This article is to serve as a review of the diagnoses of Autism, Asperger’s and PDD NOS. You can refer to other articles as to how these relate to ADD/ADHD here: Autism, Aspergers and ADD/ADHD, ADHD Medication and Autism/ Asperger’s.

The Autistic Spectrum includes two major disorders; Autism and Asperger’s disorder and a third one called Pervasive Developmental Disorder Not Otherwise Specified (or PDD NOS).

The main characteristics of the Autistic Spectrum are individuals: 1) who have trouble relating to other people, there are social difficulties, 2) there are behavioral difficulties, things like ritualized behavior and obsessive types of behavior and 3) there is trouble with speech and communication.

Now if someone has all three major categories they would have the diagnosis of Autism. If they have the social issues and the behavioral issues but no trouble with speech or communication they would have Asperger’s disorder. And if they had enough criteria that the doctor is concerned about the pervasive developmental disorders but not enough to meet one of the diagnoses they would have PDD not otherwise specified.

It’s also very important to note that individuals with PDD or autism have a very wide range in functioning. There are some individuals with autism who are developmentally delayed; they can be adolescents or adults and have trouble with toilet training and communication; may only speak three or five words or none and there are individuals with high functioning autism or Asperger’s who go on to get University education, they are professionals, they are “successful” in society and they have families. So there is a very wide range in functioning.

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This article about Autism and ADHD stems from the following question from a subscriber: ‘My son is diagnosed with PDD Autism - we have put him on Ritalin for behaviors and hyperactivity. Our family doctor feels that since the Ritalin has helped that he must also be ADHD. Could that be correct?’

As I wrote about in a previous article: Autism, Aspergers and ADHD, yes it could be correct that a child can have Autism and ADHD. In fact there is about a 50 to 60% chance of kids with autism having an ADHD diagnosis.

I do want to caution you about this kind of logic. I don’t like making a diagnosis because a medicine worked.

In other words just because Ritalin settled down some of the behavioral problems that your son was experiencing doesn’t necessarily mean that for sure your son has ADHD.

If you are concerned about the possibility of ADHD, go to a clinician who can do a thorough assessment, such as a paediatrician, psychiatrist, or psychologist. Have a thorough assessment done and see what the results are.

The medication treatments in child psychiatry are symptom specific not disease specific. This means that the medications treat symptoms, not disorders.

So if he had some hyperactivity related to Autism that may be settled by the Ritalin as Ritalin and other stimulants (like Adderall, Concerta, Metadate, Focalin, Daytrana, etc) have a clear history of helping hyperactivity and inattention in ADHD.

However, based on my experience as a Child Psychiatrist, I think it is possibe if the Ritalin is working then there may actually be a diagnosis of ADHD. However, the best practice of medicine would be to go and get a thorough assessment. This is the proper way, rather than just saying: ‘well the pill worked so it must be so’.

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This article comes from a subscriber’s question about ADHD and Autism.

The question is: “what is the prevalence rate of ADHD when the child has been diagnosed with Autism?”

This is a very good question. In fact this is a question that led me to do a lot of homework. I pulled out the textbooks, I pulled out notebooks from conferences I’ve been to. I pulled out journals, I searched online etc. and I finally have an answer for you. It was a very smart question.

First of all I need to go back to the DSM which as you will recall is the Diagnostic and Statistic Manual of the American Psychiatric Association that has the diagnostic criteria for the psychiatric disorders.

In the diagnostic criteria for ADHD which is covered in a previous article, there are exclusionary criteria.

Criterion E is ‘the symptoms do not occur exclusively during the course of a pervasive developmental disorder, schizophrenia or other psychotic disorder etc.”

Now for those of you who are not aware a Pervasive Developmental Disorder (PDD) is another term for autism or another disorder on the autistic spectrum (such as Asperger’s Disorder).

Thus, by strict interpretation of the DSM-IV-TR criteria, when someone has a diagnosis of Autism or a Pervasive Developmental Disorder, then they technically shouldn’t be diagnosed with ADHD.

Coming back to the question: ‘what’s the prevalence rate of ADHD when the child has been diagnosed with autism?’

According to the DSM-IV-TR, it is zero, because it is not possible.

Now the reason why I spent so much time looking for the answer is because I see it in my office a lot; kids who have Autistic Spectrum Disorders (another term for PDD, Autism or Asperger’s) and seem to have ADHD type symptoms and benefit from ADHD treatments.

I was able to find somewhat of an answer in an article published by Goldstein and Schwayback in the Journal of Autism and Developmental Disorders published in June 2005.

