Aspergers or ADHD? The answer will surprise you.
Recently a flurry of articles about academic overachievers appeared in scientific journals. Specifically, the research found that people with a diagnosis of autism were more frequently high achievers in school. And people diagnosed with ADHD were more frequently low achievers in school.
A paper published last week in the Journal of Autism and Developmental Disorders explains the reason for the gap in achievement between kids with ADHD and kids with autism: overachievement in written communication was common among kids with autism and kids with ADHD. But kids with autism were overachievers in reading comprehension and math, whereas kids with ADHD were underachievers in those areas.
This gave me a moment of glee because I’m a sorter (sorting and hoarding both symptoms of autism and ADHD) and I have been sorting autism research nearly a decade. I have coached so many people who clearly have autism but they tell me they have ADHD. “My psychiatrist told me!” And I have also helped hundreds of parents figure out how to steer their kids through school, and the parents frequently tell me it’s not autism, “The school told me it’s ADHD.” Soon all those people will have to face reality. And I love the idea of everyone knowing the truth.
ADHD is the diagnosis of choice for people in denial
It’s very difficult to tell parents their kid has autism because they don’t want their kid to be associated with autism. It’s easier to tell parents their kid has ADHD because then the parents can tell themselves it’s not their fault that their kid is having trouble, but also the perception among parents is that ADHD is manageable.
Public schools hate giving an autism diagnosis because those kids are entitled to thousands of hours of extra help and resources under the Individuals with Disabilities Act. Kids with ADHD have a much smaller claim for services. The schools protect themselves by giving kids with autism an ADHD diagnosis because the only thing the schools care about fixing is getting the kid to sit still in class. The other stuff (social skills, OCD, etc) will be the parents’ problem down the line.
Medical governing boards hid the overlap of ADHD and autism
The DSM tells doctors what they can and cannot diagnose. And until 2013, the DSM did not allow for someone to have autism and ADHD at the same time. Regardless, scientists kept studying the overlap, and we now understand both autism and ADHD are working memory disorders coming from dysfunction in the prefrontal cortex part of the brain.
Stephen Becker’s textbook on ADHD shows that the older a person is the more likely their ADHD diagnosis is to morph into an autism diagnosis. This makes sense to me, because people with autism show more symptoms as they get older, so it’s easier for people to overlook autism when kids are younger. I think this ADHD morphing trend will increase as people realize that autistic kids outperform ADHD kids.
ADHD and autism are probably different aspects of the same disorder
In December of last year enough data emerged to draw the conclusion that ADHD and autism are probably not completely separate disorders. This is not fringe research. This is a paper published in Nature, one of the most highly respected journals in academia. The authors conclude, “Overall, patterns of associations were similar in autism and ADHD, supporting common underlying biology and the blurring of the diagnostic boundaries between these disorders.”
Many studies show that specific disorders that correlate to autism also correlate to ADHD. For example, bulimia, OCD, dysgraphia, substance abuse disorder, and strong desire to sort and organize things. Today people study the correlation between autism and ADHD at the molecular level. I think scientists will determine that autism is an umbrella label that encompasses a wide range of disorders, including ADHD. Until then, we can learn a lot about ourselves by examining our own attitudes toward the two diagnoses.
The label you give a kid is a reflection of who you are.
I think a diagnosis of ADHD or autism for a child is mostly a reflection of the adult’s experience with the child. Autism is the diagnosis for kids who are odd but brilliant. ADHD is the diagnosis for kids who can’t be managed. Researchers found that kids with autism are more likely to be bullied, and kids with ADHD are less likely to be bullied. But kids who have autism and ADHD get bullied as much as kids with only autism.
The bullying research shows me that the science behind autism and ADHD is intuitive to kids: ADHD is a label for kids who bug the teacher and disrupt class. So they are fun kids to be friends with. Autism is a label for kids who are constantly in their head finding patterns and solving puzzles. So they are dorks and easy to tease.
In fact, neither the ADHD kid or the autistic kid is paying attention in class. And that’s why they draw so much attention from the neurotypical kids. And here’s another commonality between ADHD and autism: those who break rules and defy authority are most likely to make a lot of money as adults.
The diagnosis’ is complicated. I do, however, see your points and they have truth. I work with students every day.
