View Full Version : adhd an autism spectrum disorder?


daveddd
11-28-12, 08:38 PM
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3123401/

just thought this was a good article with several good links

daveddd
11-28-12, 09:20 PM
i wonder though, should it be an autistic spectrum disorder, or a PDD of its own

only because its seems this theory would result in very similar traits

it seems like it would be a deficit vs. inhibition issues?

that would certainly have much different treatment implications ?

Fortune
11-28-12, 09:31 PM
"PDD" is autism, so if it's not autism, it wouldn't be classed under PDDs. I am not saying that ADHD is not pervasive, but rather that the label is intended to describe a specific cluster of disorders.

It's not surprising to me that people with ADHD have more autistic traits than would be expected. It shows a lot in what people post here, and I've a friend who has ADHD and a lot of autistic traits, although she is not herself autistic.

I do not think that ADHD is on the spectrum, but I do think a lot of people are rather spectrummy (as I mentioned above) and that the percentage of people with ADHD who also have autism is higher than the percentage of people in the general population. The reverse is even more true, but with greater frequency (33-75% of autistic people meet the criteria for ADHD across several studies).

daveddd
11-28-12, 09:44 PM
i know what you mean, i meant maybe just specifiers

a lot of the articles seem to find an adhd+odd subset that comes up very often as a PDD nos

i feel like this represents a core temperament that is adhd-c with emotional regulation issues


i believe this results in some specific PDs

adhdc+emotional dysregulation

+externalizing acting out-odd/adhd

internalizing -borderline (the non abuse one)

internalizing+externalizing+inhibition =avoidant

if you control for the above behavior you have a profile that is almost to similar to ignore

personality dimensions, empathetic processes, social issues, impulsiveness and even learning disabilities

i may also being heading into a manic episode

hard to say

daveddd
11-28-12, 10:27 PM
also similar drugs responses and patterns of abuse

ritalin-positive

adderall/cocaine/other stimulants-very sensitive(mild paranoia-psychosis)

daveddd
11-28-12, 11:05 PM
i think NTs are able to self soothe through things like self talk, social interaction and emotional reflection

due to our executive dysfunction and emotional issues we are unable to do this, or avoid situations that would accomplish this

leaving us to our instinctual drives (reward system dysfunction)

so obviously we use a wide variety of defense mechanisms

including perseveration, that may not be healthy, but is low in harm avoidance and can result in positives

ginniebean
11-29-12, 12:46 AM
Fortune, why such a degree of overlap.. both ways?

Fortune
11-29-12, 04:37 AM
I suspect because while diagnoses are discrete categories, brains tend to have this fuzzy organic development thing going on, so if you have one thing not developing ideally, you might have more. But that's just what I think, I have no particular basis for it and evidence otherwise would encourage me to reconsider.

daveddd
11-29-12, 07:37 AM
http://www.ncbi.nlm.nih.gov/pubmed/21667451

daveddd
11-29-12, 07:47 AM
the separation from classic autism is important for treatment reasons

the classic autism, represents a deficit

we (adhd as a pdd) get sarcasm, we have interest in social relationships

we all respond with "high distress" in empathic situations

Fortune
11-29-12, 08:08 AM
the separation from classic autism is important for treatment reasons

the classic autism, represents a deficit

we (adhd as a pdd) get sarcasm, we have interest in social relationships

we all respond with "high distress" in empathic situations

I know people diagnosed with "classic autism" who get sarcasm, are interested in social relationships, and even respond with high distress in empathic situations. This is not true across the board, but it is not impossible either.

Fortune
11-29-12, 08:14 AM
Also, a lot of people diagnosed with AS and PDD-NOS actually do meet the criteria for autism.

daveddd
11-29-12, 08:18 AM
thats where semantics become tricky for me

what i am talking about i believe can and often does garner a autism dx (mainly asperger, HFA)

due to meeting the criteria for autism

but, i believe what i am talking about is a syndromic and genetic neurological condition, with very specific underlying pathology (with different outcomes from the same problem)

to the outside world, i think autism is mainly viewed as the idiopathic , non verbal type of autism that is associated with actually deficits as opposed to dysfunction

same symptoms different problem

not trying to split anyone from any dx

daveddd
11-29-12, 08:23 AM
the only reason i sometimes refer to it as adhd, is because thats the forum we are on and it seems to be the dx in common with the pds and such i mentioned, plus the most prevalent

but unlike adhd pi who are driven by distraction

this common pathology is driven TO distraction

Subtract81
11-29-12, 08:30 AM
Hopefully i will have expressed myself ok in this post, if not please ask any questions about it before jumping on my back thanks :)

I believe more than there being plenty of basis for there being no such thing as discrete categories of mental disorder, i believe there is no alternative.

Where the human brain is concerned categorization can be at best vague, and at worst completely incorrect leading to possible further adverse consequences through incorrect treatment. The current diagnostic taxonomy is in my opinion woefully inadequate due to a number of factors. Many apparently unrelated diagnoses share many similarities, (please bare with me on this part) there is a massive amount of what i guess you could call diagnostic duplication of effort, meaning people can easily jump from one diagnosis to another as symptoms from any number of apparently disparate disorders can be identified, seeing disorders as completely disparate from one other and their context would seem to be the wrong way of going about things, even though patterns can be spotted with certain more common groups of symptoms i do not believe this method to be particularly progressive and in fact becomes increasingly unintuitive and confusing.

In addition to this, the fact is the brain is an extremely complex neural network, so everything is interconnected, there is a constant mental/contextual interaction, so literally everything affects everything else at all times, this inevitably leads to a complexity far beyond anything current diagnostic language could possibly define with any degree of accuracy.

The basis for diagnosis is always going to be primarily a symptomatic view along with incomplete and possibly incorrect contextual knowledge. Due to the nature of the human brain you are ALWAYS going to end up with a complexity that defies any kind of generalized all encompassing wholly inclusive or accurate specification, even multiple diagnoses are going to be at best extremely abstracted. I have witnessed first hand diagnoses being handed out on a trial and error basis, where response to medication seems to be the only indication of accuracy in diagnosis, and a subjective view of improvement is seen as conclusive evidence of accurate diagnosis. This can obviously have extremely adverse consequences when found to be incorrect.

