ACQUIRED AUTISM IN ADHD
Of late there has been some correspondence about the occurrence of co-morbid Autistic Spectrum Disorder (ASD), and Attention Deficit Hyperactivity Disorder (ADHD). After more than 40 years of treating these populations intensively, I can assert that there is a relationship between ASD and ADHD. In some cases, it is clearly a genetic overlap. However in many cases the "ASD" is acquired. This will be elucidated below.
There is the difference in the evaluation of a child with ASD and the later diagnosis of ADHD in contradistinction to the evaluation of a child with ADHD, and the findings of symptoms of ASD. If one looks one often finds. The ADHD symptoms may not be florid and may not meet the unhelpful criteria of DSM-V but the child with ASD has many signs, symptoms and characteristics of a child with ADHD.
A large number of children with ADHD manifest ASD-like symptoms, but do not really have an Autistic Spectrum Disorder. The additional diagnosis of ASD in these patients is harmful because it's incorrect.
Children with ADHD have a totally different set of brain operations than children without ADHD. They perceive, process, and express differently. The majority of these children are alienated from the popular group of children who coalesce together. What is happening here?
The popular crowd, which of course is a majority of individuals who see things the same way, cognate the same way and express the same way. Children with ADHD just think differently. They tend to have an extremely high speed nonlinear processor. They often blurt out answers before the teacher has completed, asking the question. They cannot explain how they do it. Simultaneously they have difficulty trying to think and learn and respond the way a teacher wants because it makes absolutely no sense to them. This can be observed in preschoolers (which, as a parent and grandparent I have had my share of experience with that population).
Often these children are derided, chastised and marginalized. They have absolutely no idea why this happens. They can be very smart little kids at five or six or seven but they are still very concrete, without insight and self-awareness. They feel defective and do not know why. But by the middle of first grade, they are outsiders. This contributes mightily to low self-esteem, depression, and other psychosocial problems.
Ostrasizem from the crowd dramatically impacts the child's ability to socialize. Besides being teased and taunted and made fun of they are excluded in painful ways. They are not invited to events. They are not picked for teams and clubs. No one wants to partner up with them for projects. Then someone diagnoses them with ASD, which is a useful excuse to many teachers and counselors. They appear to be autistic-ish or Asperger’s-ish. They are not.
This is a sort of acquired anaclitic ASD. Children with ASD have difficulty picking up social cues and developing relationships. Children with ADHD who have been deprived of the opportunity to learn social skills, interpersonal interactions and the like appear to be ASD. Many of them will succeed nonetheless, but will have paid a price along the way. Many others are permanently affected. They are socially awkward and uncomfortable. They misread cues, or are not even aware of them. They expect to be ignored, teased or taunted. These are symptoms and characteristics of ASD but they are not biological. They are acquired.
Beside the intrinsic issues identified above, the problem is magnified exponentially by the anti-ADHD people. There are a series of mistakes made. First is the failure to make the diagnosis, or to deny the diagnosis. Second is the refusal to treat. Third is maltreatment. The vast majority of patients that I have seen who have been diagnosed at some point in their lives and treated in someway have had suboptimal outcomes. If the patient and family are not educated thoroughly about ADHD; if proper, age-appropriate, cognitive, behavioral therapy is not applied; and if prudent psycho-pharmacotherapy is not initiated and monitored closely the results are not great.
Indeed there is an association between ASD and ADHD that has a genetic/biological basis. Yet it is very important to diagnose correctly acquired "autism" in ADHD children and help them properly. Another label does not mean a better outcome.
