What’s the link between ASD & ADHD?


While there are similarities between both conditions, there are fundamental differences between the both of them as well.

Intro

Many individuals are often confused about the relationship between Autism Spectrum Disorder (ASD) and Attention Deficit Hyperactivity Disorder (ADHD). This confusion is understandable due to the homogenous behaviours that are displayed in both disorders. It is not easy for general paediatricians to correctly diagnose ASD or ADHD in young children since more obvious markers are displayed only at a later age. Furthermore, parents might not realise that their own child has difficulties socialising with their peers, making friendships, and regulating their emotions. Children with either one of these diagnoses may be impulsive or aggressive, have a low attention span and trouble building relationships with others. Even though it is difficult to differentiate between the two conditions, their relationship matters.


Similarities

Much of the connection between ASD and ADHD lies in the social and development aspects of both conditions. These disorders seem to be partially caused by genetic factors and both disorders tend to run in families. In fact, both are neuro-developmental disorders in which some form of brain development has been affected. This means that both conditions affect the central nervous system, which is primarily responsible for movement, memory and focusing skills. If long term memories - things learned, done and seen - are impacted, it would most likely also affect the brain’s executive functioning, which is responsible for decision-making, impulse control, and time management. As a result, symptoms such as fidgeting, impulsiveness, being hyper-focused, social awkwardness, and difficulty settling down would be generally present in group settings.


Differences

On the other hand, there are some important markers that distinguish ASD and ADHD from one another despite their similarities. Although both of these disorders are neuro-developmental conditions, ADHD renders it difficult for kids to concentrate, pay attention, sit still, and curb impulsivity, whereas ASD causes challenges with social skills, communication, repetitive behaviours, and thinking. Some obvious symptoms for ADHD would be day-dreaminess, forgetfulness, and being easily distracted. However, this does not imply that individuals with ADHD have difficulties understanding given instructions. Instead, individuals with ADHD will appear as if they were not listening and will have trouble staying on task due to a lack of focus. It would be much better if instructions and tasks were broken down into simpler phrases, such as providing one step at a time which enables them to focus much better. In contrast, individuals with ASD tend to show symptoms such as avoiding eye contact, having delayed or no speech, and exhibiting echolalia (repeating the same phrases over and over again) or an unusual need to stick with routines. Working on eye contact and awareness would be an efficient strategy for individuals with ASD. Some may even require work on speech skills.


Furthermore, when a child with ADHD has tantrums and meltdowns, it is generally due to frustration, impatience, and a lack of self-control. While individuals with ADHD may have the head knowledge of expected behaviours (not to get into a fight or to hit someone) and also how and why they feel angry, they may not have been taught how to restrain themselves. In contrast, children with ASD have meltdowns due to sensory processing issues, frustration, anxiety, or communication difficulties. They need to be taught how to identify their own emotions, communicate effectively, and to regulate their feelings.


Lastly, the level of awareness is different in ADHD and ASD. Children with ADHD may interrupt people during a conversation, say inappropriate things that immediately pop up in their heads due to impulsivity, and struggle to maintain friendships as they may dislike and avoid things they have to concentrate on. They are not aware that these actions may indirectly hurt others.


On the other hand, a child with ASD struggles with social skills, nonverbal cues, and understanding feelings (both other people’s and their own) as they struggle to do things they do not like. For example, Person A is sharing some issues regarding weight control to Person B, who has ADHD. Person B may initially listen for a while and respond appropriately, but then gets distracted, and no longer pays attention to what Person A is saying, and proceeds to label Person A as “fat” and transitions to a different topic. In this scenario, Person B with ADHD is clearly able to communicate appropriately with others, but acted without thinking and may not have understood the consequences of their choice of words. Meanwhile, the main struggle for individuals with ASD in this same scenario would be in making friends, understanding how to relate to other people, and making sense of social cues. Person A may be sharing some issues regarding weight control to Person C who has ASD. However, Person C may not even realise that Person A is talking to them, may not be sure how to respond, and could simply ignore Person A and continue with their current activity.


Next Step/Treatments

The first step any parent or caregiver should take, if they are concerned for their child who may be showing potential symptoms of ASD or ADHD, would be to talk to a doctor. ASD is likely to be more noticeable and can be observed from 18 months onward, whereas ADHD might be observed when a child around the age of a toddler is increasingly exposed to various social settings (preschool, extracurricular activities, events, etc.).


While there is no specific cure for either condition, there are recommended treatments which vary depending on the child, their symptoms, and the presence of other conditions, if any. Several therapies and/or medications can help children with either diagnosis to make progress in the varying areas that are challenging for them.


Behavioural therapy is typically the first line of treatment for younger children. For older children, a doctor might recommend a combination of behavioural therapy and medication (stimulants, non-stimulants, and antidepressants). While behavioural therapy and medication are able to provide beneficial intervention for children with ASD and/or ADHD, the need to improve awareness and acceptance are probably the best resources to enable parents, caregivers and others to better help them. Taking a proactive approach can make a huge difference in one’s attitude and behaviour towards an individual with ASD/ADHD, promoting better acceptance.


With the help of parents, caregivers and better awareness, we can play a bigger part in the process of readying them for life after therapy and medication.


Written by: Hannah Ng




References


Colombi, C., & Ghaziuddin, M. (2017). Neuropsychological Characteristics of Children with Mixed Autism and ADHD. Autism research and treatment, 2017, 5781781. https://doi.org/10.1155/2017/5781781


Rommelse, N., Visser, J. & Hartman, C. Differentiating between ADHD and ASD in childhood: some directions for practitioners. Eur Child Adolesc Psychiatry 27, 679–681 (2018). https://doi.org/10.1007/s00787-018-1165-5


Scandurra, V., Emberti Gialloreti, L., Barbanera, F., Scordo, M. R., Pierini, A., & Canitano, R. (2019). Neurodevelopmental Disorders and Adaptive Functions: A Study of Children With Autism Spectrum Disorders (ASD) and/or Attention Deficit and Hyperactivity Disorder (ADHD). Frontiers in psychiatry, 10, 673. https://doi.org/10.3389/fpsyt.2019.00673

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