Slow (or lack of) Response - Inattentive ADHD or Autism?

[Pheath]

My 8yo son has both Autism and ADHD diagnoses (predominantly inattentive).

For as long as I can remember it's been hit and miss whether he will respond to you when you talk to him or ask a question. He's had hearing tests which are completely normally but he gets very easily distracted and can zone out when you speak to him. He's fully verbal and articulate.

We know several other autistic boys who all obviously have different traits but they all somehow seem more present than my son is who so often gives the impression of being at one remove from things and as though slightly spaced out. When he does respond there can often be a time lag between you talking and him responding unless it's something he's interested in and then you get an immediate response. It makes trying to initiate and sustain a conversation quite an effort!

We're trialling methylphenidate for the ADHD but to be honest it's not helped massively and school say he's even more spaced out on it so hoping a non-stimulant might help.

We are also going to investigate auditory processing disorder although don't think that's what it is as he doesn't seem to fulfil several of the criteria.

Just wondered if anyone had any similar experiences or could offer some advice?

Thank you.

It could be either, or both. Medication can help but often takes time to figure that right one and right dose. Other things are making sure you have DS’s attention before speaking, written instructions, 1 point at a time, in the classroom think about sensory environment/placement within the classroom.

Thanks for your reply, yes it probably is both. The doctor has suggested we try a non-stimulant now, Strattera, as we haven't seen massive gains on methylphenidate unfortunately.

He's a lovely boy in so many ways, very capable and chatty when he chooses to be, but wish something would help to reduce the feeling that he's behind a pane of glass so often when you try and speak with him.

Hey there, I was just searching for others who have found that methylphenidate made their child more zonked than without medication. Our son sound a bit similar to yours, although older, and I had high hopes for trialling medication for the first time recently. Sadly this methylphenidate seems to make him worse. How did your son find the strattera?

Have a read about monotropism? Might be the challenge of shifting focus in a 'single channel' brain, when you operate on a 'multi channel' basis, so find this much easier?

Hi Dermot
We have been some months trialling Strattera with what I'd say has been moderate success although not life changing. My son is currently on 16mg which is a relatively low dose I believe. We went up to 20mg but he was quite irritable, hyper, spaced out at times and very tired often. After a couple of weeks we reduced as it was spoiling the summer hols although now wonder if I gave it long enough to kick in as you need to give it time to build up in the system. On the lower dose he seems a bit calmer, more cooperative and responding better when I talk to him though can still be a bit hit and miss. He still has a rather slow processing time although that's more a hallmark of autism I believe.
I do like the fact that Straterra is a 24hr med so it doesn't wear off late pm like the methylphenidate did. On the downside it seems to suppress appetite a lot more than the methylphenidate during the day so we have to compensate with a substantial breakfast and dinner. Some non stimulants can make you drowsy so it's quite a balancing act.

Interesting re. monotropism. Describes my son quite accurately, much of the time. He can be quite receptive to learning about new and different things although always seems to default back to his favourite topics! Wonder if it's connected also to a difficulty in switching focus.

Thank you.. quite a balancing act like you say. Has it had a positive effect on his productivity? Our son finds it very difficult to get started on tasks and can sit for hours doing nothing.
Did you ever try amphetamine or is he too young?

Hmmm. Difficult one to answer. We scaffold my son with homework quite a lot but possibly he's been working a bit more independently now with less day dreaming. With school it's been a bit up and down, often needing prompts to start but then better when he gets going. Really hard to know whats autism making it hard to transition between tasks and what's being daydreamy and spacey due to ADHD. The titration with this med has taken so long but hope to get fresh feedback in 2/3 weeks from the teacher as to how he's doing . I think overall he functions a bit better on it.
The doctor never suggested amphetamines, I can enquire.

He sounds very like my son. We haven't done medication for ADHD yet. He also has diagnosis of autism, dyslexia, meares irlen and slow processing speed. He has a very sensory avoidance profile.

He had glue ear as a child so for a long time we thought it was to do with that and then I felt it was auditory processing as a complication from glue ear. Then we got his Autism diagnosis instead.

My son is v anti medication (he already takes melatonin) and in Y5 so I might wait until next year to get him started on anything. However he is so far behind academically. We are seeing if assistive technology has any positive effects for him...