Ilse Andrea Carranza Ramírez, a teacher and clinical psychologist specialized in child and adolescent psychotherapy, neuropsychology, and ASD (autism spectrum disorder), provides us with her knowledge about the diagnosis of autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD) in this article.

Autism spectrum disorder (ASD)

Autism spectrum disorder (ASD) is a neurodevelopmental condition that affects individuals from an early age and manifests differently in each person. Characterized by difficulties in social interaction, repetitive behavior patterns, and limited interests, ASD is frequently associated with concurrent medical conditions, according to the definition proposed by the Domus Autism Institute in 2018.

Diagnosing ASD is based on specific criteria, such as those established in the DSM-5. This manual provides a clear and evidence-based guide to identifying the distinctive characteristics of autism, facilitating an appropriate approach to treatment and support. Some of these characteristics include social difficulties, restricted interests and repetitive behaviors, communication problems, and sensory sensitivities.

• Social difficulties: they may have trouble relating to others, interpreting social cues, making friends, or maintaining intimate relationships.
• Restricted interests and repetitive behaviors: they may have restricted interests and repetitive behaviors that provide them with a sense of comfort and security.
• Communication problems: they may struggle to understand nuances of non-verbal language, such as tone, volume, and inflection of voice. They may also have difficulties initiating and maintaining conversations.
• Sensory sensitivities: they may be hypersensitive or hyposensitive to sensory stimuli, such as light, sound, touch, and smell.

Who diagnoses ASD?

This is a question that many parents and adults who consider the need for an evaluation ask. Diagnosing ASD requires the involvement of mental health and developmental professionals with specific experience and training. Typically, the treating physician, such as a pediatrician, is usually the first to detect it.

This professional usually refers the individual to other specialists in healthcare for further assessments. These specialists may include neuropsychologists and clinical psychologists for administering standardized tests, as well as direct observations of the patient.

Additionally, an occupational therapist may be requested to assess the patient’s sensory profile. The multidisciplinary assessment process may also involve collaboration with other autism specialists such as communication therapists and speech-language pathologists. The multidisciplinary and transdisciplinary approach ensures a comprehensive evaluation that provides detailed information not only to confirm or rule out ASD but also to design an intervention plan and understand the specific needs of the patient to ensure optimal care.

How is ASD evaluated?

The evaluation of ASD involves various methods, including the use of tools such as the ADOS-2 (Autism Diagnostic Observation Schedule, Second Edition) and the ADI-R (Autism Diagnostic Interview-Revised), tests to assess the child’s development, as well as complementary tests to estimate the intelligence quotient (either through specific standardized tests or developmental tools that provide this information).

These tests can be administered by psychologists, neuropsychologists, or educators who are certified and trained in their proper implementation and evaluation. Typically, these certifications and training are obtained from specialized centers dedicated to providing this training to these professionals.

This thorough and evidence-based evaluation provides a comprehensive understanding of the individual’s strengths and needs, enabling specific recommendations and strategies to support their development and emotional well-being. Additionally, it helps families and professionals make informed decisions regarding the necessary treatment, education, and support for the individual.

The symptoms of ASD in children are usually detected in the early stages of development. However, some children with seemingly normal functionality may go unnoticed until adolescence or adulthood when social demands increase, and their difficulties become more evident. Therefore, diagnosing ASD in teenagers and adults is also crucial.

Usually, the assessment of these profiles is conducted through comprehensive interviews and using some of the aforementioned tools. Although the evaluation method remains the same, the format and adjustments are adapted to target the adolescent and adult population.

Attention deficit hyperactivity disorder (ADHD)

Attention deficit hyperactivity disorder (ADHD) is a neurobiological developmental disorder that affects a person’s ability to sustain attention, control impulses, and regulate behavior appropriately for their age and environment. It is characterized by symptoms of inattention, hyperactivity, and impulsivity. Individuals with ADHD can also be very restless, talkative, act without thinking, or have difficulty waiting for their turn.

These symptoms may manifest differently in each individual and can be detected in childhood or adulthood. ADHD can affect people of all ages and have a significant impact on daily life, including academic performance, interpersonal relationships, and occupational functioning. The treatment of ADHD usually involves a combination of cognitive-behavioral therapy, neuropsychological rehabilitation, educational support, and, in some cases, medication.

Diagnosis and treatment of ADHD

This process is usually conducted by mental health professionals such as psychiatrists, psychologists, neuropsychologists, and pediatricians. These experts assess the symptoms comprehensively and design a personalized treatment plan for each individual. The evaluation is comprehensive and multidisciplinary. The role of clinical psychologists or neuropsychologists is to administer a series of psychological tests to understand the individual’s cognitive functioning, whether they are children or adults.

Based on the results of these tests, an intervention plan is proposed to address the symptoms. The evaluation can be shared with the treating physician (neurologist, psychiatrist, or pediatrician) to consider the need for medication. However, the decision to prescribe medication rests exclusively with the treating physician, based on the comprehensive assessments performed in collaboration with the multidisciplinary team of professionals.

Attention deficit hyperactivity disorder (ADHD) is not exclusive to childhood; it also affects adults, although it may present differently. In adults, ADHD symptoms can range from chronic distractibility to difficulty completing tasks, procrastination, and a tendency to make impulsive decisions. There are adults with ADHD who face significant challenges in maintaining stable employment and finances, as well as establishing and maintaining healthy personal relationships.

It is important to recognize that ADHD is not simply a problem of lack of attention or hyperactivity but a complex neuropsychiatric disorder that can have a profound impact on quality of life. Adequate diagnosis and treatment are necessary for symptom improvement.

Both neurodevelopmental disorders imply a multidisciplinary treatment, where, in general, what is sought is that the treatment has an impact on the quality of life of both the person suffering from the disorder and his or her family.

Bibliography

• Vaillard, J, Reza, D (2018) El ABC del Autismo, Domus Ediciones, México.
• American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).

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