Autism, Aspergers and ADHD/ADD
ByThis 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.
My son was diagnosed with PDDNOS and also ADD. I have often wondered if many kids who are diagnosed with ADD actually have PDDNOS. I’m also wondering if anyone has studied if early childhood bi-polar is not also closely related to PDDNOS. Just wondering
Hi CJ,
You are writing a very complicated question. A very good one too.
When it comes to kids with ADD having an autistic spectrum disorder – the numbers aren’t that high. About 5-7% of school aged kids have ADD/ADHD, and I am not aware that a higher percentage of the ADD/ADHD kids have PDD/ASD compared to non ADD kids.
The main difference is that the ASD/PDD kids have significant social skills difficulties. Even though kids with ADD struggle socially, in ASD/PDD, it is different. It is a lack of desire for social interactions, or an inability. Whereas kids with ADD/ADHD often struggle socially because they want to be the ‘boss’ of the games, or create their own rules, or can’t listen to the other kids to play along appropriately.
When it comes to bipolar – this is also a very tricky one. Childhood bipolar is very complicated. It is different than PDD NOS and Asperger’s. Of course a very small percentage of kids may have both – and these children can be very hard to diagnose and treat.
I hope this helps.
Dr. Kenny
My now 10 y/o son was diagnosed at the age of 4 by our school district with “Autistic Tendancies”. He received fine/gross motor skills therapy for 1 year. Then at the age of 7 he was diagnosed by a professional with ADD with inattention. I have ALWAYS felt he was mis-diagnosed with ADD and showed many signs for Asperger Syndrom. I was hoping you could tell me what the difference is between the two disorders, so I can be certain he was correctly diagnosed. And if there was an online test you could direct me to to figure this out. Thank you for your help. Sincerely Mrs K Franzese
Question – has anyone looked into Brain Balance Achievement Centers – I attended one of their seminars. It sounded amazing – almost too good to be true. I would love to know if anyone has had any experience with their claims of helping children with ADHD and autism.
My daughter Amaya has “Autism” and sensory issues. My wife and I caught it early and Amaya has come a long way in less than a year’s time. The one thing that we learned, that most of the medical field never mentions, is that most of these children are normal and just have viral and/or fungal issues going on in their brains. These can be treated and your child can live a normal life again. I encourage you to read some of the material on a new website I put together (still in the works): http://www.not-autism.org
I think this information could be very helpful for you. As parents we have to rise up above the current medical system and do what is right for our children as the current system is dismissing our precious children.
Justin Lofton
My oldest son has ADHD (diagnosed in 1984!). My 2nd son was developmentally delayed, then ADHD, then at age 12 both ADHD & autism. His I.Q. is low, but I truly believe his ADHD is much more disabiling than his autism. He has temper outbursts, but that could be either diagnosis. He bonds well w/family members and caregivers. His autistic symptoms have only appeared in situations where he is more excited or stressed. Ex: At Christmas, with a crowd of family, his aunt patted him and he said, “You poked me.” My daughter WAS ADHD until puberty when something chemically changed and she became just ADD and very shy–”social anxiety: avoidance”!
Dr Kenny, what percentage of children do you estimate you see with ADHD who later are actually bipolar? I know that this is a tough area to assess. Once the bipolar is treated, the child may still look like they have ADHD. Do they actually a have ADHD or is it still some part of the bipolar? In complex cases, insightful professionals often look at the symptoms and what needs to be treated, rather than get caught up with the diagnosis itself. All these conditions are very complicated, especially when they are comorbid with each other. Thanks.
Danette,
The issue of the overlap between ADHD and Bipolar in kids merits more space than I have in the comments here…
One of the best resources for childhood bipolar is here: http://www.bpkids.org/
Hi my son is two and has been diagnosed with P.D.D-NOS. He is having ADHD symptoms and is getting treated for that. Now with that said. He goes to school in August and the teachers at the IEP meeting was trying to say that there is no way he has P.D.D-NOS.
They was going on his social, playing with toys right, so on and so forth. But if they seen my child a year ago, they would have a different answer.
He has been in therapy (Speech,OT,and An Early Interventionist) for over a year now.
They have really done wonders with my son.
So I personally think school systems are trying to be physicians instead of teachers.