My view is the current diagnostic process is not fit for purpose, and at worst contrived in its confusion, i even believe the word "disorder" should be scrapped but that is another thread entirely, it is my view that a disorder in a person is an natural/organic process and thus a reflection of a disorder in society, and i know many will not share this opinion but it has not been effectively disputed at any point so it is one of those agree to disagree situations.

Maybe Dave or someone else could devise a taxonomy of mental states/disorders that can possibly more accurately reflect the state of the human brain, as you seem to have a knack of describing mental states in more objective terms. If such a diagnostic method could be achieved, it would be far more intuitive and helpful, as it would have the ability to have aspects of such diagnoses altered incrementally, more in keeping with the organic nature of the brain as opposed to the over simplistic more subjective and quite frankly inadequate language used to define current mental states/disorders.

I hope i have expressed myself adequately although i fear i most probably have not.

Fortune
11-29-12, 08:32 AM
thats where semantics become tricky for me

what i am talking about i believe can and often does garner a autism dx (mainly asperger, HFA)

due to meeting the criteria for autism

but, i believe what i am talking about is a syndromic and genetic neurological condition, with very specific underlying pathology (with different outcomes from the same problem)

to the outside world, i think autism is mainly viewed as the idiopathic , non verbal type of autism that is associated with actually deficits as opposed to dysfunction

same symptoms different problem

not trying to split anyone from any dx

What is the distinction you're trying to draw between actual deficits as opposed to dysfunction? I have actual deficits, which is why I was diagnosed as I was with ADHD and AS.

What the outside world views as autism is a fairly narrow interpretation of what autism is that isn't even based on what Leo Kanner documented in his first study in the mid-40s.

Fortune
11-29-12, 08:49 AM
Also, I don't think you're trying to separate people from their DX, but I don't quite understand some of the distinctions you're making or why.

daveddd
11-29-12, 08:52 AM
im not good at analogies but i will try

2 patients- one has no right arm, the other has a lame right arm

they both will have very similar difficulties throughout life

one day they find out the patient with the lame right arm, has an issue that through medicine or surgery(medication, therapy , whatever) can restore some or all of the use of his right arm

Fortune
11-29-12, 08:58 AM
But they both have a deficit. One has a more severe (and more absolute) deficit than the other. What makes a less severe deficit a "dysfunction" instead?

The second word in ADHD is deficit as well. I mean, yes, it's a terrible name for what ADHD is, but it's still about deficits.

daveddd
11-29-12, 09:00 AM
yes, but only one has the ability to POSSIBLY regain use of his right arm

state vs trait

Fortune
11-29-12, 09:03 AM
But a nonverbal autistic person has the possibility to learn to communicate, or gain speech. Not all nonverbal autistic children remain so throughout their lives, and many start speaking before they're 12.

I don't understand what "state vs. trait" means.

daveddd
11-29-12, 09:09 AM
i have to go get some work done, ill come back later

there are things that cant be learned though

i thinks the things that are learned maybe already there in this group

but they have been shut off

Fortune
11-29-12, 09:16 AM
i have to go get some work done, ill come back later

there are things that cant be learned though

i thinks the things that are learned maybe already there in this group

but they have been shut off

I guess my confusion is that you seem to be categorizing some things that can be learned as things that can't be learned, and seem to see classic autism as a static condition and high functioning autism as a form of ADHD? None of this is drawing a coherent picture for me, as I do not know what the basis is that you're working from, and some of the things you've posted seem to contradict other information I've encountered.

So my main problem is I do not understand what you are saying.

daveddd
11-29-12, 10:54 AM
I see

Yes I see there being a distinct disorder than ranges from ADHD to hfa


I've drawn this conclusion as my own theory

Fortune
11-29-12, 11:31 AM
Oh.

I don't think I have much to contribute then.

daveddd
11-29-12, 11:52 AM
I guess my confusion is that you seem to be categorizing some things that can be learned as things that can't be learned, and seem to see classic autism as a static condition and high functioning autism as a form of ADHD? None of this is drawing a coherent picture for me, as I do not know what the basis is that you're working from, and some of the things you've posted seem to contradict other information I've encountered.

So my main problem is I do not understand what you are saying.

As I mentioned before this could also be the ravings of a manic episode


I'm guessing if I'm not making sense it may be. Because it makes sense to me

Fortune
11-29-12, 01:14 PM
BTW, I apologize if I am coming across as confrontational. When I don't understand something, I try to figure out how to understand it, and I can get a bit stubborn about trying to get things clarified.

Dmitri
11-29-12, 01:30 PM
Imo ADD should just be its own LD.

Yes ADHD-HI draws many similarities but ADHD-PI has very strong differences.

Putting it under autism may be misleading. A disorder should only be under autism if every subtype would itself fit under autism.

But that's just my opinion. Try thinking of it this way: Parkinsons and depression both can be traced to dopamine deficiency. However not all forms of depression fall into that category, therefore you can't put clinical depression under dopamine deficiency.

That article does bring interesting points to light though.

ginniebean
11-29-12, 02:42 PM
Imo ADD should just be its own LD.

Yes ADHD-HI draws many similarities but ADHD-PI has very strong differences.

Putting it under autism may be misleading. A disorder should only be under autism if every subtype would itself fit under autism.

But that's just my opinion. Try thinking of it this way: Parkinsons and depression both can be traced to dopamine deficiency. However not all forms of depression fall into that category, therefore you can't put clinical depression under dopamine deficiency.

That article does bring interesting points to light though.

70% of people diagnosed have ADHD-C where you stuffing that inconsequential majority? People with ADHD most often have all of the inattentive symptoms.

daveddd
11-29-12, 03:11 PM
BTW, I apologize if I am coming across as confrontational. When I don't understand something, I try to figure out how to understand it, and I can get a bit stubborn about trying to get things clarified.

