How can you tell the difference between autism spectrum disorder, ASD, and attention deficit
hyperactivity disorder, ADHD? That's what I'm talking about today. I'm Dr. Tracey Marks, a psychiatrist and I make mental health education videos. Today's question is based
on several viewer questions asking me to talk about this. ADHD and autism are
neurodevelopmental disorders. Neurodevelopmental means that
they start early in childhood and affect how your brain
grows and functions. Examples of neurodevelopmental
disorders include ADHD, autism spectrum disorder or ASD, intellectual developmental disorder, and learning disorders. It is common if you have
one to have another one. In fact, there's a high
prevalence of people with autism spectrum who also have ADHD. The reverse is not as common for people with ADHD to also have ASD, but people with ADHD can have features of autism spectrum without
having the complete disorder. Both disorders are highly genetic, meaning the genes from them are passed down through families. Before comparing the two disorders, let's look at autism spectrum disorder. ASD is a spectrum disorder because there are many features of it. The features can be grouped
into two categories: problems with social communication
and relating to others, and restricted, repetitive patterns of behaviors, interests, or activities. This is the category
that includes being hyper or hyporeactive to sensory experiences. Here's another way of looking
at the symptoms on a spectrum. Going from left to
right, you have language, which is social communication
skills such as body language, eye contact, and small talk
just to name a few skills. Then there is social awareness, which is the ability to read the room, pick up and follow social norms, like saying hello to
someone who walks up to you. Next is narrow interest. This is the tendency to narrowly and intensely focus on a niche interest and have trouble shifting
tasks or activities. Information processing is the ability to learn new information and apply it to different situations. Sensory processing is a person's
response to sensory input like sounds, smells, tastes, and textures. Some people can be hyperreactive
to certain sensory inputs and hyporeactive to others. Repetitive behaviors is a tendency to stim in response to different emotions. Stemming refers to
self-stimulation behaviors like hand flapping, rocking, or blinking. The last column is neuromotor, which refers to the ability to
control your motor movements, and this can range from being clumsy to having little control over intentional movements including bowel and bladder control. A person can have a range
of different functioning in all of these categories such that some categories
may not be as affected as much as others. So in each of these areas, the person with autism spectrum disorder has something going on that is divergent from what is considered standard. If you think of these
columns as a slot machine, you pull the handle and
it turns each column to a different level of function, so each pull of the handle can turn up a different presentation of the disorder, which is why everyone with ASD is unique. For example, let's look
at the language column. One person may not be verbal at all, but is able to pick up on social cues, whereas another person can communicate, but tends to miss social cues and interrupt people when they're talking. A third person may also be
verbal and communicative, but has trouble interpreting
sarcasm and metaphors. For that person, for
optimal communication, they need you to be clear
and use direct words. There's a lot of overlap
between ASD and ADHD. The person who only has ADHD may have a few of these
features, but not all. The person with ASD will
have a functional change in all of the areas to some degree, and they may or may not have problems with attention, impulsivity,
and hyperactivity, which are problems that
come along with ADHD. Let's look at some of
the overlapping symptoms between ADHD and ASD. And this analysis is not all inclusive as this is a very big topic
with a lot of subtleties, so to keep it simple, I'll
be covering the major areas. People with ADHD and ASD both
have executive dysfunction, like being oblivious to time,
emotional dysregulation, and trouble getting things started. Both people with ADHD and ASD also have trouble picking
up on social cues, but for different reasons. The ADHD person may miss social cues because of trouble paying attention to the entire conversation, or hijacking the conversation topic by interrupting and
going off on a tangent. On the other hand, the person with ASD may have social interaction problems because they don't understand
the subtext messages from body language, or they may get overwhelmed with the sensory demands of chit-chatting. Also, the person, or if the
person thinks very literally, they may miss important social
signals or subtle messages. So you can see the difference and the reasoning behind the problems, even though the end result is similar. Self-stimulation is
another overlapping trait that anyone can use to reduce
anxiety or to help with focus, but it's used more consistently
in people with ASD. Sometimes people can
mistake stimming behavior for hyperactivity like shaking your legs or feet under a desk or fidgeting. The difference comes from the
reason behind the activity. The person with ADHD may
fidget to help them focus, even though it may be
also calming and soothing. The person with ASD, if
asked, will usually tell you that something in the environment is making them uncomfortable and they need to fidget to feel better, or the behavior can be so automatic that they can't always tell you that there's something bothering them, they just need to do the behavior. Also, with ASD, it's
usually not random fidgeting like clicking a pen top or doodling. It tends to be more intense with a repetitive pattern like rocking. A difference between ADHD and ASD is with ADHD, you seek out
novel and new experiences and you can become bored with routine. But with ASD, you're comforted
by familiarity and routine. Both of these disorders
show some signs in childhood because of how they
affect brain development, but both disorders may not
be diagnosed until adulthood, especially if your
symptoms were manageable for you to get by without
professional help. If you have the inattentive form of ADHD without hyperactivity, you may not come to the
attention of teachers because you don't pose
discipline problems, but you may be underperforming
with Cs and Ds, just enough to pass your classes. And sadly, no one questions
if you are capable of more because maybe they've put you in the lazy, poor effort category
and just let you flounder. It's not until you have
more serious problems like keeping up with work or
feeling emotionally unstable that you seek professional help. I talk about some of the ways that ADHD can look different in
adults in this video. As for autism spectrum, the symptoms appear when
children aren't meeting their developmental milestones, like they're still wearing
a diaper in first grade or have social communication problems, or intense meltdowns
from sensory overload. These children will usually
come to the attention of a pediatrician or
maybe a child therapist to be evaluated and diagnosed early, but without obvious problematic behaviors, you may go undetected or undiagnosed until adulthood with ASD. One of the problems with getting diagnosed is the variability in the presentations, and doctors aren't trained as well to notice the subtle signs. Also, standard medicine focuses more on pathology than wellness. So even if your doctor notices that you have a different speech pattern and you obsess about things and need to self-soothe in
response to certain sounds, all things suggesting ASD, your doctor still may not intervene unless these behaviors are
causing problems for you, like keeping up with the job
or forming relationships. Another way ASD can go unaddressed is if you have one of the
common comorbid disorders that can accompany ASD, like social anxiety, depression, OCD, or even complex trauma. If you do struggle with any of these, chances are your doctor will
treat you for those problems and not screen you for ASD. I don't recommend trying
to diagnose yourself based on learning things on the internet. However, if you are curious if you may have some
autism spectrum traits that someone missed, I'll have some online
screening tools listed in the description and
they're freely available. If you score high on any of the tools and your symptoms or manifestations are causing problems for you in your work, school, relationships, or with your ability
to feel mentally well, then you should see a professional, preferably a therapist or psychiatrist who has experience
diagnosing and treating ASD. You can tell them you took an
online screen and scored high and you're looking to see what options there are for getting help. If you print out the results, you can have some good talking
points for the clinician. And if they don't think
that you have the disorder, they can explain the discrepancy between your answers and
their clinical impression, and they can help you understand why they don't think
you have the disorder. If you want more on
ADHD, watch my playlist. That includes adult ADHD
and emotional dysregulation, a more detailed explanation
of executive dysfunction, and what happens in the brain that causes people to have low motivation. I also have a skills management playlist, teaching you techniques
for time management and finishing tasks. Thanks for watching. See you next time.