In that article they looked at 57 kids with an Autistic Spectrum Disorder and they reviewed all of the data available in what was called a retrospective chart review - that’s looking back at children that had already been assessed. They found that they had sufficient data in 27 children to see whether they actually had ADHD symptoms to the level that they could meet a diagnosis for ADHD. Of the 27, 7 of them or 26 % met enough criteria to reach a diagnosis of ADHD combined type. Nine of them or 33% had enough criteria to meet the ADHD inattentive type and 11 of them or 41% didn’t have any ADHD type symptoms.
In this very small sample, what I would call a preliminary study, about 26% of these Autistic kids had ADHD combined type and 33% had ADHD inattentive type; 41% didn’t have ADHD at all.

Now as I said this is a very preliminary study and it’s not conclusive at all and certainly a lot more needs to be done.

I will tell you that in my clinical practice I do see kids with Autistic Spectrum Disorders who do have symptoms of ADHD, or meet the full diagnostic criteria.

Perhaps I should have prefaced this article with the fact that I can’t do a comprehensive review of Autism in this article. Frankly, a whole blog can be written about autism because of its complexity and the struggles that families have in dealing with children (and teens and adults) with Autism. For an overview, please visit this article on Autism and Asperger’s.

So coming back to our question I guess we can say that according to a preliminary study 26% of kids with autism had ADHD combined type and 33% had ADHD inattentive type suggesting about 50 to 60 percent of kids with autistic spectrum may have ADHD. As I say take this with a big grain of salt because it’s a preliminary study.

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A subscriber sent in this question: “when I was a child I was diagnosed with ADD. Although I was never on medication I didn’t actively seek much help. I’m beginning to realize that perhaps now at age 26 it is related to my depression and anxiety issues as well as motivation. I’m still struggling to get through a degree and not quite sure where to turn. I think I should go see someone about this but I’m not sure who the best person to turn to is”.

This question is a very important one. This is an adult who is describing having been diagnosed with ADD early in life and now has depression and anxiety issues. It sounds as if the depression and anxiety are the main concern - however, let’s remember that this person sent his/her question in to The ADHD Doctor! So, obviously there is some concern there about the impact of the ADD or ADHD as well.

This question is very important along the lines of comorbidity of ADD and ADHD, particularly in adults.

I’m going to assume that the individual who diagnosed the ADD early on was accurate, and that a thorough and complete assessment was done.

Is ADD still a problem for this individual?

I don’t have a lot of information to go on, but it seems that it likely still is. He or she is struggling with motivation, and completion of a degree. That said, this could be completely related to the depression and anxiety that is going on.

It would be important for this person to have a thorough assessment with a psychiatrist with expertise in adult ADD or ADHD. The problem is that they can be hard to find. Also, often it is the child psychiatrist who are better at ADD or ADHD. All child psychiatrists train in adult psychiatry first, and we learn about ADD and ADHD, and how it can change through the course of the lifespan.

Comorbidity in adult ADD is very common. Only 14% of adults with ADD don’t have a second disorder. In other words, comorbidity is the rule, not the exception.

It is very common for an adult with ADD or ADHD to have comorbidity with depression and anxiety.

Sometimes, it is minor depression or anxiety - somewhat of a self esteem issue. This can relate to all of the years of people saying:
“you would do better if you would only live up to your potential, or try harder or keep more organized, I know you can do better etc.”

Eventually a person with ADD can start to feel, “well I must be that kind of loser that everybody’s talking about.”

Then, depression and anxiety can develop.

Coming back to the specific question, the main issue for this person is figuring out if the depression and anxiety are the main problem, or whether the ADD is still active and is the main problem.

If the depression and anxiety are the main problem (or the dominant problem, even if ADD is still there), then they have to be treated first, with therapy plus or minus medication. After these are more stable, it would be important to review if ADD is still there and if it needs treatment.

If the ADD is the main problem, then it will need treatment - with therapy, coaching, plus or minus medication. If the ADD improves, most likely minor depression and anxiety would improve as well.

It can be very complicated for adults with ADD or ADHD, because there aren’t that many doctors who are comfortable and competent in adult ADD.

Start with your primary care doctor (family doctor), ask questions, and seek referrals until you have the answers you need. Also, consider a psychologist who may be able to help with the diagnosis and therapy, though he or she couldn’t prescribe the medication.

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I am pleased to announce that I have been asked to be the guest on a Talk Radio Show called:
ADHD: The Good News, with Laurie Walsh.

This show will be recorded live on CKTB 610 AM St. Catharines, Ontario. That means that if you live in the Niagara Region (Canada or the US), or as far east as the Greater Toronto Area, you will be able to hear the show live, and call in with questions, if you like.

If you don’t live near the radio signal: you can listen online! Just visit: CKTB, and click on the ‘Listen Now’ Button on the top left. I would guess that you could call in as well, even if you are from Europe, Australia, etc - you would just have to pay the long distance charges.

