ASD presenting differently if ADHD too?

[LizK]

Not sure if I'm making much sense in the title but hope someone can help especially those whose children have ASD and ADHD. I don't think DS (4) has ADHD but I think he does have some difficulties in that area. He's not got a formal diagnosis yet though likel yot be along the lines of milder ASD, AS or DAMP.

 

My son (4) has a lot of trouble concentrating at times and has poor attention. He can be quite impulsive physically and emotionally, gets carried away with himself at times becoming hyperexcitable, manic and quite out of control. I'm never sure whether this sort of behaviour is all part and parcel of ASD or whether he has a separate attention/concentration problem.

 

Do you think having ADHD or attention problems alters how ASD presents? Does the ADHD counterbalance some of the ASD traits?

 

For example aside from a couple of specific activities (CBeebies on computer, marble maze) my son is unable to occupy himself or play alone at home and wanders around like a bored teenager asking for me to play with him. Makes the day hard work as he needs constant supervision, gets easily bored and resorts to slamming doors, trying to turn to microwave on so can watch the digital display or fiddling with the washing machine buttons before moving onto something else Yet I hear about other children with AS/ASD who spend hours playing with specific toys even if repetitively. DS just hasn't got the attention span to do this. I'm not sure whether his boredom is related to his ASD in the fact he has limited imaginary play so can't relate to age-appropriate toys or whether it is more of an attention problem.

 

He is emotionally impulsive too, will give me great big hugs and kisses and then dash off. Many people have been surprised he may have ASD as they describe him as an affectionate little boy. He can show crippling social anxiety in strange places or with unfamiliar people but once he is familiar and happy in a situation he can go the opposite way. It's like his emotional regulatory thermostat is out of sync so either under or over does it. He changed room at nursery 2 mths ago, initially was distressed and withdrawn so the change had to be done gradually. Within a week of being settled he then went the opposite way and is now often overexcitable and loud. When he is withdrawn he has less of a desire to interact with others but now he's playing much more with the other children and moreover they seem to want to play more with him.

 

We notice a difference with his speech too. He has an expressive and receptive speech delay of about a year. If he's calm and more ASD than ADHD he doesn't talk so much but tends to listen and understand better. If he's a little sped up we get the best of both worlds in a child who will chatter along but will also take in anad process what we are saying. If he's very sped up he talks ten-to-the dozen, often compeltely inappropriately and doesn't seem to register or listen to a word you say

 

Aside from the above he has a real problem sitting still. He'll often want to sit on my knee but he just fidgets and squirms constantly and it gets quite uncomfortable. He often tries to poke or prod me, fiddle with toys or random objects often without thinking and still likes to mouth or chew toys. If we are out in shops he almost seems to have a compulsion to fiddle with things on the shelves or impulsively try to run off somewhere whcih can make shopping trips stressful.

 

The thing is he's so variable too. We can get days when he seem slocked away, days when he's more ASD like than anything, days when he's a little hyper but manageable (these days are the best as he's sociable, interactive but can generally concentrate ) and then times when hyperactive to varying degrees, sometimes completely out of control and I feel like the worst parent ever The hyperactive days are getting more frequent I think

 

I think he does have some sensory issues and wonder how much of that is responsible for his variable concentration. If he gets sensory overload he tends to go a bit manic. Changes in routines or lack of structure also make him like this. Sometimes he jsut seems to be like this for no reason which is why I'm wondering if he has a primary attention problem rather than it just being secondary to ASD stuff. In some ways he's less impaired when he's more ADHD like but it makes it harder for me to parentWhen he is high he often doesn't strike as the (stereo?) typical child with ASD so was wondering if ADHD and ASD can balance each other out to a degree.

 

Be really interested to hear anyone else's experiences or thoughts

 

Thanks

 

Liz x

 

PS Sorry post so long

[mel_jayne]

Hi Liz, I'm too waiting for dx for my 9 year old son,ASD and my doc seems to think he also has ADD. As i read up on them i started to get confused I got overloaded with info. It all gets confusing trying to see which ones your chid might have,i bought a ADD book off ebay and a book on asperger syndrome off abebooks.co.uk. It's helped me understand things better.Sorry if it's not much help but good luck anyway

[UltraMum]

There's a paper in the AWARES conference on this:

 

The Hidden Autism Epidemic: How ADHD Interferes with an Autism Spectrum Diagnosis

 

Abstract

 

It is all too common for an ADHD diagnosis to interfere with an early, accurate diagnosis of an autism spectrum disorder, specifically Asperger?s Syndrome (AS). Because children with AS often exhibit hyperactivity, impulsivity, and inattentiveness usually associated with Attention Deficit/Hyperactivity Disorder (ADHD), children on the autism spectrum are often diagnosed with a behavioral disorder. This paper discusses the common conditions and impairments that lead to a misdiagnosis of ADHD when an autism spectrum diagnosis more fully accounts for a child?s symptoms.