I know


If it came across that I thought u were, I didnt

State vs trate--

Robert mcctavish said its not what we don't know or don't have

It's about expressing. Or doing it

What inhibits us?

That's what comes with the ,what I believe is a distinct malfunction in the group


I'm trying to pass off

daveddd
11-29-12, 08:07 PM
http://www.ncbi.nlm.nih.gov/pubmed/23006031

im trying to find something further on this

Dmitri
11-29-12, 10:05 PM
70% of people diagnosed have ADHD-C where you stuffing that inconsequential majority? People with ADHD most often have all of the inattentive symptoms.

I don't exactly understand what you're saying can you restate that maybe lol?

If course I realize there is mixed ADHD. My point was that unless all subtypes fit under autism I don't believe it should Be anything but its own disorder.

Kind of like animal classification.... I mean almost all turtles are entirely aquatic, but there are also terrestrial turtles therefore you can't really classify turtles as aquatic creatures.

daveddd
11-30-12, 07:12 AM
I don't exactly understand what you're saying can you restate that maybe lol?

If course I realize there is mixed ADHD. My point was that unless all subtypes fit under autism I don't believe it should Be anything but its own disorder.

Kind of like animal classification.... I mean almost all turtles are entirely aquatic, but there are also terrestrial turtles therefore you can't really classify turtles as aquatic creatures.

the think is i dont think the to adhd types are the same thing

adhd-c has a much different and more severe course

it is why i believe adhd is just a list of symptoms currently

Fortune
11-30-12, 07:19 AM
Dave, what do you say to Barkley's statement in a recently posted video that the types of ADHD are ADHD with and without conduct disorder, and otherwise the number of symptoms (inattentive, impulsive, and hyperactive) reflects severity rather than a difference in variety?

daveddd
11-30-12, 07:32 AM
similar to what i am trying to say

except 'with conduct disorder' has a different meaning for me

conduct disorder (reactive impulsive type) has been significantly linked with trauma

if u take CD, but take away the actual outward acts of social disobedience

you will be left with what i am trying to say

it is a core disorder adhd-c with emotional dysregulation

if you did an extensive psychiatric dimensional trait chart on the specific "subsets" of the disorders ive mentioned, involving emotional and empathetic processing , cognitive profiles , social anxiety (sensitive to the environment)
you end up with a base or core disorder


even amygdala activity while processing emotional faces

pre pulse inhibition also plays a role

daveddd
11-30-12, 07:34 AM
http://www.ncbi.nlm.nih.gov/pubmed/21667451

just for clarification the conduct disorder with the callous/unemotional specifier, has continued to show zero correlation with ADHD of any type

Dmitri
11-30-12, 11:19 PM
I mean that is a valid point. You seem like a very intelligent and motivated person why not become a doctor yourself and research this stuff? Make bank lol.

Also you'll have more resources available than the average person. All I see is you posting speculative studies about new research, it seems like you already are into it I feel like you'd be a great psychologist

daveddd
12-01-12, 12:00 PM
Study's I post are ways for me convey what I mean

It's all based off of research I've done

Ive made a lot of mistakes. Ohio would never allow me a medical licsence

Or I would of finished school

Fortune
12-01-12, 10:17 PM
Dave, that is unfortunate. You are fairly knowledgeable, and you really do deserve better.

Dmitri
12-02-12, 10:22 AM
Study's I post are ways for me convey what I mean

It's all based off of research I've done

Ive made a lot of mistakes. Ohio would never allow me a medical licsence

Or I would of finished school

Oh I see
yeah I hate Ohio law sorry to hear you fell victim.
Have you considered getting licensed elsewhere?

ginniebean
12-04-12, 10:45 AM
A very interesting study'


Overlap Between ADHD and ASD


The inadequate social behaviors of many children with ADHD are characterized by an apparent lack of comprehension of the impact of their actions on others, and the presence of a limited repertoire of social responses. These features are similar to those that apply to the social behavior of children with ASD and suggest a certain degree of
symptomatic overlap between ADHD and ASD. It is an interesting question whether the social problems in children with ADHD are not only similar in presentation to those of children with ASD, but also share a common pathology. However, the nature, causes, and consequences of the symptom overlap between ADHD and ASD are relatively understudied.


Diagnostic issues
The paucity of studies on the co-occurrence of ASD and ADHD is at least in part due to two diagnostic issues. In the first place, both the International Classification of Diseases (ICD-10, World Health Organisation [WHO], 1992) and DSM-IV (APA, 1994) implicitly state that ASD takes precedence over ADHD, which does not easily allow for a combined diagnosis of ADHD and ASD. This strict segregation of ADHD and ASD may not do justice to clinical practice and research findings. Both ADHD and ASD are highly heritable disorders that can be seen as lying along a continuum of severity (Constantino & Todd, 2003; Constantino & Todd, 2005; Levy, Hay, McStephen, Wood, &
Waldman, 1997; Pickles et al., 2000).


Some children with ASD display symptoms of ADHD (Ghaziuddin, M., 2002; Ghaziuddin, M., Wedmer-Mikhail & Ghaziuddin, N., 1998;
Goldstein & Schwebach, 2004; Keen & Ward, 2004; Lee & Ousley, 2006; Yoshida & Uchiyama, 2004). It is therefore not unlikely that some children with ADHD also have subtle ASD symptoms. A strict division of ADHD and ASD may leave children with ADHD with serious deficits in social behavior with an incomplete diagnosis, and vice versa.


