I just joined this group after reading Driven to Distraction by Dr. Edward Hallowell, in which he mentions this website.
My daughter is 6 and after 4 years of seeing many professionals with many different opinions the verdict is between mild autism and/or ADHD. (Some professionals say autism, some say ADHD).
She didn’t speak much until close to 3 years old. She doesn’t have any repetitive behavior, she’s aware of her emotions, but she does have difficulties carrying on a conversation. She has oral sensitivities - doesn’t eat fruits, veggies, or typical things that kids like, such as: cake, ice cream, popcorn, juices of any kind, etc...
How can I know for sure? There seems to be a fine line between ADHD and mild autism....Why are professionals from the best hospitals in the US and abroad missing this?!
Any feedback will be appreciated.
Thank you.
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MissOz
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I’m sorry you are struggling with getting the right diagnosis. It’s hard.
Two things:
My doctor said to me yesterday that while a diagnosis may be important on some levels the most important thing we can do is start treatment for what is impeding daily functioning. He agreed that there is so many overlapping symptoms of diagnoses that it’s hard to tease out sometimes. But you do you know what the issues are on a day-to-day basis and you can work with therapists or counsellors or whoever to come up with strategies to deal with those to improve your child's and your lives regardless of the diagnosis. I only share it because it was quite meaningful to me.
Second, I’m in Canada and here we use an assessment tool called the ADOS-Autism Diagnostic Observation Schedule. Along with questionnaires and observation this is used to diagnose autism. Not sure if you’ve heard of that or looked into it but maybe it’s something to ask about.
This helps a lot! Thank you for taking the time to write me. Currently, attention and communication (back and forth spontaneous conversation) seem to be the most limiting symptoms, so she is on medication to focus and is also working with a speech therapist.
She took the ADOS when she was 3.5 year old, but she didn’t meet the requirements. I will ask her new doctor to do it again just in case.
Our son was the same with the diagnosis of adhd poss autism. However our doctor said to treat what we can see and see if the autistic tendencies were still there. We started on a Ritalin drug and the autistic tendencies have ceased, so they were as a result of his self esteem and struggles at school and home.
My cousins little girl was diagnosed as autistic then go t a subsequent diagnosis of ADHD.
In the states there is a spectrum 1-10, i think...and a lot of the adhd symptoms can land a person on the spectrum. I wouldn't focus so much on a diagnosis as treatment to address day to day issues. Good luck.
The part about the Scale is incorrect. There is no scale. That's a misread of the umbrella term "spectrum". To clarify from a diagnostic standpoint (I'd definitely agree to focus on the individual's actual day to day issues), it helps to think of ASD as a diagnosis like Cerebral Palsy, meaning, there are various different "flavors" of [palsy] which /each/ have their own varying degrees of severity, and these descriptions are used to note what a clinician sees manifesting as presented symptoms in order to be specific. They aren't all something different in the sense of general cause and are all more or less given the same treatment. ASD is the same sort of term. The different presentations are more or less irrelevant because diagnoses are there to describe treatment, and they are all different manifestations and presentations of the same underlying cause.
Why that's important to say is that, a person can have both, and a few symptoms might appear similar, but the course of treatment is different. Clarifying that makes a big difference.
My son is in a similar place, but he is twelve. I was told by his psychiatrist that we would probably treat his symptoms (aggression, anxiety, impulsivity) for either diagnosis, but that kids with ASD have no typical response to medications. If the pharmaceutical treatments for adhd help your child, then I would consider yourself lucky. We are getting somewhere, but finding effective medicine has been a painful and somewhat elusive process.
I did hear that medicine is not as effective for kids with ASD. We are still in the beginning of this journey trying different dosages. It does help the concentration part when it comes to homework. It does not help, however, with the self defeating attitude, anxiety and procrastination.
They ruled out autism on my son because he's aware of his feelings and because he will look you in the eyes. They told me they would treat him the same regardless it adhd or autism. They don't treat the disease, there's no cure. They treat symptoms these diseases portray. My son lacks social skills, he's hyper, he has odd. The hyperactivity we treat with medicine. All the rest? Cognitive behavioral therapy....and lots of love.
Thank you. Yes. My daughter’s symptoms are similar to your son’s. My daughter, however, tries her best to be social, she wants to make friends, she seeks friends and gets hurt when she’s rejected. Unfortunately, she can’t carry on a conversation at her peers’ level, and sometimes her answers make no sense.
Like another member mentioned here, I’m trying to figure out if she’s socially delayed (a 4 year old in a 6 year old body), or if she’s a little different.... But all the feedback I got is right. We need to treat the symptoms.