 

The conference is free to register and there are discussions about the papers.

http://www.awares.org/conferences/

[LizK]

Thanks Mel-Jayne. You are right it is confusing and trying to piece together what is due to which is difficult. In some ways his concentration issues helps counterbalance his ASD issues but in other ways it make sit much harder (for me!)

 

Mothereve, thank you so much for pointing me in the direction of that paper. What a coincidence Interesting about how ADHD may not be a disorder in its own right, that seems to apply to my son anyway

 

Can anyone else esp those with children with dual diagnoses of ASD and ADHD help? It's something that I'm struggling with at the moment and would love to hear of others experiences. Hope my original post makes sense, I have been known to warble on at times

 

Liz

[Strange girl]

Hi, My 7 yo was diagnosed with ASD as the prominant dx but with underlying ADHD. It is useful for me to be able to understand both conditions as much as I can because some of his behaviour is more easily explained by either one or the other dx. Of course I don't fully understand the distinction and doubt that even the professionals are in agreeance over the neuro-sciences on this..

 

Basically all I do know is that he meets the diagnostic criteria for ADHD, but also has additional traits that meet the triad of impairments of ASD. Confusing, but children diagnosed with ADHD alone, will not have the full list of autistic traits. Where as with autism, the ADHD traits may or may not be a part of the symptoms included under the umbrella of autism. I think you would get a second diagnosis of co-morbid ADHD as a stand alone condition, if all the criteria for ADHD were met independantly of the autistic traits. If the autistic criteria are also met the main diagnosis would be autism, as adhd falls under possible symptoms of an asd, but autism is not necessarily a symptom of adhd.. I'm confusing myself!

 

In my son, he is always on the go, fidgety, hyper-excitable, lacks concentration (but can hyper-focus on some things) is impulsive, unpredictable, etc. Added to a social communication disorder it can be quite a combo! But like you, my son is very affectionate. He is tactile seeking and has the need to be touchy feely. He also runs up kisses me then dashes off I think that there is this great misconception that people with autism are unable to display affection, or are cold and detached. (well this describes me better than it does my son ) But I know many children with AS and HFA who are affectionate. I don't know many that are so highly charged as mine though. He is like a clockwork toy too tightly wound up, lacking in forethought and self control.. but he is a loving, clever special boy with a lot of charm.

 

Hope I haven't confused you even more with my interpretations!

[smiley]

Hi LizK,

 

My son is 6 and has a diagnosis of Aspergers, his consultant also feels he has ADD and Tourettes (twitches etc). ADD is Attention Deficit Disorder - basically, ADHD without the 'H'.

 

The problem with diagnosing other conditions alongside ASD's is that until the Autism is a bit more controlled, or managed better, and any underlying sensory problem, communication problems are eased it's hard to tell if it's a condition in itself - or a reaction/anxiety...

 

Still a bit muddled - - i'll give you my consultants take on it...

 

M finds it increadibly difficult to remember things, i can send him upstairs to get something......he will go to the top of the stairs and begin to wander about. Sometimes remembering he's up there for something but not sure what, sometimes he's totally forgotten he need to get something - just finds himself upstairs and a little confused! This follows through on all aspects of his life - the speech therapist will ask him to point to three things in a picture, M will remember 2, then 'get lost' in thought............. (problems with sequencing)

 

The consultants / speech therapist 's take of this (and the tics) is that, he will have these problems present in AS, at the moment they are very obvious, therefore M may well have these conditions also. But they may also be a sign that he is overly stressed out and that we need to make sure he is less stressed ( huh?!) when a formal diagnosis of ADD/Tourettes is made.

 

Just read through what i've written lol, i hope it makes sense! I think what i'm trying to say is that it can be difficult to diagnose for certain until the primary condition is more controlled...........

