Autism and ADHD: Comorbid conditions or complete crock?

So, did everyone survive Thanksgiving? I for one can say that I’m glad it’s over. I had one too many turkey mishaps and was more than ready to just chuck it all and take everyone to McDonald’s! Now Christmas is nearly upon us and life really feels like a whirlwind. Does anybody else feel that way?

One of the things that always gets me is how much the twins genuinely hate holidays. They just despise anything that wrecks their routine. Speedy is usually quietly resentful, but Crash goes off the walls. It made me glad that we decided to keep his meds going even though he wasn’t in school. X took a break from his, and was perfectly happy floating from one thing to another, and playing Minecraft with a buddy online for far longer than we usually allow. It really got me thinking about the differences between the two of them and how their autism presents itself.

Dual diagnoses

Oftentimes when I’m scrolling my autism Facebook groups, I see parents describe their kids as having both autism and ADHD. There’s often a lot of confusion about these two conditions, and it’s understandable as to why. There are a lot of similarities between the two. Today I want to look at both of these diagnoses, how they’re similar, how they’re different, and why it seems that they pop up together so often.

Disclaimer: I am not a medical professional. This post and any related material is solely for educational purposes only. I am not qualified to diagnose any kind of medical condition. If you suspect you have a medical condition, please seek the advice of a qualified medical professional. I am not responsible for errors or omissions in reporting or explanation.

Autism and ADHD: A quick rundown

I’m assuming if you’re here, you’re likely familiar with one or both disorders. But for the sake of consistency, let’s do a quick review of the typical characteristics of both conditions.

Autism (ASD) is a developmental disorder characterized by problems with communication, motor development, social skills, and verbal skills.

Attention Deficit Hyperactivity Disorder (ADHD) in recent years has been divided into three categories, ADHD-hyperactive, ADHD-inattentive, and a combination of the two. ADHD-H is largely recognizable by the inability to keep still, while ADHD-I is characterized mostly by difficulty focusing on tasks and activities.

In both instances, it’s important to remember that both autism and ADHD are spectrum disorders, meaning that characteristics can vary in severity by individual. It’s said that if you meet one person with autism, you’ve met one person with autism, and that’s true. However, there are hallmarks of both conditions that present themselves consistently.

Our story

Both X and Crash have comorbid ASD/ADHD diagnoses. What we observed with our guys was that their inattentiveness was pervasive, but presented differently. X was easily overwhelmed, wanting desperately to do what was asked of him, but unable to focus long enough to complete even short tasks. His frustration was very real, and it absolutely broke my heart. I was having to prompt him to stay on task constantly, sometimes as often as 35 times over the course of an hour. We were both unbelievably frustrated. On day one of starting meds, his prompts went down to 6 per hour. Now, 2 months in, he can do 3/5 of his schoolwork independently and all of his piano practice. It’s been amazing.

Crash was totally different. Since his ASD is more severe, the inability to focus on a task was definitely an issue. However, of even greater concern was his sudden impulsivity. He was making some downright dangerous choices, like climbing too high on playground equipment or eloping from us in public. When a sudden impulse to kick in the midst of a particularly silly moment resulted in me ending up in urgent care needing an x-ray of my jaw and resulting in thousands of dollars in dental procedures, we knew it was time to at least try to see if medication could tone him down a bit. And it kind of has, at least during home time when his activities aren’t as structured.

Similarities and differences between autism and ADHD

This diagram is the best representation I’ve seen that highlights just how similar ASD and ADHD can look. For instance, stimming is most commonly assigned as a hallmark of autism, but now we know that autistics aren’t the only ones that stim. On the other hand, while both types have difficulty reading social cues, it’s for very different reasons. People with ADHD misread social cues due to inattentiveness, while autistics generally just don’t understand social cues, especially unspoken ones. There appears to be a lot more similarities than differences, which is why now you simply hear the term “neurodivergent” instead of differentiating between the two. I think there are pros and cons to lumping the two together, because there ARE differences between ASD and ADHD. Those differences carry some serious ramifications. But it’s also helping to de-stigmatize autism somewhat, and I think that’s important.

Comorbidity: What the research is saying

First of all, for those unfamiliar with the term, comorbidity is when two or more conditions occur in the same individual. Back when COVID was first a thing, there were a lot of patients who were diagnosed with both COVID and pneumonia. Those are comorbid diagnoses. So for our purposes, we’re discussing people with whom ASD and ADHD have both been diagnosed.

The comorbid diagnosis of ASD and ADHD has been happening for a long time. X and Crash have both diagnoses, which is a relatively recent development in our family. X has had great success with stimulant medication, but Crash has not, which has led me to this path of research. I’m not a big academic, nor am I a medical professional, so the research has been mind-numbing, but has brought up a bunch of interesting points.

Things to consider

• Anecdotally speaking, there are many similarities in the inattentive behaviors of both ASD and ADHD populations. However, there have been recent studies done that suggest that although from a clinical observation standpoint, the attributes of inattention are the same, from a physiological standpoint, the inattention originates from different parts of the brain, thus no longer making them comorbid, but an entirely unique diagnosis in and of itself. (source)
• There have been studies done to determine if stimulant medication is less effective in patients with more severe ASD symptoms, but in clinical trials, there is no disparity between the two groups in regard to effectiveness. (source) Personally, we are not finding that to be true, but due to other issues, Crash is only able to take this one kind of medication. It may be that it just isn’t the best medication for him, and is therefore less effective.
• There are different kinds of inattention. ADHD inattention is usually due to a lack of focus, but we’re finding that ASD inattention is caused more by hyperfocus on one thing, contributing to the lack of focus on literally anything else. Productivity gurus would call that “flow” and it’s considered a desirable state of being. (source) Maybe we should stigmatize it less as a maladaptive behavior in an autistic brain when it is lauded as a virtue in a neurotypical brain. As such, it should be treated as a behavior instead of a medical condition.

So what now?

Well, unfortunately, there are still a lot of questions. Can ASD and ADHD be diagnosed comorbidly? Yes. SHOULD they be diagnosed comorbidly? The short answer is maybe, maybe not. It seems that there needs to be a lot more research done in this area. But, if medications are helping your kid be able to focus better at school and have less impulsive/destructive behavior at home, then I say don’t fix what ain’t broke. Personally, I’m a bit split. Since starting medication, we’re seeing huge improvements in focus and attention from X, which has really helped with school and piano. But with Crash, school isn’t reporting much improvement in focus, more so a reduction in impulse behaviors and general bounciness. For us during home time, that’s a huge improvement, so all is not lost. In a just and fair world, we could have it both ways, but that’s not reality.

My takeaway

I have learned a very valuable lesson in the last couple of months. I was so resistant to the idea of ADHD meds, I was willing to do almost anything else, including making the decision to homeschool X. For me, meds were an absolute last resort. I still think that ADHD meds can be overprescribed and that not all kids that are on them necessarily need to be on them. But for kids like mine, who were genuinely struggling, refusing to medicate is like refusing chemo for cancer. It’s certainly not as life-threatening, but if it can improve their quality of life, it’s at least worth the discussion with the pediatrician.

I hope your holiday season continues to be merry and bright! See you next time!