Thank you for this insightful article. As a parent of a child diagnosed with Aspergers I appreciate the information you have presented. Have followed your posts for many years and I really enjoy them.
What, no comments yet? Why, that Nature article is a great find.
I am not able to judge if what they see in those young brains makes any sense. But I have known for some time now that ADHD and Aspergers tend to get mixed up. Throw in some extra giftedness and the mix becomes even more blurred.
Of course all diagnoses are mere constructs. I have diagnosed myself with several consecutive things and I am quite willing to agree that they ALL apply.
And so even if I cannot judge that article, I know what they say is true. ADHD and autism often overlap. May be more so in highly intelligent people – at lest I have seen it happen a lot in such cases.
We spent last summer having my son tested and even the psychologist (who said she needed not one but two extra sessions to try to tease out a diagnosis) said the ASD/ADHD/anxiety/GT mix is a very murky area because there is so much overlap. We left with an ADHD/anxiety/GT diagnosis but she told us she would have felt very comfortable giving us an ASD diagnosis if we needed one.
Looking forward to reading the links – it’s late afternoon between my job and my kids’ school, I’m done for the day.
Yes, BJ, that’s how it often goes.
This is no science. It is people judging people from faulty lists in the first place. IA diagnosis is often hit and miss.
Mind you, brain imaging does not necessarily prove anything either. Psychiatrists are very fond of these images, but they do not really know what most of the pictures mean. It just looks really scientific ;-)
I know! The article in Nature is amazing and no one’s writing about it. I’m so glad you said something – makes me feel good that there’s a link there.
Penelope
The title of this is so perfectly clickbait-y that it makes me wonder if you did it in a sarcastic way.
Interesting stuff. I like to think that ADHD was probably an evolutionary response to herding/pastoralism, and Aspergers along with OCD were more of an evolutionary response to tending plants/agriculture. So they’re similar in that they probably tended to show up as adaptations that made humans increasingly more successful, but at an extreme, they don’t really work as well with modern social frameworks. And tending to plants would be very similar to tending to computer programs and systems and databases, whereas ADHD is mainly good for…herding things. Maybe herding people? Leadership?
Are there stats on CEOs and ADHD?
Some children with Asperger’s syndrome also have mental health problems or other conditions, which means that children need different levels and types of support.
Schools in turn need to be prepared to better serve these children.
You’re right that schools don’t service the kids who need lots of support. It would be too expensive. Schools just want to follow the law and that’s it. It’s pretty easy for schools to follow the law and not give kids what they need. We have a very big problem that we don’t have enough money to educate kids with learning disabilities. So schools get great at addressing easy issues, and then schools ignore the kids’ complex issues.
I think the whole situation is hopeless right now. Only the parents who have the money to sue the school district get what their kids need. If you can’t sue the district they don’t feel pressure to give your kid more services. Remember all the people who work with your kid get paid by the school. And those people need to protect the school over your kid – that’s their job.
Penelope
You said, ” We have a very big problem that we don’t have enough money to educate kids with learning disabilities.”
But really, let’s be clear about this . . . the actual very big problem is that there are so many kids with learning disabilities in the first place.
Fifty, sixty, seventy years ago . . . there were nowhere near the numbers. And do not start with the canard about “better diagnosis.” I know a man who is about 85 or 90 years old now, and when he was in school — all of the K to 12 years — it was well known that he had dyslexia. They just didn’t call it that, back then.
Today there are masses, absolutely overwhelming numbers, of all sorts of disabilities. This is not better diagnosis.
My son is a 13 year old African- American diagnosed with ADHD & Aspergers. I mentioned African-American because I believe it played a factor in him being diagnosed incorrectly at first. He started out in public school and we were told that he is brilliant, but he is disruptive. They wanted to move him into a higher grade specifically for math, but were hesitant because of his immature behavior…this was 3rd grade (their words not mine). He was evaluated by 2 neurologists chosen by the school that asked questions and said immediately “He has ADHD.” Something did not sit right with me so I sought out a doctor that at that point was 1 of 3 African American developmental pediatricians in the country. After an extensive evaluation, he determined my son had Aspergers. We pulled him out of public school into an independent school that really cultivated his gifts and love of learning. Now as an 8th grader he got accepted into a really competitve private highschool. He is a math/technology wiz (to the point where its scary..cause as parents we don’t even know what he is talking about with these subjects any longer) That last doctor mentioned the rampant amount of misdiagnoses that occur with Afr-Am males (especially as it relates to ADHD). Your article has helped me understand that this happens beyond color lines. I still would be interested in seeing research that compares the misdiagnosis between various groups. I wonder about how racism may have an impact on him in his future as well. I’ve actually had people say to me that there are not really that many Black boys with aspergers/autism. Next time I hear that I will direct them to your article.
