Autism Spectrum Disorder (ASD) and Attention-Deficit/Hyperactivity Disorder (AD/HD) are two common neurodevelopmental disorders. Recent statistics from the CDC’s Autism and Developmental Disabilities Monitoring Network found that 1 in 54 children are diagnosed with ASD. The CDC also found that 11% of children have a diagnosis of AD/HD. Parents, educators, and clinicians are faced with the challenge of determining which diagnosis, or possibly both, are most appropriate for a child given the symptom similarities in attention and focus, social functioning, speech delays, heightened sensory response, defiant behavior, emotion dysregulation, and challenges with planning and inhibiting behavior. This article will highlight symptoms common among both disorders explain differences in their presentation.
- Inattention –Children with AD/HD often have an impaired short-memory and become easily distracted, which is most prominent when the child is bored and uninterested. Children with ASD may appear uninterested in what is happening in their environment, lack an understanding of instruction or communication, and demonstrate repetitive behaviors that preclude them from sustaining attention.
- Hyperactivity – Children with AD/HD generally lack impulse control and often pursue their ideas or interests without thinking through their actions or its consequences, which can manifest as fidgeting, running around, and getting out their seat. The frequent movement associated with ASD reflects a release of tension from built-up stress, which may manifest as fidgeting, rocking, and tics.
- Focus – Children with AD/HD often display hyper-focus, a fixation on a preferred interest, such as video games, and have difficulty moving their attention away from that interest. Individuals may experience them as easily distracted outside of those times. Children with ASD often display over-focus, meaning they are fixated on a limited amount interests and demonstrate inflexibility and a low frustration tolerance when presented with other activities.
- Communication – Both children with ASD and AD/HD have challenges in social conversations because they can fixate on a topic of conversation (talking about their interests) and miss social cues. Speaking-over peers, interrupting, struggling with reciprocal conversation, and making off-subject comments are common among both disorders. Children with AD/HD may talk continually and want the last word, but do not notice how their words affect others. Children with ASD may not initiate or respond to social interactions, lack social gestures, and demonstrate poor eye contact.
- Transitions – Parents of children with AD/HD often find that their child has difficulty stopping one activity to transition to another. Children with AD/HD are motivated by what is rewarding to them, so transitioning from video games to homework may be met with resistance. There can also be a time of unstructured chaos at transitions for children with AD/HD. For example, if a child puts on their shoes but there is a waiting period before they leave the house, they may become impulsive during that waiting time. Children with ASD have a need for routine and predictability; therefore, deviations from routine can feel confusing and overwhelming due to challenges with cognitive flexibility.
- Routine and Structure – Children with AD/HD need variety in their lives and often resist structure. Children with ASD adhere to routines and insist one sameness. Therefore, children with AD/HD become upset when rules are imposed while children with ASD become upset when routines are changed.
Behavior management strategies at home for AD/HD and ASD are similar. Parenting principles such as creating routine and organization, limiting choices and options, managing distractions, communicating clearly and specifically, chunking instructions, and using goals and rewards can significantly improve social interactions and behaviors when consistently implemented. The following resources may be beneficial for families: