ADHD Combined with ASD?
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Anonymous
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We just had my daughter retested because she is heading to college in the fall. She is classic ADHD, but also quirky. We were surprised that the psychologist also thinks she is on the ASD spectrum, although more like what we would have called Asperger's in the past. It doesn't really bother us what the label is, but I keep thinking over it and I just don't see the ASD. Maybe I have antiquated ideas about what ASD can be, but I'll give you a few characteristics that seem to conflict:
-no language delays, talked early -absolutely loved pretend play as a child, the pretend play was very complex and would often create and lead pretend play sessions for groups of kids -extremely social, always wants to be where the action is, often the loudest and happiest one in the group -extremely talkative, asks many questions -extremely empathetic and loves taking care of others -very athletic, enjoys taking risks (loves mountain biking, including going as fast as she can down difficult trails) -gets bored extremely easily at home, wants to be outside and with friends as much as possible -trouble getting schoolwork completed, thinks most high school assignments are torture, but enjoys challenging, out of the box, assignments -adderall works well for her and does not make her more anxious -executive functioning deficits, very forgetful On the other hand, there are some characteristics of ASD, which are also sometimes ADHD: -social issues, makes friends easily and people are drawn to her, but has trouble maintaining those friendships (I think because she can be so intense) -lots of intense interests and will go on and on about them if anyone shows slight interest, but has gotten better about picking up on cues that others are getting annoyed -loves to draw and can often get lost in her own world while drawing or doing art -extreme anxiety, which has settled since starting prozac -has some routines that she likes to do everyday (juggling her soccer ball, drawing a sketch in the morning, stretches and strengthening exercises). She doesn't necessarily have to do them at a certain time of day, but will get stressed if she doesn't get a chance to do them. -rigidity (hard to move on from tasks) and black/white thinking -extremely critical of herself, makes negative comments about herself Psychologist recommended community college, but daughter wants to go to college. She is also a talented athlete, and the small schools we are looking at have all extended athletic offers We are looking at small, private colleges with really good disability supports close to home. I don't want to send her and have her fall flat, but she is so desperate for independence. Neurospsych showed superior scores in many areas, with very low processing speed and working memory. Anyway have a child with a similar profile? What route did your child take after high school? |
Anonymous
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It's rare to have ADHD without some other comorbidity. ASD plus ADHD is a common profile.
Your ideas of what ASD can be might not be antiquated so based on how ASD typically presents in boys. Here is a presentation at a UC Davis conference on parsing out ADHD and ASD in girls. https://www.youtube.com/watch?v=uahDrGJ4m8s&t=1702s |
Anonymous
| What good is being close to home going to do? What is wrong with a school that has really good disability supports that is larger or farther away? I think that she should go where she wants to go; knowing she chose her path is going to be a factor in her success. |
Anonymous
Those are actually her preferences, close to home and a small school. I do think it is good for her to be close given her mental health issues (anxiety) so that it is easier to monitor her mental state and have her visit her doctors at home if needed. |
Anonymous
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We will retest DS in the Spring, in view of college accommodations, and expect to receive an ASD diagnosis, in addition to his known ADHD, processing speed at the FOURTH percentile, and various other LDs. We always suspected it, and will not be surprised. His social life is non-existent. Academically, there is no issue, though, as long as he takes his Adderall and gets extended time due to his abysmal processing speed.
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Anonymous
OP here - what are you thinking as far as post-high school plans? |
Anonymous
| My daughter has a similar profile, but no ADHD. She was just diagnosed with ASD at age 18. She wants to stay close to home, but chose a larger university and our plan is to work closely with the disability services office. She is taking a gap year to work on her independence and non-academic skills she'll need to succeed in college. So far, it's been a great choice for her. She'll start college next fall. |
Anonymous
Op here - This sounds like a solid plan. What is she doing in her gap year to work on independence? Our hesitancy with that is that our daughter has many neighborhood friends who are younger than her, and we are worried that might be a barrier to her growth. |
Anonymous
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My dd is only a freshman in high school, so I can’t offer advice on college, but my dd sounds extremely similar to your dd. She had a neuropsychological exam done at age 10 for educational purposes and received an ASD diagnosis, which really surprised us because multiple doctors had told us for years that dd wasn’t on the spectrum. Our developmental pediatrician disagreed with the diagnosis. A second developmental pediatrician didn’t feel that the diagnosis mattered because dd is too high functioning for ASD-specific interventions to be appropriate. We finally took dd to a speech pathologist for ADOS. The SLP said that dd was borderline and probably was on the spectrum, but agreed that ASD interventions weren’t appropriate. She said that the only intervention she would recommend is if, and only if, dd felt like it would be beneficial, dd could book a single session with her to role play and practice more subtle things, like sarcasm.
