be able to help.

Impulsive behaviour - he doesn't think before acting. Sometimes he's triggered so his brother started humming the other day and the sound just made him lunge at his brother rather than asking him to stop. Other times it seems completely random... someone will walk past and he'll punch them as they walk by him?! He knows about road safety but if he sees a friend across the road he will just go to run over without thinking about it. When angry once he threw his scooter into the road in front of a car etc.

Repetitive behaviour - he has no repetitive behaviours, doesn't line toys up, doesn't flap hands etc etc. He did go for a few months making this sound with his throat. Kind of like clearing it. And he used to do it loudly and constantly without thinking about it, but one day it just stopped. He has no 'obsessions' and although we say he is obsessed with paw patrol for example it's just a turn of phrase and I don't believe he is actually 'obsessed'. He has loved paw patrol since he was 3 and watches the shows on repeat, has all the toys etc BUT he is quite happy to do other things.

Fidgeting - he can sit for periods of time and does at school. but he picks his skin and nails until they bleed, fidgets a lot. At home would rather stand than sit and whilst doing things tends to repeatedly stretch his legs, jump, do star jumps etc. If we go to the cinema or theatre he is up and down, twisting round in his seat, asking to get up for the toilet constantly etc so he can walk about. Whilst eating, even in restaurants he will alternate between sitting and standing, stretching legs again etc. whilst sitting jiggles legs and kicks table etc. He gets bored easily unless it's something he loves in which case he can do it for hours and actually stay focused!

Playing - he enjoys playing with others. He has friends. At the assessment they said he can't tell the difference between friends and strangers... yes he will talk to anyone, in fact sometimes he prefers interacting and talking with adults HOWEVER he knows who his friends are!!! He struggles with taking turns and everything has to be how he wants to do it. He struggles with losing and wants to be first at everything. However he has some great friends and seems to make friends wherever we go. During assessment they said he struggled identifying emotions. He sometimes doesn't seem to notice / seem bothered when you're upset... but other times he does. Like at school his friend was crying and he tried to hug her. He can be very empathetic when he wants. He's always waved and smiles when he sees you etc. They also said he struggled with reciprocal conversation and I know he tends to ramble on about what he wants to talk about but he DOES have conversations with you.

Routine - he likes things done in a certain way, in a certain order. He doesn't like you moving things. So if i tidy his room whilst he's at school he will become really angry and violent when he gets home. He keeps some things tidy like his paw patrol teddies on his pillow, his sea patroller on his windowsill etc and won't leave until everything is in the right place... However things he doesn't care as much about he constantly loses, misplaces or forgets what he's done with them.

So yes, I'm sorry this is so long and I totally understand if nobody got this far! I'm just so confused and unsure what to do. I don't want him to be labelled as something he's not.. but at the same time he needs the extra help at school?

[LiefievdM]

You don't mention which one he was eventually diagnosed with?

My DN has ADHD and I have recognised a lot of his behaviours in what you just described.

[hellohome]

he was diagnosed with asd. everyone previously has mentioned possible adhd and given us leaflets on adhd etc.

We were expecting either nothing, or an adhd diagnosis. we were absolutely floored when they said he had asd. I know he has traits but I would never have said asd. I said this to them at the assessment but they all agreed he had asd.

[LiefievdM]

Hopefully they have given you feedback as to why they gave the asd diagnoses? I have heard sometimes one can mask the other. And there is a possibility of having both. I'm certainly no expert, as we're only just starting our diagnoses pathway. Did they use the ADOS assessment?

I'm sure someone with the right level of knowledge will be along soon.

[hellohome]

thank you both.

they said full report will be posted soon but based on play observation - struggle to maintain eye contact, lack of reciprocal conversation, resistant to transitioning between things, struggled with identifying others emotions, taking things literally. they said this was based in conjunction with our parent interview (I don't think we said anything to point towards asd!), and reports and questionaires etc from us, teacher, senco and salt

[Dannygirl]

I am no expert. But my son has just been diagnosed with ASD several years after a Dyspraxia diagnosis and I was very confused about how they would disentangle one from the other. The autism assessment team explained they don't try to disentangle anything, they just look at the child's traits/behaviours through the lens of ASD (or whatever they are looking at). So several things can co-exist, it just means they meet the criteria when looking at each condition independently. As the range of ASD difficulties is so broad, and we all need to focus in on what each individual ASD child needs help with anyway, personally I would focus on the specific diffficulties he has and put in place strategies to help with those, and accept any help offered. It must be really hard when you were expecting a different outcome though so others in a similar situation may be able to offer better advice. Good luck x

[Waitingforsleep]

It is so hard to know. My dd has just been diagnosed with ADHD after they spent years looking and assessing her for asd and saying it wasn't that.
I think that they symptoms are very similar and yes you can have both but and forgive me if I'm wrong I think asd dx is more when there are problems with social communication. You didn't mention too
Much on this but once again I may be wrong

[Waitingforsleep]

Actually re reading there are a lot of asd flags that my dd doesn't do.
It could potentially be both?
Copying speech for example Echolia?
Humming could be Sensory? Has he had a sensory assessment?
Once again only a few thoughts

[StarlightMcKenzee]

How old is your son?

