Among school-age children, an estimated 11 percent are diagnosed with attention deficit hyperactivity disorder (ADHD). What most parents, teachers, and school counselors may not realize is that children with ADHD may also manifest symptoms of autism spectrum disorder (ASD).
Having two or more co-occurring diseases or disorders is defined as being comorbid or having comorbidities. A 2014 review of studies looking at comorbidity found that “between 30 and 50% of individuals with ASD manifest ADHD symptoms (particularly at pre-school age), and similarly, estimates suggest two-thirds of individuals with ADHD show features of ASD.” Researchers also determined that children with this comorbidity often had more severe levels of dysfunction—which is why early and accurate diagnosis and effective treatment are so important for parents to help these students succeed.
The good news is that many of the treatments for one disorder can be helpful for the other— which is highlighted in Strategies for ADHD: How School Counselors Can Help Today’s Students Succeed, a recent post by Counseling@NYU, which offers an online masters in school counseling from NYU Steinhardt. Here, we’ll look at strategies, like behavioral therapy, as well as the similarities and differences of both diagnoses and how they often overlap.
What’s the Difference?
Experts noted that it can be difficult to isolate a diagnosis of ADHD or ASD since the symptoms often overlap. What’s more, the symptoms of ADHD are often the same behaviors exhibited in typical childhood development—except that they persist and worsen over time.
Here are a few similarities between ADHD and ASD:
- Difficulties with attention
- Difficulties communicating with peers
- Various degrees of restlessness or hyperactivity
- More common in boys than in girls
- Present, at least partially, at pre-school age
- Have a known genetic pre-disposition
- Cause significant behavioral, academic, emotional, and adaptive problems in school, at home, and elsewhere
As far as what’s different one study says, “ADHD is defined by impaired functioning in the areas of attention, hyperactivity, and impulsivity, whereas ASD is characterized by core social dysfunction and restrictive-repetitive behaviors.” These ASD traits include behaviors such as:
- Unresponsiveness to common stimuli
- Intense focus and concentration on a single item
- Repetitive movement
- Avoiding eye contact
- Withdrawn behaviors
More Than One Diagnosis?
Available research on the comorbidity of ASD and ADHD is still scarce because prior diagnostic standards made the diagnosis of one an exclusion for the other. However, when the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) was published in 2013, it included criteria that allowed clinicians to diagnose an individual with both disorders at the same time.
With the ability to better understand the impact of ASD and ADHD as comorbid conditions, more accurate diagnoses and more effective treatment options may be available. For students with these conditions, such insight gives educational professionals such as school counselors a better understanding of what strategies they can use to help these children and their parents to succeed.
Strategies for Success
Partnering with school counselors is an important way for parents to help their children with these comorbid conditions succeed. A common approach that counselors use for helping kids with ADHD is through the use of evidence-based interventions (EBIs)—which includes behavioral techniques that are effective for children with ASD, too. Specifically, Dr. Chacko says school counselors can implement strategies that address organizational skills and the transition across settings:
“It is important that treatment should focus on outcomes and processes, not diagnosis. A child with ADHD and/or ASD can benefit from EBIs that focus on the outcomes that are problematic and focus on tailoring the EBIs to meet the unique needs of these children.”
Additional strategies parents can use at home to help their child dealing with this dual diagnosis include things like:
- Providing positive communication and reinforcement
- Creating and maintaining as much structure in their day-to-day life as possible
- Posting lists, rules, and schedules to help with organization
- Encouraging physical exercise as a release
- Learning more about available behavior parent training programs
Experts note that “Whereas both ADHD and ASD include behaviorally oriented parental intervention, the role of the family is conceptualized similarly; for ADHD and ASD ‘parent training’ often involves teaching parents to manage the behaviors of their children; in addition, ASD ‘parent education’ also places emphasis on individualized treatments that provide parents with tools to promote their child’s (social) skill development.”
Although the presence of comorbid conditions presents students—and their parents—with additional challenges, the good news is that there’s help available. By accessing expert resources, like school counselors, parents can learn how to use effective strategies to help their children succeed.
This article was featured in Issue 72 – Sensory Solutions For Life