We were told that ASD presents differently in girls than boys, and that the brains of girls who have ASD are most similar not to boys with ASD or girls without ASD, but to boys who don’t have ASD. The combination of being told that ASD interventions weren’t appropriate for dd and that her brain is very similar to neurotypical boys made the ASD diagnosis seem worthless. She has a diagnosis, but we’re not supposed to do anything about it? She’s on the spectrum, but not in a meaningful way? Her developmental pediatrician told us that there are tons of people like dd, who are on the spectrum but high functioning, and they’ll never know it simply because they’ve never had a neuropsych exam. The one person who forecasted gloom and doom was the neuropsychologist. She said that dd would have to be in a special autism program or she would be mercilessly picked on in middle school. Our public school was not about to put dd in a special program. All of the educators said dd was much higher functioning than the students in the program. We didn’t feel that everything in the neuropsychologist’s report was accurate, and the specialists who knew dd much better felt that she belonged in a gifted program more than a program for students with ASD. We went ahead with our public middle school. We have no regrets. DD wasn’t mercilessly bullied. There were a couple incidents, but they were more about her being female than about her being on the spectrum. (Boys sexually harassing her.) The important thing, IMO, is to use the neuropsych exam as a framework to better understand your dd, but not as a rewrite of everything you know to be true about her. The neuropsychologist has some insights that you don’t, but you have insights that he or she doesn’t. You know your dd the best. If you and dd feel confident that she doesn’t need to be at home to be successful in college, then don’t let someone who spent a few hours with your dd in an artificial setting dictate her college experience, especially if you won’t be financially ruined by dd transferring back home after a semester or two if it doesn’t work out. |
Anonymous
| Thank you so much for posting this. I've been debating the past little while as to whether I should have my daughter tested for ?. Anxiety and OCD seem very much present, but she is quirky in other ways as well, always has been. Has been very successful in school until highschool. Pandemic didn't help either. I felt odd thinking to have her tested at 16, like we should know this already, but gut feeling is telling me there is more than anxiety. Many similarities. |
Anonymous
The usual selective colleges, since that's what DS wants. However, I'd like them to be closer to home if possible (we considered then nixed unis in the UK, but still have McGill), and he'll have to manage his accommodations and medications, otherwise it will be a disaster - so I'm not sure about Canada. He also has some medical needs that we have to sort out before next year (unrelated to the psychiatric diagnoses). |
Anonymous
Thank you! This was so interesting and informative. |
Anonymous
| Perspective as a boy mom - we also got an asd dx in addition to the adhd and ds has no issues with perseveration/ understanding sarcasm/ pretend play/ reciprocal conversation/ extroversion etc. i think the asd profile is now honestly just so wide that you will tend to get that dx with any social emotional deficit. Adhd specifically has a lot of crossover with asd (emotional regulation and inflexibility) so hard to parse the difference. Honestly we really just don’t understand either at this stage so neuropsychs are almost becoming outdated and opinions from more consistent providers are likely more valuable |
Anonymous
What do you mean opinions “from more consistent providers” are more valuable? Does this include a teacher or tutor or parent? All of whom are constantly seeing the patterns or behaviors, whereas a neuropsych tester is not. |
Anonymous
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My DS was similar and "almost" got the ASD diagnosis. But in reality, the psychiatrist thinks its really just anxiety - a pretty serious case of anxiety.
DS is now in college. He takes meds, goes to therapy and is very self aware. Social situations are still a bit hard, he has a lot of coping skills and he knows the use them, he still sees (virtually) the same psychiatrist that he has seen since middle school so there is a lot of trust and understanding there. He is doing great in college - has friends (but of course it's not easy or perfect) and he is doing great in classes and he is very independent. He also lives alone in a single because he needs downtime and can't have someone there to talk to all the time. It's working out for him. |