Second, one of the diagnoses in the ASD category, namely Pervasive Developmental Disorders Not Otherwise Specified (PDDNOS), is used for milder conditions that do not fit into one of the other defined disorders. No positive criteria have been formulated for this disorder in the current DSM version (APA, 1994). As a consequence, there are no cut-off criteria to distinguish between normal children and children with
PDDNOS, nor between PDDNOS and other developmental disorders. The distinction between PDDNOS and ADHD may be particularly difficult, as ADHD is evidently associated with problems in social interaction, which could be interpreted as ASD symptoms. As a result of these unresolved diagnostic issues, different studies on the co-occurrence of ASD symptoms and ADHD symptoms may be difficult to compare because of varying study group characteristics due to differences in applied . Still, a number of research findings do support the presence of ASD symptoms in children with ADHD, which will be discussed in the following section.


adhd and social dysfunctioning
2
26
ASD symptoms in children with ADHD Children with ADHD were shown to have more social problems and higher scores on measures of ASD behaviors both in comparison to healthy controls and to children
with psychiatric disorders other than ADHD (Buitelaar, van der Wees, Swaab-Barneveld, & van der Gaag, 1999; Hattori et al., 2006; Luteijn et al., 2000; Santosh & Mijovic, 2004). In Table 1, key publications on this subject can be found. The symptoms of ASD that are reported to occur most frequently in children with ADHD are impairments in social interaction, and, more specifically, the inability to conceive other peoples feelings and thoughts (Buitelaar et al., 1999; Clark et al. 1999; Santosh & Mijovic, 2004).


Clark and colleagues (1999) found that over 85% of children with ADHD had “a lack of awareness of the feelings of others.” Symptoms of the two other ASD-core dimensions, qualitative impairments in communication, and restricted repetitive and stereotyped patterns of behavior, interests, and activities, have also been reported in children with ADHD (Clark et al., 1999; Geurts et al., 2004a; Santosh & Mijovic, 2004).


These symptoms appear to be present in a larger proportion of children with hyperkinetic disorder (HKD) compared to clinical controls (Santosh & Mijovic, 2004). Communication impairments in children with ASD are often due to problems in pragmatic language, referring to the ppropriate
use of language within social and situational contexts (Santosh & Mijovic, 2004).


Children with ADHD have been found to show similar problems with certain aspects of pragmatic language, including the appropriate initiation of conversation and use of syntax, as do children with high functioning autism (Bishop & Baird, 2001; Geurts et al., 2004a).


The frequent presence of communication problems in children with ADHD has also been reported in the earlier mentioned study by Clark and colleagues (1999) in that the majority of children with ADHD demonstrated “odd forms of speech” and “problems in non-verbal communication.” “Stereotyped hand and body movements” were also present in a majority of children with ADHD (Clark et al., 1999). Similar
findings have been reported by Santosh and Mijovic (2004).


Interestingly, they furthermore discerned two types of social impairment, with one confirming the importance of comorbid ODD/CD in the social dysfunctioning of ADHD, and the other suggesting that ASD symptoms in children with ADHD may be associated with a separate type of social dysfunctioning. The first type was called “relationship difficulty,” the latter “social communication difficulty.” “Relationship difficulty” appeared to be linked to conduct problems, affective symptoms, and environmental stressors, whereas “social communication difficulty” was shown to be associated with speech
and language difficulties, repetitive behavior, affective and conduct problems, and symptoms of ADHD. The authors argued that “social communication difficulty” could reflect autistic impairment, which in this study was found to be more often present in children with ADHD than in both clinical and healthy controls. They interpreted the limited contribution of environmental stressors to “social communication difficulty” as compared to “relationship difficulty” as a possible larger influence of innate deficits on the former (Santosh & Mijovic, 2004).

These findings are in line with the strong genetic component that has been established for autistic disorder (Bolton et al., 1994; Folstein & Rutter, 1977; Steffenburg et al., 1989). Conversely, with regard to the social difficulties in children with disruptive and emotional behavioral disorders, commonly the contribution of environmental factors, such as family conflict and lack of family cohesion is underlined (Biederman, Faraone, & Monuteaux, 2002; Harris, 1994).



From the above, it appears that many children with ADHD have symptoms of the three ASD-core dimensions, and that these symptoms may be associated with a distinct type of social dysfunctioning.



Research into an ADHD-related condition,namely DAMP (deficits in attention, motor control, and perception), may confirm these findings, as will be discussed in the following section.DAMP In the context of ASD symptoms in children with ADHD, Gillberg’s concept of DAMP is often referred to. DAMP is now defined as a combination of ADHD developmental coordination disorder (DCD; Gillberg, 2003). According to Gillberg (2003), DAMP is often accompanied by autistic features, and reversely, symptoms of DAMP may also often be present in children with ASD (Sturm, Fernell, & Gillberg, 2004). Data supporting
the first hypothesis were found in a population-based sample of 42 children with Minimal Brain Dysfunction (MBD; Gillberg, 1983), a term historically used for behavior and dysfunctions very similar to that of DAMP. Eight (19%) children fulfilled a diagnosis of “psychotic behaviour,” a term used previously to describe symptoms nowadays
considered ASD symptoms (Gillberg, 1983). In a re-evaluation of the study, one child was diagnosed with autistic disorder as defined in the DSM-III-R (APA1987; Gillberg & Gillberg, 1989), and three (7% of the total MBD-group) fulfilled criteria for Asperger’s disorder (Gillberg et al., 1989). It is unclear how many of these MBD/DAMP-children may have shown more subtle variants of ASD-behavior. It is conceivable that this would be the case in the 4 remaining children with “psychotic behavior” (9.5 % of the total MBD group), who did not retrospectively fulfill the criteria for either autistic disorder or Asperger syndrome as defined by Gillberg (Gillberg et al., 1989).



As all DAMP children by definition have ADHD, it seems likely that high
co-occurrence rates for ASD could also apply to ADHD in general. However, there are at least two reasons why the concept of DAMP should actually be used with care when used to refer to co-occurrence of autistic type problems in children with ADHD.



First, in a later study it appeared that DAMP, and not so much ADHD or DCD separately, tended to predict a high risk of ASD (Gillberg, 2003). Second, as previously discussed, DSM-IV and ICD-10 both do not permit the use of the diagnosis of ADHD or HKD, respectively, when present in the course of a ASD. In this regard, Gillberg’s concept of ADHD as part of DAMP differs from our major classification systems. Children who receive a DAMP-diagnosis and also have serious ASD related problems would in the DSM- and ICD-systems get a ASD diagnosis. However, although there may be differences in the classification-criteria for DAMP on one hand and ADHD on the other, research into DAMP does fit in with the findings of overlap between ADHD and ASD.


