Autistic Spectrum Difficulties

Understanding Related Conditions to ADHD

People with autistic spectrum difficulties, which includes Asperger’s syndrome, are commonly seen at our clinic. Sometimes they are seen as having autistic spectrum difficulties alone but very frequently they may have other coexisting conditions. For example, a high percentage of children with autistic spectrum difficulties also have ADHD. The presentations can be quite complex and it is frequently very difficult to be absolutely certain about the presence of autistic spectrum difficulty until the ADHD component of the difficulties are effectively managed. People with autistic spectrum difficulties are often extremely anxious or obsessive, may be oppositional and have rages and disruptive behaviour, and they may get depressed. Many of these can be effectively managed within an environmental change, therapy and at times medication. However in all cases, as with ADHD a functioning diagnostic workup is necessary so that all the elements of a child’s difficulties can be fully understood and effective managed. In this way children and adults with autistic spectrum difficulties can be much more effectively helped. The clinic has found that many of the previously recognised rating scales for autistic spectrum difficulties do not always tease out the autistic spectrum problems from ADHD and other problems and has tended to rely much more on a clinical approach than using rating scales.

This neurobiological disorder results in difficulties in social skills, in the use of language for communication and obsessional behaviour, particularly involving repetition and abnormal perseverance with a limited range of interests. These children have subtle differences in pragmatic and social language: they may have delayed speech and language development and, sometimes, a very pedantic way of speaking with peculiar voice characteristics. They may have an impaired understanding of speech and misinterpret comments in an excessively literal way. Sometimes their expressive language is superficially perfect. Some of these children are diagnosed as autistic when younger, and at other times they have schooling, socialising difficulties, language disorder or ADHD. Some will first appear to have depression in adolescence or may only be diagnosed as adults.

Experts in ADHD and Autistic Spectrum Difficulties are increasingly recognising that some children do not have Autistic Spectrum Difficulties as a pure condition, but may have features of both this and ADHD. In the past, the problems have been interpreted as characteristics of Autistic Spectrum Difficulties alone. These children are frequently hyperactive and impulsive and/or inattentive, but also are often obsessive and have rituals.

Children with Autistic Spectrum Difficulties tend to have stereotyped or restricted patterns of interest. They have persistent social skills difficulties either instead of, or as well as, those commonly seen in children with ADHD. In ADHD, the social skills tend to be deficient more because of verbal and physical impulsiveness, misreading of body language and not concentrating on the other person. There is a lack of appreciation of social cues and a lack of empathy. In Autistic Spectrum Difficulties, there is a lack of need for reciprocal interaction and the child does not really desire to share or socialise and tends to be aloof, has problems in developing age appropriate peer relationships and poor use of non-verbal abilities. In contrast, children with ADHD want to have friends and want to socialise, but they get it wrong. In these cases, the lack of eye contact often seen as diagnostic of Autistic Spectrum Difficulties is simply lack of concentration.

Whilst most children with Autistic Spectrum Difficulties do not have ADHD, the concept of co-existence is important for appropriate management. Children with both conditions do not respond as readily to psychostimulants and other medications as do those with ADHD alone. However, medications are often very helpful and can make the child function much more appropriately. As with other co-existing conditions, it is sometimes difficult to fully assess the extent of any Autistic Spectrum Difficulties features until the core ADHD symptoms are treated and the on-going obsessions and social skills deficit are recognised.

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