The intention in writing this article was to develop a concise understanding of the relationship between Autistic Spectrum Disorders (ASD) and ADD/ADHD; the road was far from short and generated its fair share of questions on the way. Nevertheless, I succeeded, albeit momentarily, to adjust the circles to some semblance of a straight line.
The first of my circles, oddly enough, began right at the beginning: do ASD and ADD occur together in a significant number of cases? The answer is both no and yes. According to the Diagnostic and Statistical Manual IV (DSM-IV), the tool used by members of mental health professions to diagnose disorders, a diagnosis of ADD can only be made once Autism has been ruled out; the two cannot co-occur. Yet the same professionals who use this diagnostic tool have seen with their own eyes a single child who ticks all the boxes of both ASD and ADD. To appease the DSM and allow for a comprehensive treatment plan ASD can be said to co-occur with features of ADD including inattention, impulsivity and hyperactivity (as a side note I tried to rephrase this since inattention, impulsivity and hyperactivity define ADD and ADHD, but to avoid another circle I accepted it in all its humour).
After avoiding that circle, I stepped straight into another one: the development of a comprehensive treatment plan. For some, a change in diet and various therapies, such as OT and Behavioural Therapy, can have the desired effect on a child with ADD to concentrate more effectively for longer periods of time. For others, medication is the answer and for others still a mixture of everything is required. For a child diagnosed with ASD with features of ADD, where non-medication therapies are not quite enough, the question of whether or not to introduce medication arises, followed immediately by which one: stimulant or non-stimulant?
Stimulants, such as Ritalin, which are widely used to treat inattention and hyperactivity as a result of ADD and ADHD, often have the side effect of increasing anxiety. For children with ASD anxiety is already, very often, part of the package; an increase is not welcome to say the least. Furthermore, research has shown that those with Autism respond at a lower rate than those with ADD alone. Side effects of non-stimulants such as Strattera can include mood swings and suicidal thoughts. Mood swings are another symptom where an increase is unwanted. Should the individual already be self-injurious, the addition of suicidal thoughts could be disastrous. Having shared these terrifying thoughts, there are those on the Autistic Spectrum who have benefited greatly from stimulant and non-stimulant medications. Some parents have reported an increase in language and calmer behaviour.
This medication circle was never suitably uncurled in my mind beyond the fact that every child is different. And so came the temporary straightening of my circular adventure; no eureka moment of how to completely separate or entwine ASD and ADD, nor a treatment option that worked for at least 99% of individuals with a primary diagnosis of ASD or ADD with features of the other. After my momentary frustration I decided to take solace in the fact that I confirmed something we all know: despite a diagnosis, each child comes with a unique set of traits and needs to be treated accordingly; and that path unfortunately is rarely straight.
Published in Living ADDventure Issue 3 Oct 09