ADHD symptoms in children with ASD


Although the number of studies on ASD symptoms in children with ADHD is limited, the investigation of ADHD symptoms in children with ASD has received somewhat more attention. DSM-IV (APA, 1994) notes that features associated with ASD often include hyperactivity, short attention span, and impulsivity, which are the core symptoms of ADHD. Children with ASD have been found to score as high as children with ADHD on questionnaire scales related to hyperactivity and acting out behavior (Jensen, Larrieu, & Mack, 1997). Frazier and colleagues (2006) found that a majority of children with ASD who exhibited ADHD symptoms (82% of their sample) actually met DSM-IV criteria for ADHD. Moreover, the prevalence rates of ADHD subtypes in ASD samples have been found to be similar to non-ASD clinic-referred children (Frazier et al., 2006; Gadow, DeVincent, & Pomeroy, 2006; Lee & Ousley, 2006), and the severity of ADHD symptoms the same for all ASD subtypes (Gadow, DeVincent, & Pomeroy, 2004).



In some children, ADHD symptoms dominate the clinical picture to such an extent that a ASD diagnosis can be missed initially (Perry, 1998). These findings may indicate that ADHD symptoms in at least some children with ASD are identical to ADHD in non-ASD children. Nevertheless, there is an ongoing discussion whether ADHD symptoms in the context of ASD represent ‘true’ ADHD or are part of what constitutes ASD. In DSM-IV, as mentioned before, ASD remains an exclusionary criterion for ADHD.


Overlap in Theory of Mind and Executive Functioning in children with ADHD and ASD


Apart from phenomenological studies reporting that many children with ADHD also have ASD symptoms, and vice versa, there are also other sources of information that support the existence of overlap between the two disorders. Results from Theory of Mind and emotion recognition tasks also tend to confirm the findings of a lack of awareness of the feelings of others in children with ADHD (Buitelaar et al., 1999; Yuill & Lyon, 2007). These tasks are designed to discern deficits in information processing that are supposed to underlie the social behavioral abnormalities in autistic disorder.


Theory of Mind refers to the ability to attribute mental states, such as beliefs, desires, and intentions to oneself and other people and thereby to understand and predict behavior. Buitelaar and colleagues (1999) found that a majority of children with ADHD were as impaired on these tasks as high-functioning children with autistic disorder
PDD-NOS, especially with regard to second order mentalizing skills (the ability to predict beliefs about beliefs). Both healthy and clinical control children (children with dysthymia and conduct disorder) performed better on these tasks than did children with ADHD (Buitelaar et al., 1999). These results, however, need replication in a larger sample, as the number of children with ADHD in this study was limited to 9 subjects.


Other indications for overlap between ADHD and ASD stem from studies into executive function (EF). Deficits in EF, commonly described as deficits in mental control processes, have been considered central deficits in both ADHD (Barkley, 1997) and ASD (Geurts, Verte, Oosterlaan, Roeyers, & Sergeant, 2004b). There is still ongoing discussion about the type of EF-profile that may be specific for either ADHD or ASD (Geurts et al., 2004b; Happe, Booth, Charlton, & Hughes, 2006; Nyden, Gillberg, Hjelmquist, & Heiman, 1999; Ozonoff & Jensen, 1999).


It has been suggested that an inhibition deficit could be specific to ADHD (Geurts et al., 2004b; Sergeant, Geurts, & Oosterlaan, 2002; Happe et al., 2006; Sergeant et al., 2002) and that children with ASD
more often show impairments in planning and flexibility (Hill, 2004). However, these findings have not been consistently replicated.


Remarkably, in a recent paper by Jonsdottir and colleagues (2006) EF deficits in children with ADHD were not found to be related to ADHD symptoms, but only to comorbid depressive and autistic symptoms. It would be interesting to further investigate whether children with both
ADHD and social impairments have more profound EF deficits than children without social impairments, and what type of EF deficits may be specific for this subgroup. This would aid in defining a socially disabled/ASD-related ADHD subtype.


Genetic overlap between ADHD and ASD?


As previously described, studying underlying cognitive deficits is one way to try to unravel underlying mechanisms for the overlap between ADHD and ASD. Looking into genetic mechanisms may be another valuable approach. Interestingly, genetic linkage findings have partially suggested the same genetic regions of interest in both
ADHD and autism, that is 16p13 (Ogdie et al., 2003; Smalley et al., 2002), 17p11 (Ogdie et al., 2003), 15q (Bakker et al., 2003), and 11p15.5 (Yamagata et al., 2002). Thus far, these findings await replication in independent samples. It would be interesting to
investigate whether the overlap in linkage findings would be stronger in socially disabled children with ADHD as compared to children with ADHD without social disability. If this would be the case, this would strengthen the hypothesis that the socially disabled phenotype is a distinct ADHD-subtype.


Summary

Summarizing, although DSM-IV and ICD-10 do not allow for a combined diagnosis of ASD and ADHD, in practice there appears to be mutual symptom overlap between the two. Just as a majority of children with ASD appear to have ADHD symptoms, many children with ADHD have ASD symptoms. Children with ADHD frequently show
symptoms of all three ASD core dimensions, that is impairments in social interaction, communication problems, and stereotyped and repetitive behaviors. Apart from symptom overlap there is considerable overlap in cognitive deficits between the two disorders, and it may be hard to discern children with ADHD from children with ASD based on these deficits. Interestingly, there are genetic linkage findings that suggest common genetic underpinnings for both disorders.


Full study can be found here

http://www.google.ca/url?sa=t&rct=j&q=&esrc=s&frm=1&source=web&cd=38&ved=0CGYQFjAHOB4&url=http%3A%2F%2Fdissertations.ub.rug.nl%2FFILES%2 Ffaculties%2Fmedicine%2F2011%2Fj.s.nijmeijer%2F02c 2.pdf&ei=fP-8UMj9Mcq5igLm6YDoCQ&usg=AFQjCNFug5AnxTYtESBzOP-D87MlOp9Nhg

ConcertaParent
12-05-12, 12:03 AM
That study in 2008 made suggestions for future research:

The exact role of ODD/CD and ASD symptoms in the social dysfunctioning of children with ADHD, and their influence on its treatment and prognosis needs more attention in future research. Furthermore, much work needs to be done in establishing clear-cut criteria for broader spectrum ASD symptoms and methods of assessing these validly. This would greatly facilitate distinguishing between ASD- and ADHD-related social problems.


