Comorbidity | Autism Expert Advices

Imagine that there is a child who was extremely active as an infant and toddler. Her mother discovered her at 12 months repeatedly climbing out of her baby’s bed onto a near to dresser and jumping from the dresser to her bed again. She went to preschool at age 3 because her mother was exhausted and being sick of keeping up with her. Afterward, her teacher noted an incapability to sit still and listen respectfully; disruptive and aggressive behaviors; and problems with social interactions and relations. First of all, the teacher could not decide whether the child has Autism Spectrum Disorder (ASD) or ADHD ( Attention- Deficit Hyperactivity Disorder). Because it seems that they are controversial disorders in childhood period. For this reason, the child should see the doctor in order to diagnose for better life quality. Almost everyone thinks that autism and ADHD are replicable disorders. However, actually they are very different from each other at the main symptoms, even they have some common symptoms. Because of this reason, this article aims to explain what is Autism Spectrum Disorder (ASD), what is Attention- Deficit Hyperactivity Disorder (ADHD), the relationship between ASD and ADHD, differences between ASD and ADHD; and how these disorders can be diagnosed. Autism Spectrum Disorder (ASD) ASD is a neurodevelopmental disorder that has lifelong implications. It is characterized by impairments in social interactions and communications; disability in how they experience the world; repetitive thought and behavior patterns. Atypical Autism It is the diagnosis given to children who have symptoms of ASD but do not meet enough criteria to be diagnosed. Atypical autism has difficulty in speaking, difficulty in communicating, disorders in development, repetitive speeches, problems with socialization, but these symptoms may appear in later ages or may be seen to be less likely to prevent a full diagnosis. The most important feature that differentiates atypical autism from other types of ASD is the ability to overcome speech and communication disabilities which are experienced by individuals through early diagnosis and proper treatment methods. Atypical autism is more similar than ASD with Attention-Deficit Hyperactivity Disorder (ADHD). They have more similar symptoms and they are confusable most of the time. Attention- Deficit Hyperactivity Disorder (ADHD) ADHD is a neurodevelopmental disorder that has effects in lifelong. The disorder consists of 2 main dimensions which are inattention and hyperactivity-impulsivity. Children with ADHD have higher activity levels than age groups. They are unable to sustain attention. They have impulse control behaviors and poor self-regulation. Symptoms of Hyperactivity • Difficulties with fidgetiness and staying seated• Moving about, mostly running• Climbing more• Playing noisily• Accident prone, engage in dangerous behaviors• Responding quickly• Talks excessively and interrupts others• Unable to wait in line, take turns, delay gratification, resist temptations• Acts without thinking, careless, rude (IMPULSIVITY)• Irresponsible, immature Symptoms of Inattention • Unable to focus consistently (sustained attention)• Having trouble in selective attention and attentional alert• Unable to manage simultaneous stimuli or switching from one task to another• May focus on unimportant information• Unable to concentrate and to persist at tasks• Trouble to follow rules or instructions• Daydream or off-task, seems to not listen when spoken to• Fail to finish assignments, easily distracted• CONTROL and SELF-REGULATION are the main problems of inattention. The symptoms of Attention- Deficit Hyperactivity Disorder (ADHD) should be present before age 12 and the child should display the symptoms for at least 6 months. Because all the criterion behaviors also can be observed in normally developed children and they may vary with developmental level. The professionalist diagnoses only when the symptoms are at odds with developmental level. The symptoms of ADHD must occur at least in two different settings in the same time period, for example, both at home and in school. The symptoms interfere with social, academic or occupational functioning. On the other hand, it may reduce life quality. In addition to those, the symptoms of ADHD cannot be explained by another mental disorder. Secondary Features of Attention- Deficit Hyperactivity Disorder In addition to the main symptoms, ADHD has also accompanying symptoms. Motor Skills = Clumsiness, delay in motor milestones, poor performance in sports, neurological soft signs, a deficit in fine motor coordination and timing Intelligence and Academic AChievement = lower score on an intelligence test, lower verbal IQ, low school grades, being held back in grades, placement in special education courses, failure to graduate, incomplete homework assignments, excessive absence from school, need tutoring Executive Functions = having difficulties in planning and organizing actions, impairment in working memory and verbal self-regulation, uninhibition of behaviors Adaptive Behavior = deficits in self-care, immature behaviors, require monitoring by adults, failure to learn everyday skills, failure to perform known skills Social Behavior and Relationships = excessive activity, inappropriate talkativeness, interrupting others, negative style of social interaction, physical and verbal aggression towards others, rule-breaking, hostile controlling behavior, having slow behavioral style, showing a tendency toward shyness and withdrawal, easily irritated and tantrums, more demanding, less cooperative Peer and Teacher Relations = being disliked and rejected by peers, having trouble making and keeping friends, less cooperation and other positive behaviors, less opportunity to acquire social competence and empathy Family Relations = more negative and less rewarding parents, negative interactions and conflicts, hostility Health, Sleep and Accidents = inability to fall asleep, night awakening, fewer hours of sleep, teeth grinding and leg restlessness during sleep, having a more accidental injury such as bone fractures, accidental poisoning, and automobile accidents, motor incoordination, defiant and aggressive behavior Nowadays, about %3 to %5 of school-age children have Attention- Deficit Hyperactivity Disorder. Boys are diagnosed more frequently than girls because boys display more antisocial and aggressive behaviors than girls do. Developmental Course of Attention- Deficit Hyperactivity Disorder Examination of the first years of life can be important and critical for understanding the origin of ADHD. The developmental course of the symptoms of the disorder can only be understood by observing the persistence of the symptoms in adolescence and