Challenges of Comorbid ADHD and ASD

Attention deficit hyperactivity disorder (ADHD) and autistic spectrum disorder (ASD) are neurodevelopmental disorders that have increased in the number of diagnoses over the last few years. The conditions are specific and individual, but also frequently co-occur. Prior to 2013, diagnoses of concurrent ADHD and ASD were not allowed because the Diagnostic and Statistical Manual of Mental Disorders Version IV (DSM-IV) considered a diagnosis of autism as an exclusion element for ADHD. With the release of the DSM-V, which acknowledges the comorbidity of the two disorders, clinicians are able to look for symptoms of these conditions occurring together.

Challenges of Comorbid ADHD and ASD

What Is ASD?

Autism is a neurobiological developmental disorder that causes repetitive behavior patterns, sensory problems, and deficits in social interactions. When the DSM-V was released in 2013, the characteristics of autism spectrum disorder were expanded to include autism, childhood disintegrative disorder, Asperger’s syndrome, and other mental disorders falling under the “not otherwise specified” category. An official diagnosis of ASD includes significant deficits in the following:

  • Ability to engage in social-emotional reciprocity, including initiating or maintaining a conversation
  • Nonverbal behaviors, including eye contact, gestures, body language, and facial expressions
  • Understanding, developing and maintaining relationships

In addition, two of the following behaviors must be displayed for an ASD diagnosis:

  • Repetitive physical movements, speech, or use of objects
  • Insistence on routines, order, and repetition
  • Highly intense, fixated focus on restricted areas of interest
  • Hyper-reactivity or lack of sensitivity to stimuli

What Is ADHD?

ADHD is generally characterized by an inability to pay attention or keep still, but there are more specific traits that exist with an ADHD diagnosis.

  • Distractibility
  • Tendency to abandon tasks or jump frequently from one task to the next
  • Difficulty maintaining focus or concentration on a single task
  • Incessant talking
  • Difficulty sitting still
  • Tendency to interrupt
  • Hyperactivity
  • Lack of concern or reaction to others’ feelings

Autistic Children with ADHD

Autism comes with a wide range of co-occurring conditions, but ADHD is one of the most common. Studies suggest that 37% to 85% of autistic children present concurrent symptoms of ADHD. The converse is also true, with an estimated 14% of children with ADHD also diagnosed with ASD. When both conditions are present, the symptoms of each are magnified. Children with these comorbid conditions commonly display symptoms such as:

  • Intense focus on things of interest
  • Impulsivity
  • Trouble settling down
  • Social awkwardness

Support for Individuals with ADHD and ASD

Managing ADHD symptoms can also help in managing ASD symptoms. The behavioral support recommended for addressing ADHD symptoms is effective in treating the symptoms of autism. Behavioral therapy is seen as the primary level of treatment for children under six. Those over six should combine behavioral therapy with medication. Clinicians will likely experiment with different combinations to find the right treatment for each individual, as ASD and ADHD tend to combine and present differently in each case.

While ASD and ADHD are lifelong conditions, management of symptoms is possible with the proper level of support. Accurate and early diagnosis is important to enabling caregivers to try a variety of treatment options to find the most effective. Visit WPS for more information about diagnostic options for ADHD and ASD.