Another worthwhile focus for further research would be to disentangle the role of environmental and genetic factors on the development and possible persistence of social problems of children with ADHD, ideally by identifying a socially disabled subtype in twin and adoption studies. If a socially disabled ADHD phenotype proves to be a meaningful in terms of prognosis and heritability, this phenotype could be used to reduce heterogeneity in genetic studies, possibly leading to more powerful associations in subsequent candidate gene and gene-environment interaction studies. Perhaps either protective or risk genetic and environmental factors for social problems and their long-term consequences can be identified Thus, ideally, individualized risk-profiles may be generated, forming a basis to apply tailored treatment strategies.

Does anybody know if any of the above research has been done since?

ginniebean
12-05-12, 12:11 AM
There are studies ongoing but, there isn't a whole lot of information about social disability in adhd.

daveddd
12-05-12, 03:24 AM
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3351908/

everything ive read, and i wish i could post and site it all, points to emotional regulation issues as the cause for our social issues

unfortunately studys like this use strict dsm criteria for diagnosing these extremely high amounts of "comorbids"

i think it would be more effective to use dimensional trait scales

Subtract81
12-05-12, 10:40 AM
.....

ginniebean
12-05-12, 10:57 AM
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3351908/

everything ive read, and i wish i could post and site it all, points to emotional regulation issues as the cause for our social issues

unfortunately studys like this use strict dsm criteria for diagnosing these extremely high amounts of "comorbids"

i think it would be more effective to use dimensional trait scales

I think, from what I've read there is not just emotional dysregulation, but also emotional processing issues involved. Which I think is pretty interesting because at this time we've got "count from 3-10" as the common method but if you're not being signaled to content that's particularly not useful.

Subtract81
12-05-12, 11:20 AM
I have a lot of respect for your posts Dave, and i do understand where you are coming from with this thread, but it highlights my point that if you look at the bigger picture here, this entire line of argument regarding diagnoses such as adhd autism comorbids etc becomes a moot point.

Dave, you have highlighted yourself that traits/symptoms as of themselves are undeniably ambiguous/subjective, they are viewed in isolation of context from which they originated and so have no objectivity. Using transitive logic, a symptomatic basis as is used in this diagnostic taxonomy becomes redundant, it is predicated on the false logic that symptoms can be definitive (they are only definitive of themselves). Its only purpose is as a generic description of a vague group of 'symptoms' nothing more.

As you are only describing a vague group of subjective symptoms it begs the question how does this serve as a particularly useful or progressive diagnosis?

The only benefits i can see is vague descriptive brevity and misplaced peace of mind.

These definitions in no way reflect reality or any objectivity, so are insufficient as a diagnosis that would be useful in effectively guiding treatment or progressing deeper understanding of these disorders...

I am not saying get rid of all current diagnostic definitions, i am saying they should no longer be referred to as diagnoses as they are not fit for this purpose.

daveddd
12-05-12, 01:47 PM
My reasons are what if the core symptoms of the dx or whatever , all stem from one issue

one treatable issue, and I believe they do


Living it everyday, I'd like to here that instead of a long list of "atypical " versions , of every disorder in the book

ginniebean
12-05-12, 01:48 PM
Oh, one more thing. Emotional processing issues do not fall under the symptoms of ADHD, all of which are regulation issues. Just as the mental processing issues of SCT don't fall under the definition of adhd as an output disorder. Processing is an input issue. (hence artistic traits in apparently 50% plus of people with adhd. What this leads to is, input issues are a neglected area of adhd. There is some form of hybrid disorder that falls between ADHD and autism, or adhd with emotional and social disability is another form of autism. A subtype of adhd, or a subtype of autism.


For myself, my difficulty in reading people, being told I was using 'big words as a child, my walking on tip toes, lack of proprioceptive and special perception, and my **** for social skills, and my intense areas of interest, could be explained to some degree, but, we're just not terribly yet.

ginniebean
12-05-12, 01:49 PM
My reasons are what if the core symptoms of the dx or whatever , all stem from one issue

one treatable issue, and I believe they do


Living it everyday, I'd like to here that instead of a long list of "atypical " versions , of every disorder in the book

Any thoughts on what thatbone treatable issue is?

daveddd
12-05-12, 01:50 PM
I think, from what I've read there is not just emotional dysregulation, but also emotional processing issues involved. Which I think is pretty interesting because at this time we've got "count from 3-10" as the common method but if you're not being signaled to content that's particularly not useful.

I have no idea what the 3-10 thing means


Emotional and empathic issues also are there

The theory I'm going by is that the empathetic issues cause overstimulation in social settings

daveddd
12-05-12, 01:52 PM
Any thoughts on what thatbone treatable issue is?

Yes.

Can't type it all on my phone though

I will after I get done working

ginniebean
12-05-12, 01:56 PM
Looking forward to it... Yipee! Oh and I meant the treatment advice for an emotional storm is count to three or count to ten, and for me, I could count to a hundred and still blurt something out that's inappropriate.

LunaTehNox
12-05-12, 02:07 PM
That's nice to know. Just a few months, I decided to look up Asperger's, because a few of my friends have it. I almost had a panic attack, because many of the symptoms described me perfectly. So I asked my dad if he'd ever considered that I might have Asperger's, and he said that I was tested when I was very young, and that it was confirmed that I have some autistic tendencies, but not Asperger's.

