SUPPORT for DUAL DIAGNOSIS
(AUTISM + ADHD)
AUTISM AND ADHD OVERLAP
WHAT IS AuDHD?
AuDHD is a relatively new unofficial term that describes a person who has both autism and attention deficit hyperactivity disorder (ADHD). Thus, the merging the terms Autism and ADHD into AuDHD.
STATISTICAL OVERLAP
Autism Spectrum Disorder (ASD) and Attention Deficit Hyperactivity Disorder (ADHD) are both neurodevelopmental disorders that can affect a person's behavior, social interaction, and communication.
There is a significant overlap in symptoms between the two disorders, such as difficulties with attention, impulse control, and hyperactivity. It is estimated that 30% to 80% of individuals with ASD also have symptoms of ADHD, and up to 20% to 50% of individuals with ADHD may also have symptoms of ASD (Kernbach et al., 2018).
Some studies suggest that the two disorders may share similar genetic and neurobiological mechanisms. Research has also shown that both disorders may involve differences in brain structure and function, particularly in regions related to social communication and executive functioning.
GETTING A CLEAR DIAGNOSIS
The Diagnostics and Statistics Manual (DSM) provides the standards for mental health diagnosis in the mental health sector. Prior to 2013, the DSM did NOT permit co-occurring diagnoses of these conditions as they were viewed as mutually exclusive.
With the publication of the 5th edition of the DSM (DSM-5), the American Psychiatric Association acknowledged that a single diagnosis did not describe the wide range of symptoms many clients experienced. Accordingly, if you seek an assessment today and you meet the criteria for both ASD and ADHD, you would receive a dual diagnosis of ASD and ADHD. The shorthand that is sometimes used outside of the official terminology is AuDHD.
If you are interested in a formal diagnosis, please know that we partner with the Adult Autism Assessments Center which would be glad to talk to you about getting assessed for both Autism and ADHD.
COMMON AND DIFFERENT TRAITS
It is important to note that the main diagnostic criteria of ASD and ADHD do not overlap.
The core characteristics of ASD are:
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differences in communication and social interaction,
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repeated behaviors, and
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specialized interests.
By contrast, the core symptoms of ADHD are:
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attention difficulties,
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hyperactivity, and
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impulsivity.
Sometimes symptoms may appear similar but the underlying origins are different. This can be seen in the points below:
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Individuals with ASD and ADHD can struggle with friendships; yet, this may be attributed to:
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social communication deficits for those with ASD
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as opposed to impulsivity for individuals with ADHD.
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Individuals with ASD and ADHD struggle focusing on items that they to not have interest in.
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For those with ASD, it may be due to an intense pull to focus on something else.
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For those with ADHD, the issue may be one of distraction.
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Individuals with ASD and ADHD often have some degree of motor-skill deficits which may impact coordination and fine motor skills like handwriting.
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For ASD, this may appear as repetitive movements.
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People with ASD and ADHD more frequently have sensory-processing differences when compared to others with typical development.
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For individuals with ASD, they have greater differences in auditory processing than children with ADHD or who are considered neurotypical.
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For visual processing, children with ADHD score higher than those with ASD or neurotypical (Little et al., 2019).
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ORIGINS OF ASD AND ADHD
GENETICS
Studies have identified several genes that may be involved in both ASD and ADHD.
One such gene is the dopamine receptor D4 (DRD4) gene, which is involved in the regulation of the neurotransmitter dopamine (Thapar & Cooper, 2013). Dopamine is known to play a key role in many cognitive and emotional processes, including attention, motivation, and reward. Variants of the DRD4 gene have been associated with an increased risk of both ASD and ADHD .
Another gene that has been linked to both ASD and ADHD is the serotonin transporter gene (SLC6A4). This gene is involved in the regulation of serotonin, a neurotransmitter that is important for mood, appetite, and sleep. Variants of the SLC6A4 gene have been associated with an increased risk of both conditions.
In addition to these genes, there are several other genes that have been implicated in both ASD and ADHD, including the cadherin family of genes, which are involved in cell adhesion and signaling, and the neurexin genes, which are involved in synaptic function.
It is important to note that genetics is only one of several factors that contribute to the development of ASD and ADHD. However, understanding the genetic basis of ASD and ADHD can help researchers develop better treatments and interventions for individuals with these conditions.