The core problem in ASD is a significant difference in social interaction (not only quantity, but also quality) while ADHD has social immaturity (Ok, but at a younger age, usually about 2/3 of the child's age). Many doctors do not understand this distinction and label any child with a difference in social behavior as ASD (not asking why the difference occurs, which can be ASD, ADHD, social anxiety, lower IQ, lack of experience to give some reasons). Your daughter may have some anxiety and clearly has a history of a speech/language problem, which can affect the quality and extent of social interaction. If she is friendly with familiar people, ASD is less likely. Repeating the ADOS will not answer the question since the test is dependent on the tester's ability and knowledge and can be skewed if the reason for not doing a task is interpreted incorrectly. I agree that it is more important to treat the behaviors that are affecting daily life than the label.
Thank you for your very insightful feedback. I think this is it. My daughter’s social immaturity (Dr. Russel Barkley, specialist in ADHD talks about the 2/3 delay rule), combined with her speech/language impairment affects her social life. She is very empathetic and having friends is important to her. When she’s rejected she gets hurt. She understands when she’s being left out of birthday parties and playdates.
There are some behaviors we can’t understand, though... The other day we were at a park and she, out of nowhere, said she wanted to be left alone. Nothing happened prior to that. She was playing by herself. We asked her what had happened, as she started to cry and cry when we left the park. She later told us that her brain told her to act that way. She apologized, and told us that she has a bad brain..... That made me very sad.... I told her brain is not bad, and she is a special girl.
We will continue to treat the speech/language and very poor attention as these as the two major symptoms that affect her life. Thanks again.
People with autistic disorders are empathetic; the distinction is that they might communicate the thoughts we recognize as "empathy for this thing" differently than expected, or not know how to explain it to you at all. They'll also know when they're being left out, assuming they have no intellectual boundary precluding that or/and are old enough to put two and two together. They just won't know why, or what if anything to do about it. It does hurt their feelings if they, like anyone else, regard the particular group in question as a group to which they might otherwise belong. ... but like anyone else, there are multiple reasons they might or might not want to be considered a certain kid's friend but not another's, or go or not go to a certain event, or not hug a certain relative. It'll be easier to distinguish between these attitudes by 8, I think, but that's just my opinion based on the general mercurial nature of many kids before 8 (who might be a bit less mature but within average ranges).
I was struck by your mention of the park instance, because my daughter (who is younger than yours) does similar things, but often, I think, in her case, it starts as an internal issue, then when she tries to explain, it's colored by her desire to please us. She says frighteningly, depressivly dark things when she perceives she might have affected us with her attitude, whether it was originally about us or not. The funny thing is that this sort of display of sensitivity -- the fact it's there and the trajectory it takes -- can be indicative of so many things, including but not limited to profoundly high IQ with average social development.
Exactly. It starts as an internal issue. Or sometimes triggered by something minimal. In that particular instance, as I think more about it, she asked where she had left her tennis racket. We said: it’s here. And that was it.
After about 20 minutes or so trying to get her out of a funk, and she realized she was responsible for us leaving the park, it was clear that she felt very guilty for “spoiling” the day for everyone, and she started saying no! No! No! Let’s stay. I don’t want to go! And proceeded to cry and say let’s stay, over and over again for a long time.
Another episode was when she had a playdate here at home. I had promised her pizza, but ended up forgetting to get it. She seemed deeply hurt by it, and said she would not eat anything else.
Her friend said let’s play! Unfortunately, the playdate was a fiasco. She went to her bedroom saying she wanted to be left alone. (Very similar to the park episode). I said your friend is here, you can’t leave her alone. She came here to play with you. Nothing helped. She kept crying and saying she wanted to be left alone. When I told her I would call her friend’s mom to pick her up, she panicked... But still, she could not help herself to get out of that mood, and needless to say, I haven’t heard from the friend’s parents since that day .
I'm not sure I'd read too much into not hearing from the parent. Playdates for 4-6 year olds are hard. They might simply be busy, or, unsure of your feelings or your daughter's. You can't really know! Don't let it bother you. Keep reaching out if the kids seem to genuinely want to see one another often.
My daughter, who is currently four, has recently been in classes of kids ranging from 4-6. She has a few friends who, despite getting along, have "meltdowns" right in front of the parents, the friends, just wherever. It really isn't about the people or even the situations as much as the kids just not being able to regulate their emotions yet. They appear able to at that age, because many times they do, and we see the amazing changes and think they're "there", but, they all still have their moments. I don't know where you live and if this would seem out of the ordinary, but, for kids under school age, it's completely reasonable, I think, to have the parents be there (even if they're in another room doing their own thing). Or, you could schedule playdates in small groups or let a sibling/s come along. Both ways provide for an outlet when one kid does something unexpected. I've been at playdates where one girl freaks out over something only to be fine a few minutes later because she could be taken out of one room with one set of people, and one situation, into another.