This is a super important topic. It’s fairly well reported that medical schools include blatantly racist “information” as part of their curricula. Similarly, black children are disproportionately more likely to be treated as problem-students by their white teachers. The systemic bias is a big reason why health and education outcomes are so much worse for America’s black population.
Your son’s story demonstrates where the health and education system intersected to misdiagnose him. It breaks my heart how many black children are told these fallacious narratives about their perfect normal behavior!
ahaaa….this has been my real experience.
At 60 I’m one of the Aspie “elders”. At 4 years old, in 1963, before Aspergers was recognised as Autistic Spectrum my parents took me to a psychiatrist because I was unmanageable. I had daily massive tantrums that would last for hours, and lead to me needing to be locked in a room (then I’d wreck anything I could in there….) In the parlance of the day the psycho described me as “hyperactive”. Hyperactive later morphed into ADHD. At 40 I finally got the correct diagnosis of Aspergers.
BTW Penelope, I have wanted to ask you this for ages – do you relate to this….in the last couple of decades I have re- watched many of the movies I saw as a young person. At the time they were all completely incomprehensible to me as the intricate rituals and weird interactions of NTs made no sense in my world. As I’ve grown older, more reflective and educated myself about my particular neurology I’ve begun to be able to decipher NT behaviour. I’ve rewatched Star Wars, The Poseiden Adventure, The Rocky Horror Picture Show, Sophies Choice, Desparately Seeking Susan and a squillion other movies from that era and are finally able to make some sort of sense of them. I never bothered with TV series like Seinfeld, Sex in the City et al because they were a complete waste of time. Equivalent to watching TV in untranslated mandarin Chinese for all the sense they made!
Pearl
– who is wondering what all the hoohaa about “social distancing” is….welcome to my comfortable world NTs….and keep your bloody hands OFF ME!
I was born in 1963 and was “immobilized” with anti-epileptics between 1972 and 1980. Today, since 2006, I have both epileptic seizures and psychogenic shutdowns under control.
This is necessary because you are a high-risk group in old age (CoVid19 – I also like rules on physical integrity, of course)
Your description fits the reality here in Germany very precisely. Germany is very backward in Europe. Officially there are 330,000 in the autistic spectrum. If we had the diagnosis rate like Denmark or Switzerland we would be 1.2 million.
There are many small Yuppie families in Germany who have poisoned their kids with rhetalin.
I happen to be an unexcited guy and just take cover for attacks, but I don’t see a big difference between myself and my friends who are diagnosed with ADHD. There is a difference on their side because I am autistic with strong communication restrictions. I also never took psychiatric drugs because of epilepsy. Basically, I consider this to be toxic to life-threatening in autism.
I have had Gabba tea (L-theanine) in the dosage for children with ADHD for a year! Perfect. First for me, I drink the tea if I like it or not. And my fellow human beings say I speak with it more understandable.
This is interesting my son has a diagnosis of ADHD and I keep asking them, “and what else?” Because there’s obviously something else. Just from learning and research on my own, I’d say he’s definitely on the spectrum but what I’ve read about Aspergers doesn’t quite fit.
I have two boys. The oldest has ADD and the younger one is ASD. The school situation has been interesting. Some school districts completely get it while other do not. The oldest boy was in the gifted program in school district that didn’t get it. It quickly became apparent that they wanted to program for regular kids that were just smarter than regular kids. They didn’t want to deal with any of these items that begin with capital A’s. It was hell for him.
Lucky the school district next door to ours had a gifted program, and they understood that the gifted students had a higher occurrence of these conditions. More importantly they were ready to deal with it. It was a night to day difference in the school year. See how things were going, we decided to move. We didn’t kids in two different school districts, nor did we want to deal the old district.