adulthood. ADHD is mostly observed in childhood, especially in preschool age. Because these years requires more attention, following rules, getting along with others and regulating own behaviors. If those children cannot display these behaviors appropriately, parents or teachers understand there is a problem with the child. Moreover, the symptoms can be continued in adolescence. For example; blurting something out, becoming distracted easily, not completing the task before moving to another, unable to give attention, not follow the instructions, involving in dangerous activities, moving incessantly, not seated consistently, losing the necessary materials, non-stop talking. Main features of ADHD decreases over time but secondary features are becoming apparent into adulthood. Adults with ADHD mostly have jobs and are economically independent. On the other hands, they have a tendency to switch their jobs frequently and have lower socioeconomic status than normally developed people. As a conclusion, we can say that people display symptoms of ADHD in lower levels throughout their lives but the symptoms are never gone. The continuity of problems is linked to several problems. Intervention for Attention- Deficit Hyperactivity Disorder Prevention = parental care, avoidance of environmental toxins, optimal family life Pharmacological Interventions = stimulant medication which increases dopamine and norepinephrine in the brain’s neural networks Behaviorally Oriented Interventions = parent training, classroom management such as contingency contracting and daily report card Multimodal Treatment = combination of medication treatment and behavioral treatment In the treatment of hyperactivity, the responses of children will be different from each other, so a single treatment method cannot be mentioned. The treatment should be specified individually. Co-Occurring Disorders with Attention- Deficit Hyperactivity Disorder Children with Attention- Deficit Hyperactivity Disorder also has with learning disabilities, externalizing disorders, internalizing disorders, and Autism Spectrum Disorder (ASD) at high rates. Relationship Between Autism and ADHD According to DSM – IV, Autism Spectrum Disorder (ASD) and Attention- Deficit Hyperactivity Disorder, yes, they are under the neurodevelopmental disorders umbrella. But, they cannot be diagnosed simultaneously. On the other hand, some findings suggest that these two disorders are co-morbidities. It does not necessary that every child with ASD has both ASD and hyperactivity at the same time. On the other hand, ADHD is one of the most common symptoms in the diagnosis of ASD. Most children with ASD have hyperactivity with attention deficit. Excessive mobility can be observed at around age 2. It is possible for this extremism to continue for a long time in children with ASD. This makes the situation more difficult in order to control it. These excesses may decrease after a certain time. Sometimes, excessive mobility may occur only in certain situations and in certain places. It is thought that there is a link between ADHD and ASD. However, it is still being investigated whether autism is one of the situations that are included in attention deficit and hyperactivity. It would not be appropriate to apply ASD treatments for a child with only hyperactivity characteristics. The professionalists should carry out an investigation for these kinds of situations and treatment methods should be followed according to those investigations. Autism is a disorder that has an influence on an individual’s life. Hyperactivity is likely to be treated. It can be observed that individuals with ASD often experience this distraction, but it will be more accurate to regard this as a symptom only. The professionalists mostly recommend medication or drug therapy in order to control hyperactivity. However, it may be necessary to get psychological support from a psychologist. Getting such help will give the child better life quality in terms of the child's development. Families can also act more accurately on how to behave to their children. There are certain ways in which individuals with ASD have to follow in order to enhance their hyperactivity problems. The professionalists recommend that you do not find any of this information from your environment or the Internet. Each child needs different types of interventions. With the tests to be carried out by the psychologists or psychiatrists, the treatments to be applied to the child should be established after clearly determining the child's level. Parents can improve their child’s adaptation to social life by spending more time with them in order to support their child’s treatment. ADHD and ASD can show very similar symptoms. Children who have both disorders tend to be very active and impulsive. Therefore, they may have problems interacting with others. In fact, it is difficult to pinpoint the difference between ADHD and ASD. However, the difference is very important for the future of children. Why the Difference Between Autism and ADHD Is Important? Although it is said that there are many unknowns about autism, the most important point is the importance of early diagnosis. The sooner the treatment is started, the better the child in the long term. The child with ASD can be diagnosed at 24 months of age, but the diagnosis usually remains after 4 years of age. Every year the diagnosis is delayed, the child cannot get help, which can lead to life-long unintended consequences. So it is very important to know that early diagnosis saves lives! It is not always easy for pediatricians to diagnose ASD in young children. It requires special education and spending adequate time with the child. Also, considering that the social aspects influenced by autism cannot be clearly seen before the children start school, parents do not realize that the child has difficulty in socializing with others and cannot report to the pediatrician. In addition to those, many parents prefer to hear that their children have ADHD rather than their child has ASD. Because of this reason, parents do not insist on further testing. This can be understandable, but when the actual diagnosis and the actual treatment needed does not start early, things are getting harder for the future. Autism Spectrum Disorder is not the only disorder that has similar symptoms with Attention- Deficit Hyperactivity Disorder. Some children with learning disabilities, sleep disturbances, hearing loss, and other problems are often misdiagnosed as ADHD. Therefore, before diagnosing ADHD, especially at an early age, parents should talk to pediatricians about whether further research and testing is a good idea or not. This process can be challenging for families, but it is very important to support the child in line with their actual needs.