 

Hope i've helped - and not just confused you more!!

[UltraMum]

Interesting about how ADHD may not be a disorder in its own right, that seems to apply to my son anyway

 

we've gone the ADHD - dyspraxia - ASD route - our paediatrician said that the dignostic criteria for ADHD mean that it can't be diagnosed alonside autism as it may actually be a feature of the autism itself - even if ther ehas been a prior diagnosis of ADHD the ASD diagnosis trumps the ADHD one!

 

Don't know if that helps or not ...

[julieann]

Hi LizK,

My son 16 in November has dx ASD + Dyslexia in 2003. He has been home educated since June 2003. Whilst in the school environment he had classic symptoms of ADHD/ ASD. The school were adamant that he had ADHD alone. He was on the point of being expelled as he was totally unteachable. The LEA recommended "that S was not educated in school and did not follow the school curriculum as he was highly intelligent and his learning strategies weren't suited to the inflexibility of mainstream teaching".The first six months were no picnic but gradually as he realised he was not going back to school EVER unless he chose to he began to relax. His ADHD symptoms became less and less and I know have back the calm, polite, kind helpful son I trusted the education system with 10 long and stressful years ago. <'>

Edited October 20, 2005 by julieann

[BusyLizzie100]

I'm really interested in this topic, because my eldest son is going through diagnosis at the moment! So far it's looking like Asperger's, but they seem quite interested in ADHD as well, but it has to be 'pervasive across all environments', so they're going in to observe him at school - and in the playground - as well.

 

We know my son has difficulties, we know he has Asperger's. I did think about ADHD earlier on, but it's the specific AS things that seem to have more impact. But, I'm getting really paranoid that these folk are going to turn round and say 'he doesn't fulfill the criteria for either AS or ADHD'. Awful, isn't it, to be willing a diagnosis on your child. I just know that having a diagnosis is the only way he's going to get any support, because it's all so subtle and he hides it all so well. It doesn't even really matter what label he's given, just so long as we get some insight into how best to support HIM. His teacher is definitely anxious for some input.

 

Well, two more appointments to go and we'll know one way or another. Could be a couple of weeks yet. I'll keep you posted...

 

Lizzie

[Lindyloo]

Wow - this thread has really been an eye opener to me. You could have been talking about Luke here.

 

Luke is nearly 6. He was diagnised with ADHD just over a year ago, and has been taking Equasym since then when necessary to help with the ADHD. It is since he has been on the medication that he has shown more signs of ASD type symptoms. We know that he does have ADHD, as the medication does work to help calm him down and combat the hyperactivity and impulsivness (we have been told that in NT children it would have no effect) However, when the medication does kick in, he still displays problems, more on the ASD side. ALthough several people have said that he 'probably' has Aspergers alog side the ADHD, no one seems willing to go forward with a further diagnosis, something we are finding increasingly frustrating. The consultant has even said that the ADHD is probably the secondary condition, but because it's symptoms are more noticable this takes over most of the time.

 

Like you have all said, I seem to spend all my time analysing all Luke's actions and trying to determine if they are the ADHD or the ASD causing them. It was the fact that some of his behaviour did not fall neatly in to the ADHD spectrum that first lmade me question whether there was more to his problems than just the ADHD.

 

We have definatley noticed that Luke has differant days, some days he is very loud, constantly on the go and completely hyper, where as on other days he seems much more withdrawn. He has real problems with imaginative play. DP spent a great deal of time with him over the summer trying to 'teach' him how to play. He has a very short attention span with most things and gets very easily bored - however, if something does get him really interested, he will concentrate on it for a very long time. Like others have said, he is very affectionate. In fact, one of the biggest problems at school is Luke being too 'touchy feely' with the other children, which most do not like. He is actually doing very well in school - he is very intellegant and very willing to learn. However, he is really struggling in the playground, which is not structured and where he does not seem to understand the social rules.

 

It is so nice to know that we are not alone - and that there are others out there that are still battling with trying to find out exactly what is wrong with their children.

 

I would really like to keep in touch with some of you atht are going through this confusing process, and find out how you are going.

