Is It ADHD or Autism?

April is Autism Awareness Month and organizations are spreading the word about the importance of autism screening, evaluation, and intervention. For parents of kids with ADHD who struggle with social interactions, the notices and flyers popping up in pediatrician offices, schools, and on social media can prompt questions about whether their child’s difficulties may sound more like autism symptoms than ADHD symptoms.

Autism Spectrum Disorder, commonly known as autism, is not a singular disorder but rather a spectrum of symptoms and impairments. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the diagnostic guidebook published by the American Psychiatric Association, autism spectrum disorders are characterized by difficulties with communication and interactions with other people, as well as restricted interests and repetitive behaviors. These problems are severe enough that they interfere with an individual’s ability to function at school, work, or in other areas of their life (a comprehensive list of autism symptoms can be found here: https://www.nimh.nih.gov/health/publications/autism-spectrum-disorder/index.shtml). Kids with more severe forms of autism are highly impaired and may develop little (if any) language and interact only minimally with those around them. Kids on the higher functioning end of the autism spectrum may have fully developed language abilities and can communicate with others, but overall, they struggle in their interpersonal relationships.

There is a certain degree of overlap between ADHD symptoms and autism symptoms, including social difficulties and challenges related to executive functioning. However, there are some key differences as well.

  • Communication Skills. Many kids with ADHD struggle with their communication skills. They may talk too much or say the wrong thing at the wrong time, and they may even have difficulty picking up on subtle social cues. Children with autism have these same challenges but experience them to an even greater degree. In addition to missing subtler social cues, they often fail to notice obvious changes in facial expression, body language, or tone of voice.
  • Theory of Mind. Every parent at some point finds themselves asking their child, “How do you think that other boy or girl feels about what just happened?” When a child responds to this question they are engaging a unique cognitive skill referred to as Theory of Mind. This skill provides the ability to put ourselves in another person’s shoes and see the world from their perspective. Often kids with ADHD need a bit more prompting or guidance to engage in Theory of Mind thinking. When it comes to kids with autism, their Theory of Mind abilities are often so impaired that even with assistance they are not able to truly think about things from another person’s perspective. As a result, they have trouble understanding why people to the things they do and fail to understand the intentions and feelings of others. This can lead to feelings of confusion and frustration on the part of the child with autism, and the perception by others that they are insensitive or rigid in their thinking.
  • Social reciprocity. Interactions with family members and friends involve a natural give and take. Someone asks you a question, you respond, and maybe ask a question back or mention something that you think the other person might find interesting. Social interactions also involve inviting others into our world by sharing things we are interested in, or in the case of children, showing others a favorite toy or object. Kids with ADHD may struggle with some of the back and forth aspects of social interactions, but overall, they are interested in sharing their world with others. Kids with autism display very limited social reciprocity. They struggle to make eye contact, rarely point out interesting things that they want to show to the people around them, rarely share, and often don’t respond when asked to engage.

Distinguishing between autism spectrum disorders and ADHD isn’t always straight forward. If you are wondering if some of your child’s social challenges may be due to more than ADHD, then reach out to your child’s pediatrician. They can help you locate a specialist in your area who can clarify your child’s diagnostic picture and recommend targeted interventions that can help.

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