On the spectrum...or not?
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Anonymous
The line between ADHD and ASD is somewhat arbitrary, so if your child is close to the line, testers may vary as to which side he is on. But don't get too caught up with the diagnosis. Treatment is based on the child's actual symptoms, not the diagnosis. |
Anonymous
+a million |
Anonymous
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I have a child with an ADHD diagnosis who has repeatedly been found to have "borderline ASD." Essentially she exhibits many ASD traits but not enough to warrant an ASD diagnosis "at this time."
Once I asked her developmental pediatrician what the threshold is for getting an ASD diagnosis, and was told it came down to the level of impairment. |
Anonymous
I don't think that's accurate. Kids with mild Asd are usually much less affected than my kid with severe ADHD. |
Anonymous
I agree with this post. The problem is every developmental ped you ask will tell you something different. We were told that our child is ASD by history only as he showed traits early on but not any more. He said that the level of impairment was not relevant and only relevant in which type of ASD. |
Anonymous
I think you misunderstood me, or at least I failed to express myself well. I'm not commenting on whether ADHD can cause severe impairments or not. Just saying I have a child with "borderline ASD". Multiple evaluators have seen ASD traits in my child but nobody has given her a formal diagnosis of ASD, as her ASD symptoms are presently not severe enough to warrant an ASD diagnosis. |
Anonymous
Has your child had ADOS. ADOS/ADI-R at large teaching hospitals like Children's and Hopkins are considered pretty definitive for diagnosing ASDs. |
Anonymous
Not the PP, but my kid has a similar "borderline" situation that does not warrant an ASD diagnosis at this time. And yes, my DC was evaluated at KKI at Hopkins with an ADOS. The professionals there are the first ones to tell you when there are shades of gray in your child's diagnosis and when they'd prefer to wait to see how your child develops in a year or two and then reassessing. |
Anonymous
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I'm the poster who first shared about my "borderline ASD" child. She was evaluated at Children's three times or so over the course of over a year. She's also been repeatedly evaluated by a developmental pediatrician well-regarded on this board. All see "borderline ASD." She is five and has an IEP for "developmental delay." When she's six she'll get a neuropsych exam.
I should add that an older sibling has ASD, so we know what a non borderline case looks like. But this thread is about whether someone is or is not on the spectrum--and agree that sometimes it's grey. While her doctor is not ready to apply the formal ASD diagnosis, I am told that ASD is a useful lenses for understanding my child's issues. |
Anonymous
I agree with this but would suggest you think of these diagnoses as more of a Venn diagram with overlaps in circles. Add anxiety, speech impairments as other circles with big overlaps with ASD and ADHD. It's not really a line in the sense that if you don't have ASD you have ADHD and vice versa. There are a lot of symptoms of both that could be caused by something completely different. |
Anonymous
| a quick dumb question: what is ADOS? |
Anonymous
Exactly. We really need a different word than "diagnosis" in this area, since we usually use that word to mean the conclusive identification of an underlying pathology that is causing particular symptoms. An ADHD or ASD "diagnosis" is just a word that the clinical establishment has agreed to use (for now) to describe people whose traits or symptoms or behavior meet some checklist that they have made up. A generation or two ago this thread would have been a debate about whether certain kids truly have "childhood schizophrenia." If a newer label or checklist proves useful in helping a group of kids more successfully, then instrumentally it's a better label. But it's still all just made up. This isn't a point about replicability. It can be simultaneously true that the ADOS is a replicable and consistent way of labeling certain kids as "ASD" and others not, and that the line it is drawing is arbitrary and fails to capture all of what is going on. I like the advice that one PP got -- your kid doesn't meet the DSM criteria for an ASD, but books about ASD might nonetheless give you some useful insight into certain aspects of his experience or behavior. That would be true of most of the ADHD kids I've met. |
Anonymous
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I think it's helpful to look at the actual standards, according the the DSM 5. I have a child who has the repetitive interests, but only one from Section A, so even though he looks autistic to outsiders, that is not his diagnosis.