The show will then be rebroadcast in many Canadian Cities - and I am including the schedule below.

ADHD: The Good News will cover all areas of ADD/ADHD, over 4 shows. We will talk about:

• What Attention Deficit Hyperactivity Disorder/ Attention Deficit Disorder actually is
• How to get help from your doctor
• How to help your child at school
• Parenting strategies that work,
• Medications for ADD/ADHD - are they safe? Do you need them? and how do they work?
• And a whole lot more…

What you’ll hear on each show is:

Show 1: What is ADHD, and how do you get started?
Show 2: Common Myths about ADHD and the Facts
Show 3: ADHD and the Teenager
Show 4: Spring 07- End of School and Planning for the Summer
Show 4b: Summer 07: Back to school with ADHD

The show will initially air on CKTB St. Catharines, and here is the schedule.

It will be on at 12:00-1:00 pm Eastern Time on Saturdays:

1. Saturday May 26, 2007- Show #1
2. Saturday, June 2, 2007 -Show #2
3. Saturday, June 9, 2007 - Show #3
4. Saturday, June 16, 2007 - Show #4.1
5. Saturday, August 25,. 2007 - Show #4.2

Rebroadcast all over Canada:
‘ADHD The Good News’ will then be rebroadcast in the following cities, at these times:

Hamilton - CHAM - 820 AM

Rebroadcast:
SHOW #1 - Saturday June 2 - 11am - 11:30am
SHOW #2 - Saturday June 9 - 11am - 11:30am
SHOW #3 - Saturday June 16 - 11am - 11:30am
SHOW #4 - Saturday June 23 - 11am - 11:30am

LONDON - CJBK - 1290 AM

Rebroadcast:
SHOW #1 - Sunday June 3 - 8am - 830am
SHOW #2 - Sunday June 10 - 8am - 830am
SHOW #3 - Sunday June 17 - 8am - 830am
SHOW #4 - Sunday June 24 - 8am - 830am

Kitchener- CKGL - 570AM

Rebroadcast:
SHOW #1 - Sunday June 3 - 9:30am - 10am
SHOW #2 - Sunday June 10 - 9:30am - 10am
SHOW #3 - Sunday June 17 - 9:30am - 10am
SHOW #4 - Sunday June 24 - 9:30am - 10am

Kingston - CKLC - 1380 AM

Rebroadcast:
SHOW #1 - Saturday June 2 - 11am - 11:30am
SHOW #2 - Saturday June 9 - 11am - 11:30am
SHOW #3 - Saturday June 16 - 11am - 11:30am
SHOW #4 - Saturday June 23 - 11am - 11:30am

Toronto - CHUM - 1050 AM

Rebroadcast:
SHOW #1 - Sunday June 3 - 1pm - 1:30pm
SHOW #2 - Sunday June 10 - 1pm - 1:30pm
SHOW #3 - Sunday June 17 - 1pm - 1:30pm
SHOW #4 - Sunday June 24 - 1pm - 1:30pm

Ottawa -CIWW - 1310 AM

Rebroadcast:
SHOW #1 - Saturday June 2 - 11:30am - 11am
SHOW #2 - Saturday June 9 - 11:30am - 11am
SHOW #3 - Saturday June 16 - 11:30am - 11am
SHOW #4 - Saturday June 23 - 11:30am - 11am

Windsor - CKLW - 800 AM

Rebroadcast:
SHOW #1 - Sunday June 3 - 7pm - 7:30pm
SHOW #2 - Sunday June 10 - 7pm - 7:30pm
SHOW #3 - Sunday June 17 - 7pm - 7:30pm
SHOW #4 - Sunday June 24 - 7pm - 7:30pm

Thunder Bay - CKPR - 580 AM

Rebroadcast:
SHOW #1 - Sunday June 3 - 6:30pm - 7pm
SHOW #2 - Sunday June 10 - 6:30pm - 7pm
SHOW #3 - Sunday June 17 - 6:30pm - 7pm
SHOW #4 - Sunday June 24 - 6:30pm - 7pm

Sudbury - CIGM - 790 AM

Rebroadcast:
SHOW #1 - Sunday June 3 - 10:30am - 11am
SHOW #2 - Sunday June 10 - 10:30am - 11am
SHOW #3 - Sunday June 17 - 10:30am - 11am
SHOW #4 - Sunday June 24 - 10:30am - 11am

Victoria- CFAX - 1070 AM

Rebroadcast:
SHOW #1 - Sunday June 3 - 5pm - 5:30pm
SHOW #2 - Sunday June 10 - 5pm - 5:30pm
SHOW #3 - Sunday June 17 - 5pm - 5:30pm
SHOW #4 - Sunday June 24 - 5pm - 5:30pm

