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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