Most children with autism spectrum disorder (ASD) do not receive their diagnosis until after age 6. Usually, they are diagnosed with attention deficit disorder (ADD) as toddlers. Part of the reason is doctors routinely screen children for ADD but not autism. Another reason is the social impairments of autism become more evident once a child begins school. Finally, some doctors may be reluctant to label a child “autistic.” After all, it is usually much easier to treat ADD compared to the complex nature of autism.
Doctors make their diagnoses based on children’s behaviors. Since children with attention deficit disorder and autism spectrum disorder share similar behaviors, the two can appear to overlap. However, there is a fundamental difference between attention deficit disorder and autism Children with autism lack what doctors call “social reciprocity” or Theory of Mind. Theory of Mind is “the capacity to understand that other people have thoughts, feelings, motivations and desires that are different from our own.” Conversely, children with ADD have a Theory of Mind and understand other people’s motives and expectations. They make appropriate eye contact and understand social cues, body language, and hidden agendas in social interactions.
One author put it this way: children with attention deficit disorder respond to behavioral modification. With autism, the syndrome is the behavior.
Both kinds of children can tantrum, talk loudly or excessively, and have problems modulating their behaviors. Both face social challenges like making friends, but for different reasons.
The child with attention deficit disorder knows what to do but forgets to do it. Children with autism do not know what to do. They do not understand that relationships are two-sided. When an autistic child talks on and on about his particular interest, he simply does not understand that he is showing disinterest in his friend’s side of the conversation. On the other hand, the child with ADD may know he is dominating the conversation, but cannot control his impulses
A child with ASD or ADD can appear unfocused, forgetful and disorganized. There is a difference: the ADD child is easily distracted and the ASD child has no “filter.” A child with autism sees everything in his environment as equally important. His teacher’s dangling earring is just as important as what is written on the blackboard. A child with autism does not understand that she doesn’t have to memorize the entire textbook for the next test. She does not “get” such rules.
Children with autism tend to get anxious and stuck about small things and cannot see the “big picture.” Children with ADD are not detailed-oriented. In addition, the ADD child understands the rules but lacks the self-control to follow them. A child with autism does not understand the rules.
Some children with autism retreat into a world of their own making – a world where everything goes the way they want it to. They play video games for hours or retreat into books and music. Their daydreaming and fantasizing resembles the behaviors of non-hyperactive children with ADD.
Children with autism may develop obsessive-compulsive tendencies where they live in a world created from rules and rituals. Like ADD children, they appear preoccupied and distracted but for different reasons. Instead of having trouble focusing, ASD children with OCD are always thinking about their rules. “Did I tie my shoelaces right?” “Did I brush my teeth for 120 seconds?”
Some authors estimate that 60% to 70% of children with autism have co-occurring ADD. Other authors say the two disorders cannot exist together. The real problem is that there is no hard science. No one knows exactly how slight differences in brain structure and chemistry cause such problems.
For this reason, getting the right diagnosis for a child who exhibits behavior problems may take trial and error. Diagnosis is based on clinical behavior observation. The tragedy is the child often does not receive correct medications, educational strategies, and behavioral modification techniques to help him function better. He falls further behind his peer group and loses ground when he could be getting appropriate treatments.
“Psychiatry has made great strides in helping kids manage mental illness, particularly moderate conditions, but the system of diagnosis is still 200 to 300 years behind other branches of medicine,” said Dr. E. Jane Costello, a professor of psychiatry and behavioral sciences at Duke University. “On an individual level, for many parents and families, the experience can be a disaster; we must say that.”
Carey, Benedict. “What’s Wrong with My Child? Psychiatrists Often Disagree,” The New York Times, front page, November 11, 2006.
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Myles, Brenda and Jack Southwick. Asperger Syndrome and Difficult Moments. Shawnee Mission, KS: Autism Asperger Publishing, 1999.
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Reichenberg-Ullman, Judyth, Robert Ullman and Ian Luepker. A Drug Free Approach to Asperger Syndrome and Autism (Edmonds, WA: Picnic Point Press), 2005.
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