ADHD and ASD are two different disorders, but at the same time they can often occur together in some cases (comorbidity). In this article, cognitive rehabilitation specialist and educational psychologist Samuel Rodriguez explains the differences between ADHD and ASD, how these disorders are related, their symptoms and how they can be treated.
What do we mean by ADHD and ASD?
Both ADHD (Attention Deficit Disorder with/without Hyperactivity) and ASD (Autism Spectrum Disorder) are conceptualized by the DSM (Diagnostic and Statistical Manual of Mental Disorders) as neurodevelopmental disorders.
In the case of ADHD we are dealing with a behavioral disorder characterized by excessive activity, impulsivity and difficulty concentrating.
On the other hand, ASD is a developmental disorder that affects communication, social interaction and behavior.
Although they are different disorders, they can occur together in some cases (comorbidity) and affect the development and quality of life of the people who suffer from them.
How are these disorders diagnosed?
Both ADHD and ASD are disorders that are diagnosed through observation of the person’s symptoms and behavior.
In the case of ADHD, questionnaires and neuropsychological tests are used to assess activity, impulsivity and attention span.
In the case of ASD, specific tests are used to assess communication, social interaction and repetitive behavior.
It is important that the diagnosis is made by a trained health professional because he/she should always assess the boundaries (differential diagnosis) between these disorders or the coexistence between them (comorbid diagnosis).
The high rates of coexistence between both disorders lead us to think that if we limit the diagnosis only to ADHD, for example, there is a high probability that we will overlook other problems, sometimes as or even more important than ADHD itself.
On the other hand, if we only pay attention to the most serious psychiatric disorder (e.g., ASD) and understand the ADHD symptomatology as something else that illustrates the disorder, again we may incur in a diagnostic error or a misdirection of the treatment and/or the information given to families, teachers….
Where to start?
The diagnosis between ASD and ADHD seems complicated, but it will serve to establish a starting point, a way to approach what is happening and see where to start working.
On the one hand, we could think of it as follows:
In borderline cases between ADHD and ASD (in which there are serious difficulties in guiding the intervention and the information given to families), as long as he/she does not meet the full criteria of the most severe disorder (in this case ASD) it will be preferable to stay with the diagnosis of ADHD (highlighting the ‘autistic’ symptoms) and to bear in mind in the neuropsychopedagogical intervention all aspects related to social skills.
On the other hand, we could also approach the question from the existence of both diagnostic conditions in the same subject (comorbidity). This could allow us to rationalize the treatment, for example at the medical level, recommending methylphenidate to a child with the diagnosis of autism, if he/she presents the typical manifestations of ADHD.
What are the common symptoms of ADHD and ASD?
As mentioned above (although there are some similarities between the symptoms of ADHD and ASD), there are differences between ADHD and ASD. Both require a specific treatment approach separate from the more nuclear.
While in ADHD the target elements would be around behavioral self-regulation, attentional maintenance and focus, in the case of the ASD population, the issue of communication and rapport will be preliminary.
In some comorbid ASD/ADHD cases, pragmatic language and cognitive flexibility impairment may also be observed, so a treatment focused on improving executive functioning would be appropriate in both cases.
If we reflect on the different neuropsychological functions and the special involvement of the executive system in the cognitive structures of ADHD, the proximity and overlap that may exist with other neurodevelopmental disorders becomes evident (this makes detection difficult).
If we contemplate globally the various functions attributed to the frontal lobe, we will observe interpretations for various symptoms, not only of ADHD, but also of ASD and other developmental disorders also linked to these regions.
This undoubtedly leads us to diagnostic complexity and the presence of comorbidity.
ADHD is determined by the interdependent conjunction of various executive dysfunctions, the result of which explains the symptoms of the disorder.
However, these functions are by no means exclusive to ADHD, as they may also be present in ASD and other neurodevelopmental disorders.
How are these disorders treated?
Treatment for ADHD and ASD varies according to the individual needs of each person. For ADHD, stimulant medications and behavioral therapy may be effective.
For autism, behavioral and occupational therapy, as well as medications to treat specific symptoms, may also be helpful.
While ADHD may present problems in areas of inhibition and working memory, children with ASD may in turn show greater cognitive rigidity and planning difficulties, at which point executive function work is possible and recommended.
Lezak defines executive functions as the cognitive abilities essential for effective, creative and socially accepted behavior.
Research in recent years (not only in ASD, but also in other disorders such as ADHD) has been aimed primarily at assessing those capabilities that supposedly make up executive functioning. Among them, the following stand out: Planning, Flexibility, Working Memory, Monitoring, Inhibition.
Neuropsychopedagogical intervention of executive functioning in ASD and ADHD
We define Neuropsychopedagogical intervention as the interdisciplinary exercise/work with information processing and the modularity of the mind in terms of: Cognitive Neuroscience, Psychology, Pedagogy and Education. It is carried out by the professional with multi-interdisciplinary training and for re-educational and/or educational purposes.
Executive functions are mediated by the frontal lobe, any anomaly/circumstance in neurodevelopment that may be associated with frontality (such as ADHD or ASD) and that involves this area, will surely be associated with executive dysfunction.
Thus, we see how executive dysfunction can appear both in attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD), among others. ADHD and ASD (always according to individual needs and casuistry) can benefit from neuropsychopedagogical intervention work focused on the development of executive function competence.
Individuals with ASD may present frontality giving a clinical presentation with a type of behavioral functioning characterized by inflexibility, difficulty in decision making, difficulties in planning and organization, difficulty in inhibiting erroneous responses and limited ability to solve conflicts.
In such a scenario, executive treatment will undoubtedly be a necessity. Similarly, the dis-executive casuistry in ADHD, referred to in terms of planning, working memory, impulse control, inhibition, initiation and follow-up of tasks or actions, also appear to be core executive elements in the intervention with the person with ADHD.
We have reviewed similarities and differences between ADHD and ASD, diagnosis, comorbidity, symptomatic constellation, behavioral neuroanatomy, executive functioning… and finally we can conclude that people with ASD/ADHD (always according to their individual conditions/needs) can benefit from a neuropsychopedagogical treatment focused on the improvement of executive functions.