ADHD Weekly 2017-07-06

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When your child is coping not only with ADHD but also with Autism Spectrum Disorder (ASD), your decisions regarding treatment and support can be more complicated.

It’s estimated that about two-thirds of people affected by ADHD show some features of ASD; other studies indicated 30-50 percent of those diagnosed with ASD also have co-occurring ADHD. Since 2013, the Diagnostic and Statistical Manual of Mental Disorders-5 has recognized that these two disorders can, and often do, co-occur. Frequently, a person may have a dual diagnosis of ADHD and Asperger’s syndrome, a form of autism, which requires careful coordination for proper treatment.

Edward B. Aull, MD, wrote about these challenges for CHADD’s Attention magazine in Autism, Asperger’s Syndrome, and ADHD. He says choosing medication and other treatment options that meet the needs of both conditions can be difficult at times. Dr. Aull will present the session What Are the Symptoms that Might Change the Diagnosis from ADHD to Asperger’s Syndrome for this year’s Annual International Conference on ADHD.

“Individuals with milder forms of autism spectrum disorders, such as Asperger’s syndrome or PDD-NOS (pervasive developmental disorder—not otherwise specified), are much more likely to be diagnosed with only ADHD or anxiety plus ADHD, than those with more severe forms of autism,” Dr. Aull writes.

ADHD and co-occurring Asperger’s syndrome

Dr. Aull writes that he often sees someone diagnosed as having only ADHD, while the person’s co-occurring anxiety or language difficulties related to ASD are overlooked by professionals. The reason, he says, is the need for a longer and more thorough evaluation to be able to recognize the presence of both conditions. He says, “It is not that the diagnosis of ADHD is incorrect, it’s incomplete.”

Challenges in treatment can come about partly because of the overlap of symptoms, he writes, making it difficult sometimes to know which disorder is the root cause of a symptom. The majority of people with both conditions also have co-occurring anxiety that must be addressed. Some medications for ADHD can aggravate anxiety for those who have co-occurring Asperger’s syndrome.

“Many of the medications used in ADHD can ‘pressure’ [or increase] anxiety and cause patients with Asperger’s syndrome to be less comfortable or even fearful,” Dr. Aull says. “It often requires a doctor with experience in treating autism spectrum disorders to achieve the best outcome in someone with ADHD and autism, although it is not required.”

Individuals with a diagnosis of Asperger’s syndrome and ADHD can have more social difficulties than those with only an ADHD diagnosis, Dr. Aull says. These can include:

• Difficulty joining into groups 
• Often bullied by peers
• Too trusting or gullible, which can lead to further troubles

“Individuals with Asperger’s syndrome are much more likely to say the wrong thing, at the wrong time,” Dr. Aull writes. “This trait is sometimes attributed to ADHD, but it is much more typical of someone with Asperger’s syndrome.”

What you can do to help

“Recognizing that a person doesn’t simply have ADHD, but also has Asperger’s syndrome or another autism spectrum disorder, may lead to better school and occupational results,” Dr. Aull says. “Although the diagnoses are not always easily differentiated, Asperger’s syndrome is important to consider when someone thought to have ADHD is not doing well.”

If your child who is taking medication for ADHD experiences significantly increased anxiety, or if his social difficulties increase unabated by his ADHD medication, you may suspect your child is coping with Asperger’s syndrome in addition to ADHD. If so, discuss your concerns with his doctor and seek a further evaluation from a specialist who can address both conditions.

A specialist can help you design a treatment and support plan to help your child, which may include:

• Social skills training
• Cognitive behavioral therapy
• Parent education and training
• Applied behavioral analysis
• Medication management 

Continue reading Autism, Asperger’s Syndrome, and ADHD by Edward B. Aull, MD, in Attention magazine.

For more information on ADHD and Autism:

• Ask the Expert: The Relationship Between ADHD and Autism Spectrum Disorder
• A Better Understanding of ADHD & Autism
• Asperger’s Syndrome Information

Do you have experience with co-occurring ADHD and Asperger’s syndrome?

ADHD and Asperger’s syndrome co-occur more often than most people realize. Designing a treatment plan that meets the needs of both conditions is important to help a person succeed in life. Keep reading for what you need to know to get started.