Although separate disorders, the two overlap and can occur at the same time
By Deborah Jeanne Sergeant
By the time children reach school age, most parents realize if their children have a neurodevelopmental disorder such as ADHD or autism spectrum disorder.
But in children who have both of them, the overlapping and at times contradictory symptoms can make diagnosing confusing, as well as developing coping strategies and educational assistance.
“There’s a high correlation, up to 80% in some studies for having both autism and ADHD,” said Suzannah Iadarola, URMC faculty in developmental and behavioral pediatrics.
Because autism is a spectrum disorder, some children are affected so mildly that their traits may be chalked up to individual quirks or the effects of ADHD.
“These go together quite often, but it’s important to know that ADHD symptoms should be assessed separately from autism,” Iadarola said. “Inattention, impulsivity and hyperactivity are classic of ADHD. In autistic kids, it’s valid. There’s also overlap with sensory sensitivity, hyperfocus, executive function disorder and social awkwardness. Repetitive movement, repetitive speech and sleep problems may be more pronounced with autism.”
Some of the traits of each disorder can counteract each other, such as feeling easily overwhelmed (autism) while hyperactivity prevents the calming effect of slowing down (ADHD). They may crave adhering to a strict routine (autism) but feel immobilized on beginning a task (ADHD).
Iadarola said medications for ADHD can help address those symptoms, but she believes that behavior supports should come first.
“I’d think about strategies to support executive function like breaking tasks into small steps; building reminders; offering verbal and written directions; making schedules that help the child understand what’s expected and what time; connecting them with supports for emotional regulation skills; and providing social supports,” she said. “Kids might have interest in social interactions and making friends, but they might not know what to do and might have explicit teaching and support to participate in meaningful friendships and social interactions.”
Helping parents, teachers and eventually employers understand why people with autism and ADHD act the way they do can create more understanding and extend some much-needed grace in stressful circumstances.
“The person is trying to be rude, oppositional or annoying, but their behavior is stemming from brain-based difficulties,” Iadarola said. “They’re not always doing things on purpose. That’s not always the case.”
Schools can provide guidance as to support and tools to help. In the workplace, employers must accommodate identified disabilities as long as doing so will not interfere with the performance of the role’s essential tasks.
“Inclusion is always the goal,” Iadarola said. “We want them to be successful in inclusive community settings. Some kids might prefer to hang out with other autistic kids. We don’t need to tell kids that’s wrong. It’s more about not limiting kids but setting expectations that they should be able to be in any community settings they want to. We need to be pushing them and challenging the social context or community organization to support and welcome them. It’s society’s job to create an inclusive environment.”
She encourages parents of a child with ADHD and autism to seek out other parents in similar circumstances to learn about how to navigate the challenges their children present and help them feel like others understand their struggles.