Those with children dx ADHD, what is your child like, and do they also have a related condition,eg Aspergers?

[mabanana]

My ds (7) is dx Aspergers and dyspraxia. But he is also iincredibly wriggly, fidgety, all over the place, totally distractable all the time, and very, very inattentive. Cannot begin to dress himself as will run about, think of something else to do, not even look at his vest or socks even when putting them on etc. Even the paed we saw the other day for a non-related health issue, suggested ADHD.

J is just like that, and has dual dx of ADHD and autism. He got the ADHD dx first, and the psych who made the autism dx said that many psychs believe that ADHD in an autistic child is actually just the sensory symptoms of the autism, and the distractibility is just part of the autistic inability to modulate their behaviour well. Not sure what to think of that, but ADHD meds do take away most of the ADHD symptoms in J, so I figure he does actually have both so both dx's are right.

Worth asking your CAMHS person, or whoever you see.

My DS has HFA/AS and is exactly as you describe. I have not sought a further diagnosis of ADHD, as I feel it all comes under the autism umbrella. he constantly fidgets to get a sense of body awareness, the distractability is due to his focus on often irrelevant detail. He does not dress, or complete any task for that matter without supervision and constant verbal or visual prompting. The difference I recognise is his extraordinary ability to focus when it is a subject of his choice, and this is what rules out ADHD for me.

I'm sure somewhere in the diagnostic criteria I have read that an autism diagnosis should take priority over ADHD. I'll see if I can find it

You're right, widemouthfrog. Autism 'trumps' any other dx - J's only remains because he was dx'd ADHD first, and CAMHS here only see kids (after initial dx) with dxs of both, so I'm happy to let it remain. The only thing I'd say is that kids with pure ADHD can focuson a thing of their choice well - computer games are known for this - and it's called hyperfocus, so I think even ADHD kids don't have to be 100% inattentive for a dx, if that makes sense.

interesting this as with DD she had an assessment at the CDC when she was 2 and ASD was suggested.

CAMHS say no to ASD and say that she has attention difficulties and hyperactivity with "some" traits on ASD.

dont know much about ADHD,but DD can focus on something she is interested in like painting,but 99% of the time she is figidty,restless,hyper you name it.

school say she prefers adults to children and talks non stop but appears sociable,do children with ADHD have difficulties with socialising as im not well up on it.

We have a similar problem in that ds was dx'd with AS and his ADHD symptoms has been attributed to that for years - the autism 'trumped' any suggestion of ADHD. Over the years we've made good progress with his autistic symptoms using behaviour management techniques but those relating to ADHD remain, suggesting a separate dx, which is possible. It's been suggested by ds's head teacher (before we withdrew him for Home Ed) and other professionals that he would benefit from medication to address his anger and impulsivity, which I agree. However, we've since been told by ds's psychiatrist that under the new NICE guidelines it's not possible to prescribe without a formal dx of ADHD.

The DSM IV criteria for ADHD says that 'The symptoms do not happen only during the course of a Pervasive Developmental Disorder, Schizophrenia, or other Psychotic Disorder. The symptoms are not better accounted for by another mental disorder (e.g. Mood Disorder, Anxiety Disorder, Dissociative Disorder, or a Personality Disorder)', but it is possible to have an ADHD dx after Aspergers - I think it seems to depend on the opinion of the assessing psychiatrist. It's in the personal interpretation of the DSM criteria.

That is interesting givemesleep. I guess the important point is whether separate diagnoses help in getting help, e.g medication for ADHD.

All these 'labels' blur. Dyspraxia also has such a lot of overlap with ASDs - in terms of memory, planning and motor co-rdination- it is difficult to know what is ASD and what is something additional.

My DS also has epilepsy BTW, for which he is medicated. The epilepsy medication seems to have vastly improved his autistic symptoms aswell though.

Cross posted with jenk and Streaky. Jenk - the talking to adults and talking none stop is typical ASD. Some people on the spectrum are very sociable - it is just not always appropriate. The importance for an ASD is there needs to bthe 'triad' of impairments,
social interaction, social communication, and social imagination.

hmm that is what ive said to CAMHS,she is sociable but its on her own terms and she says socially imappropriate things such as (to a little girl who was trying to play with her) i hate your hair,and she regularly asks people or rather tells them that their breath stinks!!!

the private psych who dx,d her with PDD-NOS said when i told him what CAMHS have said "she is not not not not not ADHD".

its very confusing.

PDD-NOS is now recognised as part of the autistic spectrum. Suggests many traits, but not enough in all 3 areas. The stereotypes of ASD meaning aloof and without imagination are hard to break.

CAMHS seem to be crap at dealing with ASDs. We were diagnosed by a paediatrician, and it took 6 months.

My paed actually said CAMHS were to be avoided, as it would take them years to come to a conclusion and we needed help and a label quickly to access support and services . I have no doubt that our 'label' is accurate.

Our CAMHS are great and were quick. I think it depends where you are and who the psychs are.