I'd be confident in an ASD diagnosis from what you have said, but I would want an OT assessment for sensory profiling done about his need to move, get feedback from the environment.

I also wouldn't discount ADHD as an comorbid condition. It is estimated that around 70% of children with ASD have symptoms enough of ADHD to merit a diagnosis.

[StarlightMcKenzee]

Who is 'everyone'? suggesting ASD?

I think educational professionals can 'sometimes' encourage parents to seek a diagnosis of ADHD with the view that they can access medication and stop being a pita for them to teach.

[StarlightMcKenzee]

Sorry, - I mean who are the everyone who have been suggesting ADHD?

[hellohome]

Starlight is OT occupational therapy? How would I go about that? His teacher last year, the senco and our family support worker all said they cannot say if he has Adhd but he shows the signs and finds it very hard to sit still and concentrate in class. The SALT wouldn't say if she thought there was anything but recommended a referal to camhs to see if there was anything underlying (he had already been referred and we had an appointment for assessment by this point)

[Marshmallow09er]

My DS (ASD) finds it very hard to concentrate in the classroom - but at home he will spend hours on the computer / playing Lego or play doh.
He loves being outside / in nature, climbing trees etc.
He finds the noise / environment / unwritten social rules of school very overwhelming and it affects his ability to be able to concentrate massively as he just can't 'filter out' the background noise / movements.
He also constantly seeks proprioceptive feedback as he doesn't automatically know where his body is in relation to what's around him (I think of it like invisible cat's whiskers - I just know when my hand will reach a doorknob as I go towards it, but he doesn't have this relational space understanding) - so he's always fidgeting, tapping, banging, fiddling.
If you read up about sensory processing disorder it should explain it a bit more for you.

OT is occupational therapy, and there are some who specialise in SPD.

ASD in 'real life' looks very different from the stereotypes that you can read / hear about. My DS is SO empathetic; he hates to see anyone upset. He has areas of special interest, but they are not exclusive and he will involve himself in other things too, he just needs a bit more guidance and support than other kids his age.
His emotional and social skills are definitely behind his peers, but he often just needs much more explicit explanation of situations than other kids do - he doesn't necessarily learn implicitly.

[Waitingforsleep]

I was told the need to move etc for sensory was same as the need to move re ADHD. Just different labels/names but same thing?

[Marshmallow09er]

I think there's a lot of overlap (and someone with ADHD could also have SPD?). I'm by no means an expert (only an expert in my DS!).

DS is always very fidgety; but his ability to stay concentrated on something can vastly differ depending on external factors (and of course how interested he is in it). Being able to fiddle and fidget tho is integral in him being able to concentrate (as in if you stopping him being able to fidget he'd be able to concentrate less - certainly at school. Wobble cushions etc help a lot)

[Waitingforsleep]

So confusing isn't it as to me the sound the same? Why is it all so complicated 😬

[Waitingforsleep]

Actually a big difference for us is that dd won't play for hours at home, gets bored easily and distracted, can't wait for things. Maybe because it's not the environment ?

[Marshmallow09er]

Waiting hmm, well DS is also terrible at entertaining himself and really aggrevating to DD when he's bored because he doesn't know what to do with himself - but once he does get into something he can become absorbed for hours.

I have sometimes wondered whether he has ADHD as well (as Starlight mentioned below, there are a lot of autistic children who have enough AHDH traits too that they could also be diagnosed with that), but DS is so clearly autistic there's no doubt that's the right diagnosis for him.

He's not really impulsive or hyperactive either; if anything he's very cautious apart from when he's in flight or fight mode due to anxiety when he can lose all sense of danger (which is often his default setting at school - at least it is, he is much better understood and supported now) - he just likes to move slightly in some way all the time to stay 'grounded'

[Waitingforsleep]

My dd isn't clearly asd so think the ADHD is more prominent?
The hyperactive though is not how we all imagine. It's not jumping round the room- it can be fidgeting, tapping a foot, the brain thinking, that's why I can't see the difference between that and sensory movement seeking. It's a bit of a myth they have to be bouncing off the walls hence school not believing me about this part.
Impulsive isn't always as we think either. But yes sounds like the prominent difficultly is diagnosed first?

[scrabble1]

ADHD rarely presents alone. Usually with another condition - asd traits, anxiety etc. Our sons diagnosis letter states "complex" for this very reason

[Waitingforsleep]

We have ADHD and dyspraxia

[StarlightMcKenzee]

Yes. He needs sensory profiling by an Occupational therapist. How old is he?

[StarlightMcKenzee]

Son's ADHD isn't in his outward behaviour. It is in his thoughts and head. He has too much going on in his head to concentrate on one thing at a time. He is impulsive in his head, so he will change the topic of his thoughts all the time when the teacher wants him to listen or follow her etc.