Welcome to the April edition of Ask Dr. Emily!
We often receive questions that we want to share with all our readers. To help with this, Dr. Emily Neuhaus, a clinical psychologist at Seattle Children’s Autism Center, will share insights in a question and answer format.
We welcome you to send us your questions and Dr. Neuhaus will do her best to answer them each month. Send your questions to [email protected].
Question: Does getting a new diagnosis of ASD change my child’s diagnosis of ADHD? Does this autism diagnosis mean the ADHD isn’t true? Does it replace the ADHD diagnosis?
Answer: This is an important question and one that comes up for a fair number of families. It’s pretty common for children and adolescents to have other diagnoses before they arrive for an evaluation for ASD – some common ones are ADHD, anxiety, behavioral difficulties, and others. Getting a new diagnosis of ASD doesn’t necessarily change or replace any of those other descriptions, because each diagnosis is based on its own set of diagnostic criteria. Thinking about ASD and ADHD specifically — even though ASD and ADHD often come together, their core aspects are actually pretty different.
When we evaluate specifically for ASD, we consider someone’s skills and difficulties in specific areas – social-communication (e.g., interest and skill interacting with others, ability to form friendships, richness of communication skills), their interests and how they play, sensory experiences, and so forth.
In contrast, a diagnosis of ADHD is based on difficulties in areas such as attention (e.g., being easily distracted, having trouble focusing, making mistakes, struggling with organization), hyperactivity (e.g., having trouble sitting still in class, fidgeting a lot, seeming restless), and impulsivity (e.g., interrupting others, struggling to wait for a turn).
If you compare these two lists, you can see that the core areas of ASD and ADHD are different from one another, even though there are some people who will meet criteria for both diagnoses. The bottom line is that ASD and ADHD can appear individually or can come together, and only careful evaluation by a specialist can really tell you whether either or both are appropriate for your child.
Question: Our doctor diagnosed my child with ADHD but none of the ADHD medications they’ve prescribed are helping. I’m skeptical – How can they really have ADHD if the medications don’t help them?
Answer: I can see why you’d wonder about this – it can be really frustrating to try a medication (or a series of medications) without seeing improvements! As it turns out, the effectiveness of a medication for ADHD doesn’t actually tell us whether the ADHD diagnosis is accurate.
In the question above, we talked a bit about the diagnostic criteria for ADHD – that’s the set of behaviors that we consider in order to figure out whether that diagnosis is appropriate for someone. The question of whether your child’s ADHD diagnosis is accurate is based on comparing those criteria with your child’s unique set of skills and difficulties. The issue of how to manage ADHD symptoms is a separate and equally complicated one – there are lots of different approaches to ADHD management (medication and otherwise), and some approaches will work better for some people than others. There are different categories of medication for ADHD, and even different medications within each category – as a result, there are a lot of possible medications to consider. What works for one child can be really different from what works for another child, so it can take some time and some effort to find a fit. Again, though, this tricky process doesn’t mean they don’t have ADHD.
It really sounds like you’ve been working hard to find good supports for your child, and I’d encourage you to keep working closely with your child’s team to develop a plan that feels like the best fit. Best wishes!