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
