There are many times when parents come to me concerned and confused. They have begun to suspect that their child has autism or ADHD (or both?), and they aren’t sure how to proceed. One parent told me that “as soon as I start to understand my child through the lens of ADHD, I get a glimpse of a behavior that seems more like autism, and then I’m confused again.”

This is common, especially for parents who have begun to suspect that their child has autism, because while ADHD very often occurs without autism, autism occurs most often (between 50% and 70% of the time) alongside ADHD.

Many parents come to me asking for a clear distinction between ADHD and Autism, and some clarity about how to diagnose and treat a child who might have both.

Many of the students I work with have attention challenges. Some have suspected autism. Some have both.

Differences Between Autism and ADHD

What does ADHD look like?

Julia* is a 12-year-old middle school student who has always had a hard time sitting still in class. However, because she is very bright, works hard, and displays no behavioral challenges within the classroom, the teachers have never reported concerns.

Now in 7th grade, however, all of this has changed. She is finding it increasingly difficult to sit still and reports feeling ever more distracted. She misses much of what teachers say because she is lost in her own thoughts and daydreaming.

Over time, Julia has become more and more frustrated, even angry. Her grades are in decline and she is no longer willing to do her homework, even when her mother tries to help her.

She is down on herself, refers to herself as ‘stupid,’ and is spending less time with her friends.

In short, her ADHD is having a generalized impact and affecting all critical aspects of her life; school, socially and her home life, where there is more arguing occurring than ever before.

WHAT IS ADHD?

Attention-deficit/hyperactivity disorder (ADHD) is defined as an ongoing pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development.

Key features include:

Inattention: Difficulty staying on task, sustaining focus, not becoming distracted, becoming easily ‘bored,’ etc.
Hyperactivity: The need to move about constantly, including in situations when it is not appropriate, or excessively fidgetiness/restlessness.
Impulsivity: When an individual acts without thinking or has difficulty with self-control. May include the desire for immediate rewards or the inability to delay gratification.
Some people with ADHD mainly have symptoms of inattention. Others mostly have symptoms of hyperactivity-impulsivity. Some people have both types of symptoms.

What Does Autism Look Like?

Mark* is a 10-year old boy who is having a hard time making friends and controlling his emotions.

Mark has trouble understanding others’ point of view and being flexible to their preferences in the moment. He wants friends but is being rejected to the point of being bullied.

As a result, Mark has become more depressed. He spends most of his time on his laptop because he feels so “out of place” around kids his age. He worries he’ll never connect meaningfully with others, despite more than anything wanting to

More broadly, when things fail to go as hopes, wants or expects, Mark has a hard time accepting it, adapting, adjusting and, instead, is prone to to behavioral meltdowns. He then needs a lot of time before finally calming down.

His parents feel they are always “walking on eggshells.” And, though they try their best to make things as structured and predictable as they can for him, this is not always possible.

The parents are thus also dealing with their own emotions and feel guilty that they could be doing more.

WHAT IS AUTISM?

Autism, or Autism Spectrum Disorder (ASD), refers to a broad range of conditions characterized by challenges with social skills, repetitive behaviors, speech and nonverbal communication. It is a neurological and developmental disorder that affects how people interact with others, communicate, learn, and behave.

Sometimes the individual misreads facial cues. They may not understand humor. They may also fail to appreciate that others are making fun of them. They struggle to be self-reflective during social situations or to take others’ perspectives.

At the core of autism is rigidity and difficulty being flexible in real time. Being able to pivot and adjust in social situations is very hard. The same is true when dealing with instances where things feel unpredictable, unexpected or uncomfortable.

How Common Is the Overlap Between Autism and ADHD?

For many parents, this differentiation can be confusing.

They wonder: Does my child have one? The other? Could it be both? Is that even possible?

All they know is that something “isn’t working right” and that they “can’t fully make sense of it.

ADHD often exists without Autism. That is, there can be focus issues and/or hyperactivity, but no evidence of autism.
Autism can also occur without ADHD (though this is rare). In fact, for those with ASD, there is a 50-70% overlap or ‘co-morbidity.’

Diagnosing and Managing Co-Occurring Autism and ADHD

As a pediatric clinical neuropsychologist, parents regularly reach out to me in a panic. They are worried about their child, exhausted by their effort to solve their children’s problems on their own, and often deeply concerned about how to help their children feel better about themselves.

Often, these unresolved issues dominate their home life and cause tremendous stress for all family members.

They need answers.

The parents of both Julia and Mark made the decision to have their children undergo a thorough Educational and Neuropsychological assessment. Results in hand, they were far better able to understand how their child thought about things, learned best in school, processed the world around them, and handled adversity.

Diagnostic questions were answered and specific, detailed and individualized recommendations were rendered. Services and interventions were rapidly put in place, in and outside of school.

All of this led to tremendous relief for the parents. When I spoke with them next, they told me they were thrilled to “have their child back.”

More importantly, however, was the feedback I heard from the students themselves.

With treatment working as designed, they no longer felt different, alone, unfairly criticized, and misunderstood. They have regained their confidence and feel more hopeful than ever about the months and years ahead.

To book a testing appointment or to speak further about my services, please feel free to contact me at 973-908-4860 or you can fill out our contact form here. Additional information on our services can be found at www.drkoffman.com.

Can Autism and ADHD Overlap?