ADHD is the most commonly diagnosed mental health disorder in kids effecting about 5% plus or minus. Autism's incidence is soaring, explained well by none. Autism strikes about 1 in 68 children (according to CDC's April 2017 posting.) People with autism have a 30% to 50% incidence of ADHD according to The National Institute of Health and US National Library of Medicine in 2014. (The interested reader is directed to the following link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4010758/) though one study found the rate to be over 80%! Regardless of how often it happens, the combination of Autism and ADHD presents a very challenging package of symptoms for kids and parents.
Autism is so well known for the challenges it brings kids in the areas of communication, social relationships, symbolic play and repetitive, or "self-stimming" behavior. ADHD is famous for it's triad of hyperactivity, inattentiveness and impulsivity (as I've said elsewhere in these pages, why they don't call it ADHID, to include the "I" of impulsivity in the title I don't know.....) Now think of all of these issues, throw them all together, or even some of them together, and you have the potential for some very challenging behaviors.
The signs and symptoms of each combine with the other to create what parents sometimes experience as an almost toxic mix. For example, kids with autism can become perseverative - overly fixated on games, shows, toys to a point greater than annoyance. Combine that perseveration with the impulsivity of ADHD and you've got quite a behavioral package. Or consider a great deal of hyperactivity, which can make it difficult for some kids (and adults) to get to sleep (often a challenge with autism anyway) - and put with that a lack of ability to communicate well.
I often remark that impulsivity is, in my view, the hardest part of ADHD. The simplest example of impulsivity is one in when the adult gets the child's focus, including eye contact (already a tough one for lots of the spectrum kids) and gives a simple "don't" or "do" kind of instruction, immediately followed by the child's doing or not doing the exact opposite. Now sometimes kids will display what is called "oppositional" behavior with a bit of a glint in their eye trying to make it a bit of a game. That's hard, but not what I'm talking about. I'm talking about a more pure impulse, one that is almost lightning fast. It's a unique challenge - and many of the higher functioning kids with ADHD have the same challenge that kids with ADHD without Autism have: The KNOW what the rules are. They just "impulsively" acted. It's an explanation, but not an excuse. It's certainly maddening for parents and teachers and so very frustrating for kids who are not really "bad," they're just, well, impulsive (or hyperactive or fill in whatever blank you want.
So many of the parents I see all but tear their hair out with the Autism-ADHD combo. Meds can often help, sometimes a lot, but some kids have sensory issues making swallowing meds, even the liquids difficult, notching up the challenge to parents and teachers to a "whole nuther level." Positive reinforcement can be helpful as well, but that's generally precluded on a strong sense of emotional relationship between child and adult, not something that all those with Autism have. All are used, properly so, but the unique challenges that the child with Autism and ADHD bring makes it such an unusual hill to climb.
Despite the difficulty level of these challenges, parents of kids with Autism and ADHD can only do what they always do - their best; trying to be creative and advocate for their kids as much as possible; working with their physicians, teachers and schools. I always encourage families to find parent support groups, because it's unlikely that their challenge hasn't been met by another family, and so often that's where we can get not only ideas, but strength.
For so many parents and so many professionals, the Autism - ADHD combination is almost a boring fact of life. But ask any parent, it's never mundane. Exhausting? Yes. Mundane, never.
