The relationship between ADHD and autism

AS_12-LIUB-Twitter-IconAs a child psychiatrist, the vast majority of requests I receive from a parent or colleague to evaluate a child with an autism spectrum disorder (ASD), the reason for the request involves the need to treat some other condition associated with the ASD, most notably attention problems or obsessive thinking. For the purpose of our discussion today, I’ll focus specifically on the ADHD.

Recent estimates suggest that over 30% of children with autism spectrum disorders (ASD) meet diagnostic criteria for ADHD, and another 20% of children with ASD exhibit sub-threshold ADHD symptoms.

One of the challenges we face in treating kids who have both conditions is that in my experience, kids with ASDs are more susceptible to stimulant-related side effects (irritability, emotional lability, aggression, tic exacerbation, increased stereotypies), but when they do work, stimulants are often very helpful for inattention, improving capacity for self-regulation  and reducing aggressive behavior and are far more benign from a side effect standpoint than the atypical antipsychotics that carry FDA indications for kids with spectrum disorders.

Square Peg Round HoleTeasing out the connection between the two disorders may help us in understanding the underlying causes of each disorder and begin to point us in the direction of earlier intervention. The studies to date suggest that gene variations common to both disorders and abnormalities in the development of specific brain pathways and regions are likely explanations for the co-occurrence of the two disorders. From a functional standpoint, kids with ADHD and ASDs are more likely to have more difficulty with behavioral inhibition compared to kids with either disorder alone, and one small study demonstrated increased externalizing behavior problems, aggression, delinquent behaviors, and thought problems in the ASD+ADHD group relative to an ASD group which exhibited subthreshold externalizing problems (Matsushima et al., 2008), suggesting that ADHD symptoms exacerbated externalizing problems in ASD.

One especially interesting hypothesis explaining the co-occurrence of ADHD and ASDs involves abnormalities in the development of connectivity between different regions within the brain’s “default network”…systems that are active during introspective, task-free processes. Here’s an excellent article explaining the role default networks play in the brain and why folks are interested in the role abnormalities in the development of the default network play in contributing to the traits associated with autism. The default network also appears to play an important role in the development of executive functioning…thought to be the core difference among persons with ADHD.

The implication of all this for church staff and volunteers is to appreciate the reality that if you’ve seen one kid with autism, you’ve seen one kid with autism. Effective strategies for inclusion at church and the resources families find helpful in promoting the spiritual growth of their child aren’t “one size fits all” for kids with ADHD, autism spectrum disorders, or both.

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shutterstock_144843835Key Ministry has assembled a helpful resource page for church leaders and parents addressing the topic of ADHD and spiritual development. This page includes our blog series on the topic and links to helpful videos and resources for pastors, church staff, volunteers and parents. Access the resource page here.

About Dr. G

Dr. Stephen Grcevich serves as President and Founder of Key Ministry, a non-profit organization providing free training, consultation, resources and support to help churches serve families of children with disabilities. Dr. Grcevich is a graduate of Northeastern Ohio Medical University (NEOMED), trained in General Psychiatry at the Cleveland Clinic Foundation and in Child and Adolescent Psychiatry at University Hospitals of Cleveland/Case Western Reserve University. He is a faculty member in Child and Adolescent Psychiatry at two medical schools, leads a group practice in suburban Cleveland (Family Center by the Falls), and continues to be involved in research evaluating the safety and effectiveness of medications prescribed to children for ADHD, anxiety and depression. He is a past recipient of the Exemplary Psychiatrist Award from the National Alliance on Mental Illness (NAMI). Dr. Grcevich was recently recognized by Sharecare as one of the top ten online influencers in children’s mental health. His blog for Key Ministry, www.church4everychild.org was ranked fourth among the top 100 children's ministry blogs in 2015 by Ministry to Children.
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2 Responses to The relationship between ADHD and autism

  1. Tammy says:

    so are you saying that about 50% of those diagnosed w/ASD do not experience attention deficit? and/or hyperactivity?

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    • drgrcevich says:

      I’ve seen figures for prevalence of ADHD in kids with Asperger’s Disorder quoted in the 60-70% range. Keep in mind that under the current diagnostic classification, NOBODY on the spectrum should have ADHD because autism precludes an ADHD diagnosis.

      The way I think about this is to diagnose ADHD in kids with spectrum disorders when their inattentiveness, impulse control and/or hyperactivity is developmentally inappropriate.

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