Additionally, all kids that age are still put off by "strangeness" in environment, so, it would ratchet down any awkwardness of asking a friend to go somewhere they've never been with adults they don't really know for the first time. That might not affect your own daughter's perspective but it might help the general playdate go a little more smoothly.
The pizza reaction struck a familiar chord with me. It was a good example, too, of the difficulty parsing out reasons behind behavior when your child is in one of those "gray zones." In my experience, similar situations have been about the parent's percieved "betrayal" in forgetting something so important, and then the inability to switch that emotion totally off. It seems all encompassing, they're swept away, so, even when they might intellectually know it was no big deal, the emotion remains. (And that in turn kicks off additional upset sounding like: 'Oh no, why can't I get rid of this feeling? Look what I'm doing. I'm terrible!')
Part of this is generally average and the rest is anxiety. If it was something like this I would set aside the situation as average but not ignore the anxiety. The situations will change as the person ages, and maybe be seen as more socially acceptable, but the anxiety will still be there.
On the other hand, situations like you described could be about the desire to socialize and socially please. This happens all the time! One child (or even adult) knows their friend/s enjoy a certain thing, or hopes they love it, and wants to create the best party/playdate ever, maybe even telling their friend/s there's going to be pizza, and everyone talks about it all day. "Outsiders" don't realize any of this, so, when the plan is "ruined" there's suddenly a lot of totally rational but unexplained turmoil. It seems irrational when viewed from the outside because the whole story isn't apparent. For a kid who might not have a lot of verbal control yet, this would be hard to explain because there's a lot. Even for a kid (or adult!) with more exact verbal control, it's still going to be hard after getting wound up.
That said, there's also truth that this sort of behavior can also be indicative of difficulty with change, difficulty with altered expectations, understanding emotions, switching attention, planning, knowing what steps to take to proceed ... Both ASD and ADHD. Like I said before, it's a good example, because you can imagine a number of completely likely things might have been going on but, whichever it is, still, there are going to be multiple answers in combination. It doesn't even matter if they are all average or not.
I think that one of the more difficult aspects to female behavior as opposed to male behavior, when ADHD or less severe ASD is involved, is that it "appears more normal", and from an outsider's understanding of the term "appears more normal" it seems, to them, that the situation is synonymous with "is more average" ... But the point is not how it seems to other people. Yeah, that also will impact social realities in a direct way, but, off-putting someone or acting inappropriately in a given situation can be a result of just about anything. It doesn't mean the person has had the same thoughts or was working under the same impressions, and, with girls, the likelihood of their inner workings being ignored in combination with a sometimes frightfully intense desire to please (in order to compensate socially) can be dangerous for them. In this sense, it's important to ultimately know the whys, but also ... Ok, and this is just my opinion, but one that can't hurt ... I'd concentrate on possible anxiety while working on self-esteem and sense of self. Those are things that could benefit any kid, and anxiety work, even if there's just a small speech issue that will ultimately resolve itself with some speech therapy, is something that you'd have to do no matter what you were looking at or what reasons where ultimately behind which behaviors. I'm really enjoying the AT parenting video series in YouTube right now (blog also). Finding it really helpful!
I also would like to add that it's possible asking to be left alone shows a lot of self awareness and should be responded to positively. Sometimes people might need a longer then average amount of time to calm down, or a quieter spot, but that they recognize that, even if they can't explain it -- that's a good thing. Again, I can't know if any of these things are particularly applicable because you sort of need to see things in action, but these are some of the thoughts your descriptions have brought up for me.
This incident reminds me of my seven-year-old son. He's diagnosed with ADHD, ASD, and SPD. For him, the sensory processing issues have lead to some strange behaviors and notions that, with the diagnosis, now make sense. So many of these disorders (I prefer differences) have similar presentations and for ADHD and ASD the treatment is similar. But if she has a SPD, the treatment is occupational therapy. We've only been doing it for a month and my little man is responding well. Also, his father and I understand even better where he's coming from and what he might need.
Like you, I'd love to have a definitive diagnosis but I'm so grateful to have the tools needed to help my son. I actually stumbled across the SPD possibility when I was researching dyslexia and dysgraphia. I saw dyspraxia mentioned and it was an almost perfect description of his differences. I asked his pediatrician about it and she referred us to OT.
This may not be what's going on with your daughter at all, but I thought it might be worth mentioning.
Totally agree - my doctor said that diagnosis is less important than dealing with the behavior that’s in front of you. That was life changing for me to hear because I though we needed clear diagnosis in order to treat. He said that labeling probably won’t help. Just focus on treating the behavior that impedes your child. That lightened the burden I was feeling, and it makes perfect sense. Good luck!