 

Linda

x

[mc31]

Hi all

 

My daughter C is asd with underlying adhd, i first noticed something was up when her behaviour became violent towards herself, when she was unable to do things (ie wooden jigsaw puzzles) herself, would throw the said toy around, screech and then finally would bash at herself or go to nearest wall and bang her head against it. (luckily this has now stopped) what she does now is scratches, or slaps herself, she has limited communication, and this would cause its own problems when she tried to ask for something that she wanted as she didnt have the words (and made up her own) hehe

 

i am now using pecs with her and the frustration factor is dropping per day as she now has a way of asking for stuff. Not only that i can back up what we have to do per day with the pictures, it has made life so much easier, for instance getting dressed in morning was a nightmare, would run around, kick out, scream etc, now show the pic of clothes, she now lays down on floor to have nappy changed and lets me get her dressed!!

[clintess]

all i can go on is my two boys one being what his doc says pure adhd, where he has no behaviuor issues but the lack of concertration,impulses. rushing and hyperactivity along with lack of sleep and my other boy that is adhd /asd that has all the above then all the other stuff off asd such as meltdowns continuos and lack of danger, hand flapping, speech probs,plays alone,learning difficulties, obessions etc.

hope that helps

[Brook]

Liz,

 

I thought for a minute you were writing about MY son in your post.

I could relate to everything you said.

 

My son was dx ASD by paediatrician, then five months later he was also dx

mild to moderate ADHD by CAMHS.

 

He also has a receptive language delay of two and a half years but, can talk

for hours on end without stopping for breath.

 

One minute he can be quite calm and responsive, the next he is doing headstands

on the settee and screaming and shouting at the TV and is moving constantly.

Then on the other hand, he will sit on the computer or watch a dvd, but I find

in the less structured times he does get quite hyper.

 

Brook

[LizK]

Thanks for all the replies and sorry for not posting this sooner. I've read them all with great interest and can identify with so many things posted. Good to know we're not alone. Apologies in advance for the long group response but if I don't do it know I won't do it at all

 

Strange girl Not confused think I understand what you mean about the diagnostic criteria

 

 

smileymab My son does that too when I ask him to do something, easily dsitracted and ends up doing somethign completely different. Not sure how much of it is due to poor concentration or receptive and processing of language problems. This is the confusion I've got as to how much of his 'adhd-like symptoms' are due to a primary concentration problem and how much are secondary to ASD or external factors

 

 

MotherEve The paed we saw said something similar, same part of the brain is affected hence the link and then mentioned DAMP as another possible diagnosis !

 

julieann Glad you son is doing well . Adam has actually calmed down somewhat since I posted, no idea why, it's like the storm in his brain has gone. He's more 'autistic' now but I can cope with that better. Wish he could get the balance as a bit of ADHD-ness is beneficial for him but life isn't a recipe is it!

 

BusyLizzie100

  Awful, isn't it, to be willing a diagnosis on your child. I just know that having a diagnosis is the only way he's going to get any support,

 

I can really relate to that. My worry is that because some of his adhd-type behaviour counterbalances his ASD behaviour he won't get a diagnosis of either but some vague label of having ASD or ADHD traits and think certainly once he enters school he'll likely get more help if he's got a diagnosis. At the moment it's academic as we are getting more or less maximal support. Hope things are progressing well for you and your son

 

Lindyloo and Brook I've been able to relate so much to hearing others expereinces which has been very useful. The first thing everyone comments about Adam with surprise is that he's so variable in mood and behaviour and from reading others experiences sounds like it's somethign other parents find at least.

 

mc31 Glad you are finding a way to deal with this. Don't think frustration helps my son either

 

clintess Your second son sounds like mine!

 

Liz x

[Noetic]

For me they kind of balance each other out, but they also make each other worse in some ways. For example, auditory and visual processing problems make it harder to pay attention, but they have also made me more cautious so rather than act 'wrong' or not listening at all.

 

My lack of understanding means I often observe for a long time before acting. So as a result, I am less likely to do the wrong thing or stand out by doing embarrassing, rude or 'naughty' things.

 

I think a lot of what acts like ADD problems for me is a sensory integration problem - my senses have a life of their own! But at the same time, my attention does seem to be 'unusual', insofar as I have little control over it.

 

From the ASD side of things I am more of a passive type, but the ADD/ADHD aspect seems to push me out of total isolation in times where I am not overloaded, which I think is a good thing. On the other hand, the ASD need for organisation and sameness gets rubbed the wrong way by the ADHD aspects sometimes