We moved while the youngest was in preschool. He switched preschools. Couple months after he switched the new one suggested that we have one of school district’s specialist observe him. The teachers at his old one hadn’t noticed, or had noticed but hadn’t mentioned it. We requested the specialist to observe him. We were expecting the standard ADHD diagnose, and they came back with ASD. Their schools were set-up to deal with it.
Four years later we moved across country. After our previous experience, we made sure to move into a school district that could handle it. I remember hearing about parents transferring their kids to school districts that were two towns over. I thought they were nuts. After experiencing the differences, it is completely understandable.
My 13 year old daughter was correctly identified with ASD by both a neuropsychologist and later by our school district when I asked to get her qualified for services in 6th grade. She qualified for services for social skills development, and the rest of her IEP adapted for her associated anxieties that are really just a part of being a girl with ASD, social anxiety and general anxiety. She was also diagnosed secondarily with ADHD, impulsivity, blurting, cutting.
Last year she asked to homeschool again, so school was relatively short-lived for her. Half a year in 5th grade. All of 6th grade. And then 7th at home. But she continues to receive her services at school for two periods of 48 minutes of direct instruction for social understanding in a group, and social understanding one on one. She also gets privately bused directly from our driveway to school and back. When I met for an IEP meeting and discussed that my daughter never wanted to return and for them to find an alternative they found one at the school with kids that she actually liked in small contained classrooms outside of the general ed, with less than 5 kids. So I had her there for three 48 minute periods a day for “social understanding” with a math book. The private busing arrived earlier. The goal was to try to get her into another one of these small contained classrooms before the year was over. But coronavirus hit. So now her social understanding groups are happening over zoom. But at least there isn’t snow and she can go outside and ride her scooter while wearing a mask for as long as she wants.
My youngest child is a young 8 year old (I have a middle child too) and she has full blown ADHD combined type-off the wall hyper, impulsive, angry, brash, inattentive, energy for days-and you have to let her talk, with severe Dyslexia, and apraxia of speech… no asd. I can understand the leap you might be making. But you would just be a stubborn fool if you met my child and still said you thought she had ASD just because to say otherwise would be to go against what you write all the time. She is sassy, bossy, opinionated, and will rule the world. But she understands social graces, she understands that she has a speech issue, that she has delayed reading and writing skills, and has massive anxiety over what others think of her because of that, she is empathetic, she is sweet and kind without any modeling from me, she offers to help clean the house without the offer of reward, she can take a shower without reminders, do her own laundry, crack an egg, mix batter, turn on the oven, set a baking temperature, wash dishes, empty the dishwasher…she has skills that don’t come to a child that young with ASD. Speaking for a mom with a 13 year old daughter who has ASD and ADHD in the same house… who at 8 had to still have me give her showers, pour her cereal and milk for her….it’s different.
My ADHD daughter does receive services and accommodations but this is due to her Learning Disability and Speech. Her IEP covers services for reading, writing, spelling and speech and includes accommodations for anxiety and behaviors that I want for adhd. She was given an IPAD in Kindergarten. I’m not sure what services one needs for ADHD that can’t be helped with a 504 and being allowed the freedom to move around.
So now with E-learning… I am this 8 year olds Personal Assistant. I set her up for all her Zoom appointments for the day. Every. Day. She gets lots of attention through zoom videos. She’s bored. I bought her a punching bag. Surprise surprise… she didn’t magically transform into a ninja. Now she wants a rock climbing wall. No!!! eff that… eff the rock wall…eff her getting more zoom calls than me… eff waiting until dark for my zoom calls!!! I’M gonna rocky the eff outta that punching bag and I’M gonna be a NINJA!!
Did ya see that coming?
Interesting post – I do a lot of work with elementary school kids and completely agree that there are issues with diagnosis. Just wanted to point out that the article you link to was not published in Nature – rather, it was published in the journal Translational Psychiatry (a Nature Publishing Group journal). Doesn’t mean that it’s not good research, but it was published in a much lower-ranked journal.
I dislike autism diagnoses for imprecision. The spectrum is too unscientific. Most kids with autism qualify for a separate diagnosis of ocd which doesn’t benefit from standard autism treatments involving ABA. ABA would likely worsen OCD.