Dmitri
12-05-12, 07:52 PM
Ginnie I think you might have shattered the ADDF record for longest post rofl

daveddd
12-05-12, 10:57 PM
Oh, one more thing. Emotional processing issues do not fall under the symptoms of ADHD, all of which are regulation issues. Just as the mental processing issues of SCT don't fall under the definition of adhd as an output disorder. Processing is an input issue. (hence artistic traits in apparently 50% plus of people with adhd. What this leads to is, input issues are a neglected area of adhd. There is some form of hybrid disorder that falls between ADHD and autism, or adhd with emotional and social disability is another form of autism. A subtype of adhd, or a subtype of autism.


For myself, my difficulty in reading people, being told I was using 'big words as a child, my walking on tip toes, lack of proprioceptive and special perception, and my **** for social skills, and my intense areas of interest, could be explained to some degree, but, we're just not terribly yet.


i believe a subtype of adhd, and a pretty common one around the forum

or autism, but i believe the deficit vs dysfunction thing plays an important role in presentation and treatment

and when i think autism i automatically think deficit of social understanding, inability to understand sarcasm and those types of issues(i dont know why, this may be specific to me, and not meant to offend )

our issues arise mainly from dysfunction (output)

you mentioned the emotional processing and input and output

thats were it can be tricky

input-i can honestly read, process and remember a large textbook in less than two hours , and i read at least 1 or 2 day(psyche only)

im not bragging, i could care less about that

output-yet i can sit here and know exactly what i mean and want to say, but cant express, it can take twenty minutes for me to write a grammatically incorrect and incoherent sentence:umm1:

even though i can identify proper spelling and grammer when i read

now, put that in the context of emotion(obviously different levels of severity)

say i receive emotional triggers from the environment and others(empathy) at a rate far above normal

yet i cant express it at all, so it gets externalized in various forms

i then lose the ability to gain internal reward through emotions, and im left constantly searching for external reward(impulsiveness)


so i may have not issues with the processing of emotions, i just lose the ability to identify them when they get externalized

wow, this is all over the place, sorry

i do better with questions with a couple word answers at best

daveddd
12-05-12, 11:06 PM
oh the possibly treatable issue

nothing new

high levels of physiological arousal (inborn), high eeg even without epilepsy

pretty much over aroused nervous system

glutamate and neuro plasticity are heavily implicated and being concentrated on

and im not very familiar with that stuff, so ill try to find a couple examples soon

Fortune
12-05-12, 11:10 PM
and when i think autism i automatically think deficit of social understanding, inability to understand sarcasm and those types of issues(i dont know why, this may be specific to me, and not meant to offend )

I think this is not really an accurate dichotomy.

Here are some examples of how this is not necessarily true or related to severity:

http://www.youtube.com/watch?v=c6-PwVuYy2Y

http://www.youtube.com/watch?v=fn_9f5x0f1Q

http://www.youtube.com/watch?v=5T10V4xoE8I

http://www.youtube.com/watch?v=U_GXVzZ0Unk

These people aren't unique (and they aren't really like each other) but they all have in common a history of being fairly severe and nonverbal. Carly Fleischmann still doesn't speak, but she can communicate.

I hope this helps explain what I was trying to say before when you made the deficit vs. dysfunction distinction.

daveddd
12-05-12, 11:19 PM
it does, and i understand

the problem is more the issue that for some reason, thats automatically what i think of when i think of the actual word autism

so the distinction is almost to keep it separate in my own head

i do believe that adhd-c is developmental disorder that is pervasive to all areas of development

but if i say pdd or autism the distinction of the disorder, (and i believe there is one) becomes blurred to me

so its tough for me to know or not if it does for anyone else

daveddd
12-05-12, 11:23 PM
on the other hand when i say adhd i feel restricted to symptoms of innatention and hyperactivity

ginniebean
12-05-12, 11:24 PM
i believe a subtype of adhd, and a pretty common one around the forum

I think so too, until we started discussing this there was something missing, and it was difficult to put my finger on. Now, a lot of these differences make sense.

or autism, but i believe the deficit vs dysfunction thing plays an important role in presentation and treatment

and when i think autism i automatically think deficit of social understanding, inability to understand sarcasm and those types of issues(i dont know why, this may be specific to me, and not meant to offend )

our issues arise mainly from dysfunction (output)

Just asking for clarity, are you saying that when these deficits appear in someone with autism, it's autism, when they appear in someone with adhd it's a matter of looking similar but different cause? Cause that's what I think you're saying. Which is pretty interesting.. a result of dysfunction and not a cause of dysfunction??



you mentioned the emotional processing and input and output

thats were it can be tricky

input-i can honestly read, process and remember a large textbook in less than two hours , and i read at least 1 or 2 day(psyche only)

im not bragging, i could care less about that

output-yet i can sit here and know exactly what i mean and want to say, but cant express, it can take twenty minutes for me to write a grammatically incorrect and incoherent sentence:umm1:

even though i can identify proper spelling and grammer when i read

I'm an avid reader but man a text book? i'm impressed and envious! You're my hero.

Even tho, I too can read quite fast and comprehend what I'm reading without problem, reading social gestures, etc.. Im not so good at. (no input problem here)

So, would not being able to read people's emotional postures when they do go to the trouble of masking them with self regulation (damn them) would that not be an input problem?



now, put that in the context of emotion(obviously different levels of severity)

say i receive emotional triggers from the environment and others(empathy) at a rate far above normal

yet i cant express it at all, so it gets externalized in various forms

i then lose the ability to gain internal reward through emotions, and im left constantly searching for external reward(impulsiveness)

I get what you're saying here, its like there's this disconnect between what I am intuiting/emotionally sensing in my environment and what I'm able to broadcast (it seems people rarely pick up on my experience or what I'm sending out, so maybe you just kinda stop trying) It is soothing to feel understood, to feel a reciprocity, and I know this mostly from dealing with other people with adhd, and this brings me to a point about.. with a more finely tuned emotional empathy and a lack of 'soothing' how could you not have a CNS on the edge of a cliff hanging by it's fingernails.

Hopefully, I'm following you correctly or I may just be loving where my mind is taking me at the expense of this thread.




so i may have not issues with the processing of emotions, i just lose the ability to identify them when they get externalized

wow, this is all over the place, sorry

i do better with questions with a couple word answers at best


I think you're doing just fine.. but can you give an example of externalized emotion?