http://nationalautismnetwork.com/about-autism/diagnosis-of-autism/dsm-5-autism-spectrum-disorder.html This presentation provides us with the major changes to the ASD diagnostic criteria, but there are more specific and minute changes as well. According to SafeMinds2, the following is the new diagnostic criteria for autism spectrum disorder: Currently, or by history, must meet criteria A, B, C, and D: A. All individuals must have or have had persistent deficits in social communication and social interaction across contexts, not accounted for by general developmental delays, and manifest by all 3 of the following: 1. Deficits in social-emotional reciprocity; ranging from abnormal social approach and failure of normal back and forth conversation through reduced sharing of interests, emotions, and affect and response to total lack of initiation of social interaction, 2. Deficits in nonverbal communicative behaviors used for social interaction; ranging from poorly integrated- verbal and nonverbal communication, through abnormalities in eye contact and body-language, or deficits in understanding and use of nonverbal communication, to total lack of facial expression or gestures. 3. Deficits in developing and maintaining relationships, appropriate to developmental level (beyond those with caregivers); ranging from difficulties adjusting behavior to suit different social contexts through difficulties in sharing imaginative play and in making friends to an apparent absence of interest in people B. All individuals must have or have had restricted, repetitive patterns of behavior, interests, or activities as manifested by at least two of the following: 1. Stereotyped or repetitive speech, motor movements, or use of objects; (such as simple motor stereotypies, echolalia, repetitive use of objects, or idiosyncratic phrases). 2. Excessive adherence to routines, ritualized patterns of verbal or nonverbal behavior, or excessive resistance to change; (such as motoric rituals, insistence on same route or food, repetitive questioning or extreme distress at small changes). 3. Highly restricted, fixated interests that are abnormal in intensity or focus; (such as strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interests). 4. Hyper-or hypo-reactivity to sensory input or unusual interest in sensory aspects of environment; (such as apparent indifference to pain/heat/cold, adverse response to specific sounds or textures, excessive smelling or touching of objects, fascination with lights or spinning objects). C. Symptoms must be present in early childhood (but may not become fully manifest until social demands exceed limited capacities) D. Symptoms together limit and impair everyday functioning. The DSM 5 specifies the severity levels of autism as follows: Level 1- Requiring Support: Social Communication: Without supports in place, deficits in social communication cause noticeable impairments. Difficulty initiating social interactions, and demonstrates clear examples of atypical or unsuccessful responses to social overtures of others. May appear to have decreased interest in social interactions. Restricted Interests and Repetitive Behaviors: Inflexibility of behavior causes significant interference with functioning in one or more contexts. Difficulty switching between activities. Problems of organization and planning hamper independence. Level 2- Requiring Substantial Support: Social Communication: Marked deficits in verbal and nonverbal social communication skills; social impairments apparent even with social supports in place; limited initiation of social interactions and reduced or abnormal response to social overtures from others. Restricted Interests and Repetitive Behaviors: Inflexibility of behavior, difficulty coping with change or other restricted/repetitive behaviors appear frequently enough to be obvious to the casual observers and interfere with functioning in a variety of contexts. Distress and/or difficulty changing focus or action. Level 3- Requiring Very Substantial Support: Social Communication: Severe deficits in verbal and nonverbal social communication skills cause severe impairments in functioning, very limited initiation of social interactions, and minimal response to social overtures from others. Restricted Interests and Repetitive Behaviors: Inflexibility of behavior, extreme difficulty coping with change, or other restricted/repetitive behaviors markedly interfere with functioning in all spheres. Great distress/difficulty changing focus or action. |
Anonymous
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I think A (which refers simply to "deficits" in social-emotional interactions or communications) and D ("Symptoms together limit and impair everyday functioning") are the places where the subjective nature of the diagnosis between different evaluators can take place.
D is also very tricky to pin down because it depend a lot on the subjective feedback of parents and teachers. Chess mom, if you are out there and willing to share, curious about how D applies to your experiences? |