Vancouver - CISL - 650 AM

Rebroadcast:
SHOW #1 - Monday June 4 - 8pm - 8:30pm
SHOW #1 - Tuesday June 5 - 8pm - 8:30pm
SHOW #2 - Monday June 11 - 8pm - 8:30pm
SHOW #2 - Tuesday June 12 - 8pm - 8:30pm
SHOW #3 - Monday June 18 - 8pm - 8:30pm
SHOW #3 - Tuesday June 19 - 8pm - 8:30pm
SHOW #4 - Monday June 25 - 8pm - 8:30pm
SHOW #4 - Tuesday June 26 - 8pm - 8:30pm

Edmonton - CFCW - 790 AM

Rebroadcast:
SHOW #1 - Sunday June 3 - 430pm - 5pm
SHOW #2 - Sunday June 10 - 430pm - 5pm
SHOW #3 - Sunday June 17 - 430pm - 5pm
SHOW #4 - Sunday June 24 - 430pm - 5pm

Calgary- CKMX - 1060 AM

Rebroadcast:
SHOW #1 - Sunday June 3 - 9am - 9:30am
SHOW #2 - Sunday June 10 - 9am - 9:30am
SHOW #3 - Sunday June 17 - 9am - 9:30am
SHOW #4 - Sunday June 24 - 9am - 9:30am

Halifax- CJNIFM - 95.7FM

Rebroadcast:
SHOW #1 - Sunday June 3 - 9am - 9:30am
SHOW #2 - Sunday June 10 - 9am - 9:30am
SHOW #3 - Sunday June 17 - 9am - 9:30am
SHOW #4 - Sunday June 24 - 9am - 9:30am

Please pass this message on to anyone you know who may want to learn more about ADD or ADHD. We will cover a lot of information over the four shows. People in the Canadian Cities listed above can listen live on their radio stations - and of course, you can listen live online - as decribed above.

I really hope that you enjoy these radio shows. If you do listen to the show - and call in (especially if you are calling from outside of the radio listening area, because you are listening online), please post a comment on this blog, and I will email you with a special thank you for taking the time to participate (and I like to reward people for taking action).

Remember - it all starts this Saturday afternoon - I hope to hear from you!

Dr. Kenny

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This article comes from a subscriber’s question: “are you looking at comorbid conditions such as learning disabilities and Tourette’s that often accompany ADHD?”

To start with, I have reviewed comorbidity and what it means in this article: comorbidity in ADHD.

As a quick review, a comorbid condition is defined as another disorder which is also present when ADHD is there. It causes further morbidity, meaning more difficulties or suffering related to the second disorder.

When someone has ADHD it is very common that they would have a second disorder that affects their functioning. (Or maybe even a third disorder as well…)

Here are some of the common comorbid conditions, and how often they come:

Oppositional defiant disorder occurs in up to 60 percent of kids with ADD or ADHD. This is a behavior disorder characterized by testing limits and disobeying and defying which can be mild or quite severe and interfere with school, home etc. For more information, read this article on Oppositional Defiant Disorder.

Conduct disorder can be up to 25 percent of individuals with ADHD. This is a much more serious behavior disorder where individuals actually test limits to the point that they are crossing the line. These behaviors are severe enough that they would actually be considered criminal behavior. The symptoms include: stealing, setting fires, hurting animals, starting physical fights, bullying others etc.

Mood disorders occur in 20 to 30 percent of individuals with ADD or ADHD; depression much more common. Bipolar disorder is less common but causes a lot of difficulty. A child with bipolar disorder and ADHD can be one of the most difficult children to treat in all of child psychiatry.

Anxiety disorders can be up to 30 percent; that can be Generalized Anxiety Disorder, Separation Anxiety Disorder, Obsessive Compulsive Disorder, Social Anxiety Disorder, etc.

Learning disabilities can occur in 40 percent of people with ADHD or higher. It’s very important to realize that these are separate disorders. The ADHD does not cause the learning disability and the learning disability does not cause the ADHD. So if somebody receives good treatment for their learning disability but still has ADHD there is still interference going on or vice versa if somebody receives good treatment for their ADHD but is not receiving educational help for the learning disability there are still difficulties going on.

A small percentage of kids with ADHD also have Tourette’s (chronic vocal and motor tics) and a small percentage of kids with ADHD would have an autistic spectrum disorder or PDD (pervasive developmental disorder). We’ll cover that in more detail in another article.

So the answer to the question is ‘yes I do look for comorbid conditions such as learning disability and Tourette’s that often accompany ADHD and in fact it’s very important to look for the comorbidity’.

I will say that comorbidity can literally dictate the treatment and outcome for ADHD. By that I mean that simple inattentive ADHD is much easier to treat than ADHD with bipolar disorder for example and the comorbidity can really dictate how things go in the long run.

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