Fortune
12-05-12, 11:28 PM
it does, and i understand

the problem is more the issue that for some reason, thats automatically what i think of when i think of the actual word autism

so the distinction is almost to keep it separate in my own head

i do believe that adhd-c is developmental disorder that is pervasive to all areas of development

but if i say pdd or autism the distinction of the disorder, (and i believe there is one) becomes blurred to me

so its tough for me to know or not if it does for anyone else

I think you also touched on autism being an input/processing and output disorder and ADHD being an output disorder, and I think these are accurate characterizations.

It is very interesting to me that a lot of people with ADHD have broad autistic phenotype traits, often to the point of impairment. I mentioned this topic to my therapist today, as well as the fact that ADHD often presents with social impairments, and she agreed quite emphatically with both statements.

daveddd
12-05-12, 11:43 PM
hyperactivity, impulsiveness , conduct disorder , baseline irritability , substance abuse,

and yes i think it effects the same domains as autism, but through different pathways and causes or whatever

thats why the wording is a problem for me

the social gesture issues from what ive read and can identify with i think are more of a too much input of empathy, causing distress , resulting in avoidance or phobia of emotional interaction, done through avoidance of eye contact, therefore never catching on to social cues

i believe this defense is done early and unconsciously

and yes we are on similar pages

Subtract81
12-06-12, 10:42 AM
so basically you are agreeing that these symptomatic diagnostic definitions appear to be insufficient Dave?

daveddd
12-06-12, 11:29 AM
There fine for writing prescriptions


But anything more than that. I am in agreement with Theodore millons writings

Subtract81
12-06-12, 11:32 AM
I think "fine" is a highly subjective term.

From what i read so am I, I will hopefully read through the rest of it tonight

julesjampot
12-12-12, 06:42 PM
its all related , i adopted a boy who we found had adhd and 10 years later i adopted his true biological sister who is Aspergers

fracturedstory
12-19-12, 09:26 PM
There are far more structural differences in the autistic brain than the ADHD brain.

Something I wrote on another thread:
"The autistic brain is developed differently. Certain areas are smaller/bigger, some neurons are densely packed together and the synapses are connected haphazardly. The 'social brain' is underdeveloped. The frontal lobes are affected the most which explains the symptoms, especially the repetitive stuff we do. The sensory connections may never fully mature from when we are infants. Some 500 genes present in the autistic brain are not present in the typical brain, and I think it's the frontal lobes that work more like the temporal lobes."


^ From a lot of research I'm unable to successfully link without having a meltdown.

Most frontal lobes disorders and other disorders share similar symptoms, same affected brain areas and same genes.

Doesn't make them sub-types.

Is epilepsy a sub type of migraines? Both have similar symptoms, but one is far more severe. And they have different causes.

Treatment for autism is far different than ADHD too.

You can find many patterns in mental disorder and even illness, but there is no link. The only link is it's all happening in the human brain.

If one disorder is a sub type, it's ADHD and not autism.

Look at the neurological disorders:

Dyspraxia
Dyslexia
ADHD
Autism
Bipolar
Schizophrenia

All require different treatment, mainly medications. There are co-morbidities but not always.

These disorders are separated for a reason. Remember these labels are given by doctors, not God. It's not a perfect science but those affected get the right treatment.

Neuroscience wills et you free.

I had a severe seizure last night so I'm not able to be as open minded as I usually am, and I tend to flip out more easily when people say a statement about autism that makes no sense to me. Also, reading and comprehending is hard. And thinking. Thinking is very hard.

A sub-type to ADHD? B*tch please. Asperger's is autism.

What are you guys going to talk about mid 2013 when the shiny new DSM 5 is out?

daveddd
12-19-12, 09:38 PM
not sure if your talking to me

but what im stating is ADHD is its own separate disorder from autism

but on the severe end has social communication issues and behaviors that technically would garner an autism dx

im pretty sure thats a fairly accepted theory

so apologies if i be dissin autism, it wasnt intentional

so actually you would be agreeing with me

because i said while adhd may have symptoms that could qualify for an autism dx

the causes and treatment are different

Roundmouth
09-09-15, 05:28 PM
To the original question, I would say yes and no.

First of all: what is ADHD? Probably an umbrella for many different things with similar symptoms. From a health care view, only symptoms and treating them is relevant. Personally, I believe I've noticed some basic differences though between different types. On one hand we have the classic DAMP kid. A rather normal person with one geat problem. Or perhaps a few great problems. On the other hand excentrics like myself, who don't always have any appearant problems, we just never really fit in and we kind-of never really get anything to work.

I'd like to call the first type classic or typical ADHD, refering to the kind of disorder most people probably asociate with ADHD. This type I wouldn't label autistic. I belive many of these people suffer very much from their problems. Normal things are very close and can easily be related to, but because of this little weird thing in the brain, those normal things tend to be just out of reach.

On the other hand, there are those who are a totally different kind, where the problems are over-all present. This other type, I'd call true ADHD and I believe it to be part of the autism spectrum. I use 'true' as a neutral word, not meaning it's better than other types - and neither more nor less impairing.

Speaking formyself, I've never felt like a part of humanity even though I live with it. Part of me ignores the normal world, not expecting to be a part of it any more than a fish would expect to live in a beehive or whatever. I''m probably a lot more freaky than those damp kids but I don't necessarily suffer. I feel special and my great sadness is rather that I've never managed to make use of my originality. I do identify as autistic even though I don't qualify for any such diagnosis.

My belief is that those autistic traits - where I include certain aspects of the ADHD complex should be included - is some kind of old herritage that's been preserved through all those thousands of years for some evolutionary reason. Majority can't be like us, them humanity would never have succeded in building a world like the one we know. Yet... Without us and our wicked way of thinking, those critical inventions necessary for progress may perhaps never have been made. Not because of our impairments, but because of certain talents that I believe come with this kind of chaotic brains along with the impairments.