Autism and ADHD

[FifteenFluffyBunnies]

My understanding is that you can have a diagnosis of both autism and ADHD, one does not preclude the other. Am I also correct in thinking there is some overlap between the conditions? In which case how is it decided that X behaviour is due to autism rather than ADHD and vice versa? If you or your child have a diagnosis of both which diagnosis came first?

My reason for asking is I thought my child had ADHD, I didn’t suspect autism. We went through the assessment process and I was told no he didn’t meet the criteria for ADHD (I didn’t agree). They told me they thought his behaviour was autistic. For example, they said his impulsivity was sensory seeking. They weren’t the people who could diagnose autism so I’ve had to wait ages (with no support) for an autism assessment. Had the multidisciplinary assessment and was told that everyone was in high agreement that he was definitely autistic. However, they also said that not all his behaviour such as his impulsivity and distractability can be explained by autism. They are now suggesting he needs to be sent back to the ADHD people for a second opinion. It’s all left me feeling quite confused.

As I understand it, ADHD and ASD are two completely separate conditions but it is not uncommon for them to co-exist - i.e. for someone to have both of them. In those situations, it is more likely that one condition will be the dominant one (e.g. ADHD with some ASD traits, or vice versa as in your son's case) and that it's better to get the diagnosis for the primary condition first before diagnosing the other one. But I'm not an expert. Sorry you're feeling that you're being passed from pillar to post.

My understanding is that there are very limited - most help is in the form of support and strategies, the effectiveness of which varies enormously between individuals and situations.

Which impacts the person most is totally individual. Circumstance also important -eg the ASD likely to impact social life more than ADHD would, but ADHD likely to impact learning to drive more than ASD could. Obviously the individual is more important than the diagnosis and these examples are huge generalisations.

I would like to offer up an answer based on having both conditions in our house. I hope this is of more use.

Autism and ADHD are both about neuro diversity, differences in wiring, and experiencing sensation differently from the majority.

There is a well worn cliche that if you meet someone who is Austistic, you’ve only met one kind of Autistic person. Being autistic impacts on numerous parts of your life, and millions of difference behaviours, some more than others, and yet others will have intellectual disability too.

There are a lot of children who are autistic who also show ADHD symptoms. Frankly, I have never met a child with ADHD that didn’t also tick lots of boxes for ASD. I have a feeling that we will end up with an awful lot of kids who get the ASD diagnosis having first been thought ADHD, and that it just depends on which characteristics are most obvious/cause the most impact.

It is amazing that they are assessing all of this together, that they are professionally resilient enough to change their minds, and that they are telling you their thoughts as they occur. Even if it has left you confused!

I can only recommend, seek out work by autistic adults. There are incredibly qualified academics and clinicians who have studied this their whole lives, but in terms of actually understanding what it all entails, how it feels to be neurodiverse, and what might happen in your child’s future, keep a close eye on those who have lived it every day.

Good luck, it’s a roller coaster, but there is more information than ever.

Look at the book Neurotribes, and try Searching Austism/TedX talks on YouTube, you’ll find many great talks there which can help you understand the differences and similarities.

Yes, you can have both.

My ds has both the adhd was diagnosed 1st and when it was properly medicated they then went on to diagnose the ASD and more recently dyslexia and tourettes

Our son has both. We spent about 4 years getting an ASD diagnosis. ADHD never even occured to us until the ed psych suggested it. We got a diagnosis for that within a couple of months. The ADHD diagnosis allowed him to have melatonin for sleep and we have found that he is better able to manage his ASD for having more sleep - it's still clearly there, just not as over-whelming for him. The ASD diagnosis hasn't been helpful at all - school we're fantastic with him without needing it.

I have both I was diagnosed with autism first and then ADHD a bit later in life. I'm not really sure where one starts and the other ends in myself to be honest!

You can have both. Yes, some symptoms can be difficult to identify what diagnosis they are linked to (trauma symptoms can look very similar also). Diagnosis is a tricky thing.

My DS is diagnosed with a few conditions, this diagram shows how neuro diversity overlaps. I can’t say with him a trait is due to either ADHD/dyspraxia/ASD as they all overlap.

Yeah, there does seem to be a lot of overlap which is what I find confusing I guess. I’ve always disagreed with the no diagnosis of ADHD so I was glad that the autism assessment team want him reassessed. I do agree that he has ASD, but I think his biggest challenge is his impulsivity and emotional dysregulation. Those two behaviours combined mean he needs supervising 100% of time. So if there is a treatment for that then I want it. Which is why I think it’s important he gets the right diagnosis. A few people have said to me to drop the ADHD thing because he doesn’t need two labels, he’s got the autism diagnosis so what difference does it make.

I actually think he’s dyslexic too because he’s almost 8 and frequently misspells his 4 letter name.

I always thought you could have both, but they didn’t want to diagnosis ADHD because they felt his behaviour was better explained by autism.

My son has both. I thought he just had ADHD. A child with autism is more likely to have ADHD than a neuro typical child.

Our ed psych explained that there is a huge overlap but that his hyperactivity and impupsivity could not be accounted for within an ASD framework. And his sensory seeking behaviour, and his difficulties with relationships, were more severe than would normally be accounted for within an ADHD diagnosis.

At first I expected ADHD, then ASD, then I got both. Been a head turner I can tell you. I'll find an article I found useful.

