Attention Deficit Hyperactivity Disorder (ADHD) and Autism Spectrum Disorder (ASD) are two conditions that have become part of our vernacular. But what exactly are they and how do you know if your child should get tested? Dr. Jill Fodstad, Ph.D., HSPP, BCBA-D, a psychologist at Indiana University Health’s Christian Sarkine Autism Treatment Center, clarifies.
First, it is important to understand how the lingo has changed. The fifth Diagnostic and Statistical Manual of Mental Disorders (DSM-5) – the guide that is used for all psychiatric diagnoses and classifications – was released in May 2013, and it reclassified both ADHD and ASD. Previously, children could be classified as ADD (Attention Deficit Disorder) or ADHD, but the newest edition eliminated the ADD diagnosis and redefined ADHD to include three categories. The DSM-5 also redefined autism. In the past, a child could receive one of several different autism diagnoses, such as Asperger syndrome, but now each child receives a general diagnosis of ASD and they are placed on a spectrum based on their range of impairment.
When children have trouble with their executive functioning – meaning that they cannot stay focused or on task – they may be tested for ADHD. “Any kid can have trouble paying attention,” says Dr. Fodstad. “But, a child must have these symptoms to an extent that they are a distraction at home or in the classroom, and their symptoms must be at a level that’s impairing.”
There are three different types of ADHD. The first describes children who have difficulty sustaining or maintaining attention. The second is predominately hyperactive and impulsive, and occurs when children have symptoms of hyperactivity or impulsivity but are not inattentive. The last is a combination, kids who are both inattentive and hyperactive/impulsive.
To be diagnosed with ADHD, a child’s symptoms must be clinically significant and the child must be diagnosed between the ages of seven and 12. This means that the symptoms must be over and above what you would expect for the context or the setting. For example, if a child is wild at an amusement park, that can be expected. Or, if the child is under the age of seven, it is understandable that they may have difficulty staying quiet, sitting still or following complex directions.
There are key symptoms a parent or teacher will look for in order to determine if a child should be tested for ADHD. An inattentive child is very distractible or forgetful. A parent could ask their child to clean up their room, but 15 minutes later the child has either not started or stopped halfway through. This child is not being defiant, they simply forgot. Children who are in the first category of ADHD often make careless mistakes, ignore people even when being spoken to directly, have difficulty paying attention and following instructions, and are disorganized. For children who are hyperactive or impulsive, Dr. Fodstad likens them to the Energizer Bunny. They are always on the go, talking excessively, unable to wait their turn, constantly interrupting conversations and very fidgety in their seats. These children cannot inhibit motion.
Unlike ADHD that is defined with specific categories, ASD is one general diagnosis and children are placed on a spectrum. “Now, if a parent is concerned that their child may have autism, the clinician will try to determine if the child has significant deficits in social communication and social interaction and then restrictive or repetitive interests or behaviors. This diagnosis must happen early in life, be clinically significant and cannot be better explained by something else” Dr. Fodstad describes.
For children with ASD, their social and emotional deficits are considerable. They have difficulty understanding back and forth conversation and making or maintaining friendships. Maintaining eye contact, understanding body language and deciphering facial expressions are challenging. These children also have a hard time understanding emotions or the likes of others.
Restricted or repetitive behaviors, fixated interests or activities and insistence on sameness are other indicators of ASD. Children who rock back and forth, clap their hands or use repetitive speech fall into this category. Children may also become fixated on an interest, such as baseball, and learn everything they can about that topic. They become so involved that it is challenging to speak to them about anything else – they always change the subject back to their topic of interest. Often, children with ASD will also insist that routines be exactly the same as they were before; deviations can cause tantrums.
Finally, children with ASD are either over or under aroused with sensory input. While some could put their hand on a stove and not feel pain or enjoy very cold showers, others may only eat crunchy food or excessively smell or touch objects.
For both disorders, the earlier a child is diagnosed, the better. For children with ASD, that diagnosis can occur as a baby through routine screenings with the pediatrician. These children will receive therapies that can provide a better outcome. If a child is diagnosed with ADHD early in their academic career, the proper supports can be arranged and behavioral techniques implemented to help the child learn the skills they need to do better at school. Parents may also choose to medicate, but Dr. Fodstad recommends that behavioral therapy be a key component of any ADHD treatment. While there is no cure for either, through proper diagnosis and treatments, children with ADHD and ASD can be set up to succeed to the best of their ability.
-- By Gia Miller