Pregnancy
Pregnancy is a crucial stage in the development of the fetus, and the environment in which it grows can have a significant impact on its future health and development. Research has shown that there may be a connection between pregnancy and the risk of developing Autism Spectrum Disorder (ASD) and Attention Deficit Hyperactivity Disorder (ADHD).
Several studies have investigated the link between pregnancy and the risk of developing ASD and ADHD. One potential factor is maternal infection during pregnancy. Studies have shown that infections during pregnancy, particularly during the first trimester, may increase the risk of ASD and ADHD in offspring. Maternal stress during pregnancy has also been associated with an increased risk of ASD and ADHD in offspring.
Another factor that has been investigated is exposure to environmental toxins during pregnancy. Prenatal exposure to chemicals such as lead, mercury, and polychlorinated biphenyls (PCBs) has been linked to an increased risk of developing ASD and ADHD in offspring.
It is important to note that not all pregnancies that experience these factors will result in the development of ASD or ADHD. Additionally, many cases of ASD and ADHD do not have a clear cause or risk factor identified.
TREATMENT APPROACHES
The treatment approaches for adults with AuDHD (autism and ADHD) can be challenging because these two conditions can interact with each other in complex ways. However, there are several strategies that can be effective in managing symptoms and improving daily functioning.
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Behavioral Therapy:
Behavioral therapy, including cognitive-behavioral therapy (CBT), can be helpful in managing symptoms of both autism and ADHD. CBT is a type of therapy that focuses on changing negative thoughts and behaviors. It can be especially helpful for individuals with AuDHD because it can target specific behaviors and thought patterns that are causing difficulties. CBT can be delivered in individual or group settings and can be adapted to meet the unique needs of individuals with AuDHD.
Please know that the goal of behavior therapy must NOT be to turn you into a neurotypical person. It is to help you find ways to cope while living in an allistic world and be TRUE TO YOUSELF!
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Social Skills Training:
Social skills training can help individuals with AuDHD learn social cues, communication strategies, and appropriate social behaviors. Social skills training can also provide opportunities for individuals with AuDHD to practice social interactions in a safe and supportive environment. This type of therapy can be delivered in individual or group settings and can be tailored to meet the specific needs of individuals with AuDHD.
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Medication:
Medications such as stimulants (e.g., Adderall, Ritalin) and non-stimulants (e.g., Strattera) can be used to treat ADHD symptoms.
If you are autistic, the use of medication is sometimes used to help with accompanying issues such as depression or anxiety but the use of medication for autism is not well established.
We always refer your to a prescribing psychiatrist or physician for the appropriate guidance.
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Occupational Therapy:
Occupational therapy can help individuals with AuDHD learn skills to manage sensory issues and improve daily functioning. For example, occupational therapy can help individuals with AuDHD learn strategies to manage hypersensitivity to sensory input (e.g., noise, light) or hyposensitivity (e.g., lack of awareness of pain).
Occupational therapy can also help individuals with AuDHD develop strategies to manage daily tasks such as self-care, organization, and time management.
Please know that our group does not provide medications or occupational therapy but would be glad to help you think through these options and integrate them in your overall plan.
A PLAN CUSTOMIZED FOR YOU
It is essential to remember that treatment for AuDHD should be individualized to meet the specific needs of each person. We would love to provide a comprehensive evaluation and develop a treatment plan that fits you.
References:
Kernbach, J. M., Satterthwaite, T. D., Bassett, D. S., Smallwood, J., Margulies, D., Krall, S., Shaw, P., Varoquaux, G., Thirion, B., Konrad, K., & Bzdok, D. (2018). Shared endo-phenotypes of default mode dysfunction in attention deficit/hyperactivity disorder and autism spectrum disorder. Translational Psychiatry, 8(1), 133. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6050263/
Little, L. M., Dean, E., Tomchek, S., & Dunn, W. (2018). Sensory processing patterns in autism, attention deficit hyperactivity disorder, and typical development. Physical & Occupational Therapy in Pediatrics, 38(3), 243–254. https://pubmed.ncbi.nlm.nih.gov/29240517/
Thapar, A., & Cooper, M. (2013). Copy number variation: What is it and what has it told us about child psychiatric disorders? Journal of the American Academy of Child and Adolescent Psychiatry, 52(8), 772–774. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3919207/