When my DS was diagnosed I was a bit unsure about the ADHD diagnosis but certain about the ASD. The dr said the best way to confirm ADHD is through medication, it showed he definitely had ADHD as his impulsivity dropped so much! We also realised that his ADHD actually masks some of his ASD and he’s better off unmedicated. DS was also struggling at school and we thought the medication would help with his concentration and he would perform better, it didn’t help and we realised his biggest barrier to learning is his severe dyslexia. He’s 12 now and it has taken a long time to unpick even just a little of what’s going on as he always surprises us with what he does and doesn’t cope with!

Ive heard a few times about medication for ADHD making ASD worse. Can someone explain why to me please? Its something we are considering longer term.

DS has dyspraxia, dyslexia and ASD.
His cousin was already diagnosed with dyspraxia, ADHD and borderline ASD, his parents are trying to get a more definitive diagnisis on the ASD as a social gap between him and his peers has opened up since.
DS and DN have broadly similar dispositions, strengths and difficulties, but DN is more twitchy.

DS did a QB test as part of his diagnosis. He excelled at clicking at dots for the length of the test. ADHD would struggle earlier earlier than average and move erratically and the test is designed to exceed average attention span. DS became more twitchy through the test in an effort to maintain concentration. He says he's most likely to be told off at school for fidgeting around. He tends to bob up and down rather than the more obvious, distracting swaying. I sympathise as sometimes I need to do more than one thing at a time to focus, doodling while listening or listening/ singing while reading/ driving. I need to trigger more than one sense.

Each child is an individual, and often co-morbids can be overlooked after an initial diagnosis. For us, dyslexia, dyspraxia was more obvious from earlier on and were diagnosed through the dyslexia pathway prior to ASD diagnosis. Often ASD tends to be treated as the main issue and others overlooked if ASD is diagnosed first. Other than sleep, medication isn't applicable to ASD but may be of benefit in ADHD so a full diagnosis is helpful in understanding the bigger picture and management strategies.

DS finds life with ASD and dyspraxia frustrating as there is a clash between his perfectionist attributes and the practical challenges of dyspraxia, so it is worth understanding how two conditions interract and contradict.

I always knew DS had ASD, but it took 4 years to get a diagnosis, during that they said they suspected he also had ADHD, which I didn’t see at all, the things they highlighted, I just thought of as his ASD. But we went along with the assessment, he was diagnosed with ADHD within months and put on medication. I had my doubts, but it is absolutely true that he copes better with life on ADHD medication, he is calmer, and has far fewer ASD meltdowns, gets on better at school. It doesn’t help with his social difficulties, but he is definitely happier. I still can’t see the ADHD, only the ASD. I can’t see them as 2 separate conditions, it’s just who he is. He now has an additional diagnosis of epilepsy, so life gets difficult, and there’s lots of meds, but I would go with the professional judgement and see if the additional diagnosis accesses you further supports.

I have autism and ADHD and honestly when it comes to which symptoms are which it's more than most are both and then there's a few that are one or the other. My sensory processing issues relate to both, but my problems with socialising relate more to autism and my hyperactivity and difficulty concentrating are part of ADHD. In some cases it's just not worth the separation, in that when I have meltdowns it's because I'm autistic but the build-up towards it could have been exacerbated by my ADHD. In my opinion it was absolutely worth getting both diagnoses, because my initial autism diagnosis just didn't quite explain everything and left me with a lot of aspects of myself that I still didn't understand, and knowing I have ADHD as well allows me to learn more coping mechanisms and understand myself better than I did before. Even if you don't get a diagnosis for both I would recommend looking into research and coping skills for both, the overlaps means you can find some fantastic advice for one which ends up helping the other, if that makes sense

My dd is autistic and has adhd, we got the diagnosis at the same time. They told me that asd was the primary diagnosis so more prevalent? Who knows. I haven't really tried to distinguish her behaviours between them tbh as it would be too complex. Lack of attention span mixed in with spacing out into an imaginary world due sensory issues or lack of attention span couple with her current special interest.

I think asd is more inherent to a persons personality etc whereas adhd is a cause.

@FifteenFluffyBunnies

DS1 was recently diagnosed with autism level 1 (Asperger's in old money). The clinical psychologist suggested that he also be tested for ADHD. I believe there is significant overlap/co-morbidity.

Impulsivity is the biggest challenge so it kinda annoys me I was told it was due to autism and now I’m being told it’s not. If I could give him medication to help to control his impulsivity I think he would be so much happier.

I don’t really associate impulsivity with autism as I have another child who is autistic and he’s not impulsive at all. It’s definitely true what they say about autistic people all experiencing their autism differently as my two autistic children are complete opposites.

Without wanting to be crass, does Ritillin not help with ADHD? I don’t know what the side-effects are, and I’m sure that some people have good rrasons not to use it.

@Saz12
Ritillin (Equasim in the UK) works well in most young children and in mild cases of ADHD but in more severe cases and in older children and adults it is much less effective my ds is 11 and already on the highest dose of it already so will be moving onto the next level of medicine.
Whilst Equasim is a very effective medicine it can come with some pretty extreme side effects ranging from loss of appetite all the way through to psychosis. So it's not really a magic bullet, we have been lucky in that my ds has had no side effects from his meds ,if he had then depending on how bad they were , he probably wouldn't be on them

Thanks Cabinfever! That makes sense.

My DS has HFA (diagnosed with Asperger) and ADHD. I was expecting the HFA but not the ADHD. The consultant said they would check “just to rule it out” but DSs Teacher wasn’t surprised. Not enough to need medication. He needs no intervention just awareness of his behaviour and trigger points.