What is the relationship between the autism spectrum and ADHD

What is the relationship between the autism spectrum and ADHD

 In recent years, there has been a movement to diagnose children with both Autism Spectrum Disorder (ASD) and Attention Deficit Hyperactive Disorder at the same time. But is dual diagnosis the right approach? Is it reflected in the biology of children? Let's take a closer look at how we arrived at this situation.

 Doctors have traditionally relied on three things to make medical diagnoses: the history they receive from parents, an office exam, and medical evaluations. Doctors use x-rays, MRIs, CT scans (to check anatomy), EKGs, EEGs (to check patterns of general electrical activity in electrochemically active organs such as the brain or heart), and blood and tissue biopsies to make their diagnoses. (to evaluate cellular and metabolic information). Doctors are increasingly doing DNA tests that contribute genetic information to the diagnostic process.

 The tests are particularly useful in making diagnoses when the underlying biology of a medical condition is well understood. When doctors make a successful diagnosis, they usually call the condition a "disease." But this word does not apply very well to the vast majority of neuropsychiatric conditions, including ASD and ADHD. That's why these conditions are known as "disorders" (or even "spectrum disorders") and not "diseases."

 Behavioral disorders, ASD and ADHD, and other psychiatric disorders are usually not caused by a single genetic abnormality or mutation. Rather, each of these disorders tends to be caused by literally thousands of genetic or biological variations. 

 They are usually combined and there are often other contributing factors. A prenatal infection or other types of prenatal trauma, postnatal infection and other medical conditions, poor nutrition, physical or emotional trauma, stress, and other problems both past and present, and, of course, interactions between more than one of these factors can be the cause. of behavioral disorders.

 Since medical tests are often not very helpful when it comes to diagnosing behavioral disorders, what do doctors use to work? They have to be based on the history presented to them by the patients and the evaluation in their office. For example, for neuropsychiatric diagnoses, doctors ask about behavioral symptoms and observe patients firsthand, and then do their categorization. If the patient has behavioral symptom A, behavioral symptom B, and comorbid symptom C, then (assuming the condition is severe enough) they qualify for a diagnosis of Behavior Disorder X.

 These categories are useful for behavioral diagnosis. On the one hand, they have proven to be very practical in guiding appropriate clinical treatment, including medications if necessary. On the other, they are used by researchers, insurance companies, and school administrations, but they have their limitations, one of which is that human behavior can never be so specifically classified. 

 For example, although there are several types of anxiety disorders listed in diagnostic manuals, the general condition "anxiety" is found in many other behavioral disorders. So even though ASD is not considered an "anxiety disorder," people with ASD are often anxious. It also happens with people with ADHD, and those who suffer from migraines, asthma, cardiac arrhythmia, etc.

 For years, the manuals specified that the diagnoses of ASD and ADHD were mutually exclusive. However, in newer versions, joint diagnosis is allowed. It turns out that, based on a simple classification of symptoms, there is a good chance that these two behavioral conditions overlap. 

 There is an overall 5-10% incidence of ADHD in children and a 2-5% incidence of ASD. Based on the criteria in the manuals, about 50% of children who can be diagnosed with ASD could also receive a diagnosis of ADHD and about 15% of children who can be diagnosed with ADHD could also receive a diagnosis. a diagnosis of ASD.