Sorry give me sleep, i should have said CAMHS in our area, and not generalised. Oops

It took us 4 years to access Camhs - so ds got a dx of ADHD/LD/SLD at rising 5 but had to wait till 8 for his autism Dx! This is a common problem in our area where community paeds can Dx ADHD but not ASD and the wait for CAHMS is silly. Many children from our area therefore have a dual Dx. Ds is now 9 and in a special ASD/LD school. He can certainly hyperfocus and would not even smell/hear ice cream in this state. He is usually in constant motion but can be very still when hyperfocused. He has many sensory issues and can be over and undersensitive. He does not have the focus, attention span or motor skills to dress himself yet although he can get PJs on and off when motivated.

The community paeds can't dx ANYTHING here, except classic autism.

CAMHS have to do all ADHD/ ASD dxs.

Interesting. Ds is not violent (except when he bashes his little sister, but not as hard as she bashes him! ) but he is exceptionally impulsive and impatient. He is bright, but the lack of ability to see anything through except if he is very motivated, the fidgeting (he cannot sit on a chair for more than a few minutes in any situation) impulsiveness and impatience really hold him back in all areas.

DS is 8 and has a dx of AS and ADHD. He got both these dx together this august when he got a new paed. She said that his ADHD type symptoms may well be due to his AS but as they were reduced considerably by the ADHD med atomoxetine (strattera) she was giving him a dual dx. He is also able to focus on something he is really interested in - especially computer games.

Dustystar, thanks for your message. Can you describe how the medication helped and what symptoms your ds showed that got the ADHD dx? I really feel the impulsivity and impatience etc are so extreme they hold him back in all areas as well as making him hard to deal with at home and school. He has 25hours plus 1-1 at school already, but sometimes they look shattered at the end of the day! (I say plus because 25 hours is his statement, but even that is not enough because he is so easily distracted)

Its a bit complicated as he is on two meds. He started off taking Equasym which is a stimulant based medication like ritalin. This didn't suit him at all and actually made him worse. We took him off that after 2 weeks and he was put on fluoxetine (prozac) to help reduce his anxiety. This helped quite a lot and after a couple of weeks he was calmer in general.

However although he was much less anxious he was still very fidgety and impulsive and distractable so after a couple of months on the fluoxetine his paediatrician started him on atomoxetine which is a non-stimulant ADHD medication. This has helped a lot but it is by no means a magic bullet - ds still has all the traits of ADHD they are simply reduced by the meds.

Its hard to say which drug is most helpful as he is on both but overall I would describe the effect of the fluoxetine as reducing his base level of agitation. The result of this is that he doesn't fly off the handle quite so easily and he calms down agin much more quickly. We have also noticed that whereas before an outburst would resuly in him being edgy for the rest of the day, on fluoxetine he was more likely to calm down fully within 30 mins. The atomoxetine then helped by making him less fidgety and more able to focus.

I agree with you that this sort of thing can really hold them back in class. Ds is is very bright but without support and encouragment to stay on task he wouldn't get anything done.

Ds is on concerta a slow release stimulant. We tried equazyme (immediate release stimulant) and it really was not right for ds - he metabolised it too fast and had amazing ups and downs that were difficult for everyone!! His medication has the effect of slowing him down a little - which gives him a better chance to intercept his impulses and shortcircuited thoughts! The main advantage is the longer term one - ie he has managed to learn! Oddly his fine motor control is better too, and drops back as his medication wears off. It is far from perfect and there some downsides. The downside for ds who is not naturally anxious or aware of the people around him is to allow greater self awareness and therefore he can get anxious he can also be slightly jittery as the medication starts to work.
Ds was in real danger from his impulsivity, lack of learning from experience and lack of danger awareness and we really feared for him once he was at school and poorly supervised hense persivering with medication.

Thanks. I'm quite concerned about possibly side effects, especially on growth. Ds isn't really anxious. Just incredibly fidgety and wriggly and unable to concentrate unless something really, really grips him. He is all over the place at school really, even with a 1-1. He is a nightmare with any medical examinations, and cannot control his impulses to shout out or move or flick switches etc. And he absolutely cannot sit in a chair.

J is on Straterra and it really reduces the ADHD symptoms, which is why I still believe in the dx really. He lost loads of weight on Equasym, and still fails to gain weight on Straterra BUT put on loads of weight in the summer holidays, even on meds, so I figure that the weight loss is actually due to anxiety during term time - school stress etc.
He is so so tall and grows that way even if he does look like a famine victim in terms of weight.

Ds lost his appetite on equasym but wasn't on it long enough for it to impact upon his weight. He also had difficulties getting to sleep and staying asleep. On Strattera he still has a few problems with sleeping but nowhere near as bad as on the equasym and his appetite seems unaffected. The downside of strattera is that unlike the stimulant based meds it has to be taken every day and not just on the days when its important for the child to be calmer and more attentive.

Ds appetite ( which has always been robust!)is slightly affected by concerta when it is fully active (so lunch is often not well eaten), but makes up for that at breakfast and supper. He needs an afterschool snack as he is starving (can easily loose it!)but doesnt recognise it himself. He continues to grow like a bean stalk and remains on a higher centile for height than weight as he always has. We keep him on meds 7 days a week too now as it seems to work better that way - ds cannot cope with changes in his skills (Mondays are difficult enough)! Ds has always been an early waker, and if anything this has improved. He used to be nearly asleep on his feet (literally) by 7pm now he need a structured wind down to get him there by 8pm- he is not as physically worn out. ( but he sometimes wakes with not before the larks now!!)