ADHD, Autism or Both?

Contributed by Jill Matson, MSN, RN, CPNPM

Attention deficit hyperactivity disorder and autism can look a lot alike, making
it difficult at times for parents and professionals to tell the difference between
the two. Symptoms of both autism and ADHD include inattention, social
difficulties, hyperactivity and impulsivity. While some individuals are
diagnosed with either ADHD or Autism, others may be diagnosed with both.
Because children with autism can present with symptoms similar to ADHD,
they often receive a diagnosis of ADHD first.

A study published in the journal Pediatrics (Volume 136, number 4, October 2015) looked at almost 1,500 children between the ages of two and 17 who had been diagnosed with autism; twenty percent of these children had initially been diagnosed with ADHD. What the study found was that children with ADHD diagnosed first were nearly 30 times more likely to receive their ASD diagnosis after age six.

Why does this matter? The earlier treatment is started for autism, the better the long-term outcome. Currently, the average age of autism diagnosis is four years even though it can be reliably diagnosed in children as young as two years of age. To avoid potential delays in autism diagnosis and treatment, clinicians should consider autism when evaluating young children presenting with symptoms of ADHD.

Below is a comparison of ADHD and autism:

What Is It?Attention Deficit Hyperactivity Disorder is a neurodevelopmental disorder resulting in ongoing, clinically significant problems with inattention, hyperactivity and impulsivityAutism is a neurodevelopmental
disability that results in social communication difficulties, repetitive behaviors and
restricted areas of interest.
Symptoms must be persistent and present before three years of age.
Signs You
May Notice
• Forgetful and easily distracted
• Trouble listening and following directions
• Emotional dysregulation/ tantrums due to frustration or lack of impulse control
• Poor organizational skills and difficulty completing tasks
• Struggles to stay focused unless it is a preferred activity
• Social difficulties
• Problems sitting still during quiet activities (school, mealtimes)
• Difficulty being patient/waiting for turns
• Hyperactivity, fidgeting
• Interrupts others, blurts out inappropriate things, difficulty with non-verbal cues and personal space
• Impulsivity, difficulty understanding consequences of actions
• Plays rough, takes physical risks
• Seems disengaged; avoids eye contact and/or physical contact
• Difficulty following directions due to speech and language delays; echolalia
• Emotional dysregulation/tantrums due to sensory processing problems, anxiety, frustration or communication difficulties
• Social difficulties
• Repetitive behaviors to self-soothe (rocking, hand flapping, jumping, spinning)
• Obsessive interests, experiences; perseveration
• Hyperactivity, fidgeting
• Difficulty understanding
non-verbal cues, personal space, sarcasm, humor, feelings/emotions
• Sensory processing deficits
• Difficulty with safety/danger awareness
Emotional and
Social Impact
Impulsive behavior and poor social skills make it difficult to develop and maintain friendships; frequent reprimands for problem behavior can lead to poor self-esteemRigid, repetitive behavior and social communication deficits make it difficult to relate to others, develop/maintain friendships
May qualify for special education services (IEP or 504 Plan) with educational certification of Other Health Impairment (OHI)May qualify for special education
services (IEP or 504 Plan) under the
educational certification of Autism
Who Can Provide
a Diagnosis
Pediatricians, Pediatric Neurologists,
Pediatricians, Child & Adolescent
Psychiatrists, Neuropsychologists,
Clinical Psychologists
Pediatric Neurologists,
Pediatricians, Child & Adolescent
Psychiatrists, Neuropsychologist,
Clinical Psychologist
Treatment StrategiesMedication Management
Educational Programming
Behavior Management
Medical Management, Applied
Behavior Analysis (ABA), Speech
Therapy, Occupational Therapy,
Physical Therapy, Social Skills
Groups, Educational Programming
Co-occurring Conditions• Anxiety
• Depression
• Learning Disabilities
• Language Disorders
• Tics
• Sleep Disturbances
• Coordination Disorder (fine and gross motor)
• Dysfunction Coordination
Disorder (fine and gross motor)
• Anxiety
• Depression
• Mood Disorders
• Seizure Disorder (Epilepsy)
• Genetic Disorders
• Gastrointestinal Problems
• Sleep Dysfunction
• Feeding Difficulties (sensory, swallowing)
• Sensory Processing Disorders
Medication OptionsStimulants
Alpha-2 Agonists (Clonidine/Kapvay,
Atomoxetine (Strattera)
Atypical antipsychotics
Alpha-2 Agonists
Antiepileptic Mood Stabilizers