First off, I’m a psychologist and from the blog stuff I’ve read and videos I’ve seen, I see an extrovert with well above average language skills and social intuition. I see tremendous anxiety caused by excessive self reflection. I see elements of obsessive behavior, compulsive behavior, fear of abandonment and no evidence of a spectrum disorder. Many people dislike small talk and from what I gather, you thrive on small talk even while claiming to dislike it.
People with higher intelligence Weather! disorders better. There’s zero evidence that autism or adhd lead to higher intelligence. There might be a connection between ocd and higher intelligence and there are rare disorders associated with Measurably higher intelligence.
A significant percentage of those diagnosed with any form of autism up to 10% maybe more untapped have a significant talent or skill. A small percentage of this group have prodigy skills. There may be a link between ADHD And creativity. There is an established link between bipolar disorder and creativity.
There is
Aspergers defined by no significant language delay though from my cases I’d dispute this and say instead they catch up. Aspergers isn’t linked with higher math and science skills. ASD is. It’s only in a small percentage. Aspergers is linked with higher literary skills. You can do testing to differentiate between aspergers and asd if you feel autism diagnoses are applicable and helpful.
Hope this helps.
Penelope, I love that you’re increasingly using academic sources to support your line of reasoning but you’ve been misled by the layout of the website for which journal it was published in, the upper left corner says “Translational Psychiatry” which is the name of the journal. I’m sure that is a fine journal but it does not carry the same weight as Nature.
Nice little post! I’m a retired Clinical Social Worker – specialized in ADHD & ASD. It’s good to see the ADHD-Aspergers differential diagnosis realm getting more clarification. Would be nice if you cited your references…
Oops! I see you have lots of reference links. Thanks!
The paper only focuses on social deficits. It does not discuss any other aspects of ASD and ADHD.
Irresponsible to diagnose people. Don’t believe everything you think.
I have a kid with an ADHD diagnosis, who has been 3 separate autism evaluations because his language and sensory issues are “autistic-like”. Each time, he scores too high on the social aspect of the spectrum to meet the criteria for an autism diagnosis. And then he will monologue about something and I kind of cock my head and ask “are you sure?” I do see the evaluator’s point, having sat in on all the evaluations. I also see that they are so super closely related that the distinction is a bit fuzzy. FWIW, he is gifted (by the 2 standard deviations above the mean definition) in math. So he doesn’t exactly fit the low achiever definition either.
Hi, thank you for writting this article, it’s really helping me to put my thoughts in order.
I have inattentive ADHD and my partner is an aspie. We are both high IQ. I have noticed a tremendous overlap and similarities between our brains. For example, we both experience sensory over-sensitivities (him to noise, me to touch and smell), get overwhelmed in busy places, have high anxiety, suck at understanding people, have very strong morals and ideals, etc.
As of lately, I have started to think that I might have Aspergers too. But CAN I HAVE ASPERGERS IF I LOVE CHANGE? I get bored quickly of anything that is routine and in fact need change to not go crazy. This seems to contradict the very definition of Aspergers… It’s just all the other “ADHD” symptoms that I have fit in with Aspergers too, and when I read about aspies I seem to fit there too… Is it possible that there are some Aspies that like change? Maybe the aspie-ADHD combo can make this possible?
I’m confused…
Yep, I second Ana’s confusion. I am specifically curious about the ADHD inattentive subtype. This subtype dismisses the need for hyperactivity in an ADHD diagnosis but it doesn’t explain those ADHDers that did well in school.
A fascinating dialog of discussion!
I’m a retired LCSW (MSW) & PhD; worked in almost every aspect of the MH system and at every level; last 20 years of my career, I specialized in ADHD, ASD, Learning Differences and Mood Disorders.
Eventually, I came to the conclusion that diagnostic labels are useful only when dealing with insurance companies. When it comes to treatment solutions, a person’s “symptom picture” is what matters most. Some folks seem to love debating diagnosis, meanwhile, the patient/family suffers! So, with every patient evaluation I did, I listed “official diagnoses” (every one that applied), but, I empahsized the patient’s primary symptoms (one’s that caused the most life problems), and, then, connected each symptom with specific (or set of specific) solutions – behavior management, social management, remedial academic and medication (if needed).
When dealing with other professionals (MH, Medical, Educational, OT), I used diagnoses when necessary, but focused primarily on pt. symptoms and related evidence-based solutions. This helped minimize getting stuck on diagnosis. This also helped keep the focus on helping the patient become more successful.