First and foremost, you’re doing an excellent job and your daughter is lucky to have you. My seven year old son is VERY similar to what you described in your post. We, too struggled early on with the determining the proper diagnosis. Unfortunately, so many people now especially in the school setting want to be “the one to diagnose” and fail to even treat the symptoms. I agree with some of the replies that express the importance of treating the child not the label. As parents, I think we are always looking for the label to perhaps help us “understand” our kids. However, so much time can be wasted on getting a clear diagnosis. In the meantime, what’s best is to get to know your child! I try to work on that myself! Best of luck!
I totally agree. Maybe I thought that a label would take away my doubts and question-marks about my child. I need to accept that sometimes things are not black or white.
I will add, addressing/ discussing symptoms versus diagnostic labels has been a better approach for me when talking to my child or to others. There is ALOT of preconceived notions about ADHD (and probably ASD), that I’m hesitant to mention the diagnosis to others. My husband even has a hard time with it. But avoiding using the label & just discussing symptoms & the best ways to help them take a lot of stigma out of the discussions for me.
I agree. Unfortunately there is a stigma about ADHD and ASD. In some cases plain discrimination from other parents and even children. At this point in time I’m not ready to discuss these issues openly with acquaintances. I want to protect my child and how she’s seen/perceived. I could be very wrong. It’s just where I am in my journey.
I hope this doesn't add to any confusion, and it sounds like you might already be considering this, but many people have both ASD and ADHD. Or, some children might in reality have a specific processing disorder that appears more like a true developmental disorder when very young because it's unclear why language or textile response is a little different, etc. ... Trying different therapies and experiences is always a good idea when when it's hard to know what's going on.
But keep in mind that repetitive behaviors don't have to be obvious. A person might have repetitious thoughts, chew their lip or nails, or do something that might be perceived as normal behavior until they're older or in a different setting (at which point the same activity draws more negative attention from others). I'm not suggesting lose sleep over it or overanalyze everything (please don't! ), just keep it in mind as an informational footnote!
Thanks. Yes. I’ve heard of processing disorder too. I think I will need to wait until she is a little older, as her case is clearly not black and white. There are many options on the table at this point in time. As others said, I will need to concentrate on the most debilitating symptoms for now.
Hi. I have a very similar case with my son who is 12. Almost identical until the cake and juice part. Professionals such as doctors and teachers see this fine line but their job is to treat the symptoms and not the label. Try to think this way going forward to make sure your daughter gets what she needs to be successful. Stay on top of everything which you seem to be doing. Try not to overthink things. Sounds like you are doing great. But remember not to lose any of your energy or focus on things that others may be or may not be able to pinpoint from a diagnosis standpoint. All should be treating the symptoms. She’ll get there.
To the thread subject in general, I don't know how old it is or how many people might have heard it, but, ADDitude magazine produces a podcast/webinars called ADHD Experts. You can get to it in GooglePodcasts, too. Ep183 is about different language disorders when co-occuring with ADHD. It's really great.
Since I am exactly what you are saying, it bugged me for years after being diagnosed with Mild Autism. To be brutally Frank, I think the Autism Diagnosis is useless unless it is a severe care. The Autism people tell us "Oh. You are on the Spectrum. You are all unique". What nonsense! That helps zero. It does not give the diagnosed any options. It just makes one a victim. It is virtually meaningless in the real World. No one will respect you, because one has to be very specific in one's demands (especially in today's World). Yes. I day dream, have social skill issues, brood, get frustrated, have trouble fully paying attention, sometimes say odd and obtuse seeming things, etc. The World has and always will be very cruel to us "not sharp and fully with it". The Autism Diagnosis means less than nothing to me. If it is a neurological condition - How and what do I do? The Autism specialists do zero to help and advise. They are too busy telling us we are on a "spectrum". Then I read a book on ADHD. It hit me like an old family member coming to visit me after years of being away. Unlike Autism, which was a cold stranger to me, here was ADHD. Yes. I have a fast mind to compensate for the attention deficit disorder. Literally, almost everything in the book on ADHD hit me. And here is Temple Granlin talking about her brainwaves for five chapters with Autism. Get real. It is best by a mile to stick with ADHD. Do not waste time with Autism.
Thank you very much for your opinion. My daughter is on the waiting list to take an autism test, but deep inside I’m not sure what difference that would make, and if I want this heavy label on her shoulders. As a mother, though I’d like to know exactly what she has. The ADHD medication doesn’t seem to make much difference....
You are welcome. From personal experience I say I am probably on the spectrum, but mostly it is ADHD. Too often labels just make us feel helpless. I think most people, whatever we have or do not have, benefit more from setting personal goals. I focus on that, not some diagnosis that is too difficult to explain and work with.
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That made me very sad.... I told her brain is not bad, and she is a special girl. 
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