#7: ADHD and Autism in Children: Understanding the Differences and Importance of Early Intervention

Podcast
May 17, 2024
12:21 pm

Welcome to the Anannya Child Development Center podcast, where we explore early intervention and neurodevelopmental disorders in children. I’m your host, Isha Singh, and joining me today is our special guest, Winci Beebee, an early interventionist who has been making a remarkable impact at Anannya for the last two years. With her expertise and passion for helping children, Winci brings valuable insights to our discussion. Today, we’ll be diving into a topic that often leads to confusion and misunderstanding: ADHD and Autism in children. While both are neurodevelopmental disorders, they have distinct characteristics that set them apart. However, misconceptions and misdiagnosis can sometimes blur the lines between the two.

1. Understanding Overlapping Symptoms and Misdiagnosis

Winci: Thank you for having me here, Isha. Many people believe that ADHD and autism are always easily distinguishable. However, we know that symptoms can overlap, making diagnosis challenging. Can you shed some light on how this overlap can lead to misdiagnosis?

Isha: So Winci, ADHD and Autism are often misdiagnosed.

I have seen too many cases where the child displays the symptoms of Autism, yet they have been diagnosed with ADHD.
Because the child is very young, the symptoms of hyperactivity are very commonly seen in children, and we diagnose the child as having ADHD.
However, Autism symptoms are much more than just hyperactivity and inattention.

Winci: In your experience, what are some of the similar symptoms that ADHD and autism share? For instance, difficulty with social interactions and focus. And how crucial is a thorough evaluation by a qualified professional for accurate diagnosis?

2. The Importance of Thorough Assessment

Isha Singh: A thorough assessment by a registered psychologist and an experienced one is much needed. Something that we need to understand when it comes to children is a lot of symptoms are seen in a similar way in children for most of the neurodevelopmental disorder.

For example, the child can exhibit hyperactivity and inattention in both ADHD and Autism. The child has deficits in social interaction in both cases – in ADHD and in Autism also.

Let’s look at the key differences in social interaction:

Autism: A child with Autism does not want to socially interact with other children; it doesn’t come naturally to them.
ADHD: In ADHD, it comes naturally to them, they want to play with other children, but they may not know how to play with other children.

(a) They may not be able to follow the rules of the game.

(b) They may get a little more cranky because they are not able to follow, and the other children are not able to understand or have patience with them.

More key distinctions:

Autism: Children withdraw themselves, they like to play amongst themselves. They like to be in their own world. Their play is much more self-centered.
ADHD: Children with ADHD, their play is more social.

These very minute details set apart a diagnosis and therefore the course of action. Therefore, a thorough diagnostic assessment is necessary, almost crucial, for the path ahead for the child.

3. The Nature of the Disorders and Appropriate Interventions

Winci: That’s a great point about the misconception that Autism is an emotional disorder, while ADHD is a behavioral disorder. Considering that both conditions have a neurological basis and can impact emotional regulation and behavior, how can misunderstanding the nature of these disorders lead to inappropriate interventions?

Isha: It’s a completely valid point; it does lead to inappropriate intervention because we start targeting the behavior without understanding where it is originating from.

Here’s how interventions can differ:

ADHD: A child with ADHD has the inherent nature and needs to play with other children, bond with other children, but is not able to follow the rules, is not able to patiently wait for his turn, and therefore is not able to play in a structured way with other children.
Autism: A child with ASD, on the contrary, does not have an inherent need to play with other children or share with other children.

If we just do behavior therapy without understanding where it is coming from, yes, we are just trying to treat a superficial symptom, a behavioral symptom that we can see. As you rightly said, ASD is an emotional disorder, so we need to understand that the child does not have the need to play with other children, which is completely detrimental for him. We have to teach him how to play with other children because social skills training is an essential part of development.

ADHD: Children with ADHD have that social skill, but they do not know how to utilize that skill in social settings. So we need to teach them that.
Autism: Children with Autism need to be taught social skills from the ground up.

Therefore, one program for all children, just because their child is hyperactive, is not playing with other children, or does not have enough social skills on the face of it, does not fit. A diagnosis of ADHD and ASD symptoms come separately from two different points. Therefore, we have to target the behavior from two different intervention angles rather than one.

4. The Myth of "Outgrowing" the Disorder

Winci: That’s very interesting. You mentioned the prevalent misconception that children with ADHD or Autism will outgrow their disorders. Given that ADHD and Autism are lifelong conditions, even though symptoms may change over time, how can this disbelief in outgrowing these disorders delay necessary support and interventions?

Isha: A lot.

I see a lot of parents that wait for five years, six years, almost eight years, to come to a psychologist, to come to a registered professional, and to ask for help.
We talked about it in our previous podcast how a second opinion and third opinion is also important.

One thing that our listeners need to understand is that wasting time in getting the right support for your child is very, very detrimental for the development.

As the age grows, so does the severity of symptoms can grow.
If we give timely help and support to the child, there’s a huge chance that the severity of the symptoms can reduce significantly, so that the child can be independent, adaptive, and socially functioning in the society.
But if the timely help is not given to the child, and we wait for the symptoms to grow till eight years and nine years, it’s very difficult to reduce the severity and get the child back into an adaptive functioning in the society.

5. Gender Differences in Autism Presentation

Winci: I see where you’re coming from. Expanding on the issue of misdiagnosis, it can be particularly challenging for girls with Autism, as they may be misdiagnosed with social anxiety or personality disorders. How can Autism present differently in girls, leading to misdiagnosis or delayed diagnosis? And why is increasing awareness of gender differences in Autism presentation crucial?

Isha: It’s a very nice point, very interesting actually. Theoretically also, when we study, Autism is much more diagnosed in boys than in girls. And as you rightly said, in girls, it may be seen as social anxiety, or just not wanting to talk to other people, or just a personality factor, almost like the labels that people give as introvert.

Here are some cultural reasons why Autism may be diagnosed more in boys:

Boys are much more out there, and girls, from a younger age, are kept inside the house. Now things have changed completely; it has changed for me, in my generation only.
Because boys were much more out there. Their symptoms were much more visible to other people. People could see the deficit – that they are not able to mingle with other children, or there is a speech delay – and girls, being in a protective environment, were not so much visible to the outside society. So their symptoms was not very, very visible to other people who can question or who can ask the parents, “Okay, there is something wrong, there is a concern, and we can show to a psychologist.”

Culturally, this is one of the very important factors that we have studied and it has played, especially in the Indian cultural subcontinent that we are talking about.

6. The Importance of Awareness and Early Intervention

Winci: Increasing awareness of any neurodevelopmental disorder is very, very important when it comes to children. Autism or ADHD is a developmental disorder, be it emotional and behavioral, but at the end of the day, a neurodevelopmental disorder. So, awareness brings the right and timely support to children – very, very importantly. The more awareness is there, the more parents understand that the child can be given help, basically.

Isha: The child is brought to professionals like us, CDCs like Anannya, as early as 11 months! We have diagnosed a child with high-risk Autism at 11 months of age.

Early Intervention is Key:

When we start an early intervention at 11 months and at a five year, there’s a huge difference in that.
The child hasn’t learned anything at 11 months, right? There is just few delays that are there, and we can help the child to grow up, reduce the gap in the developmental delay that he or she has. But at five years, that speed becomes a little bit slower.

Help Your Child Thrive

7. Similar Symptoms, Different Interventions

Coming to the presentation of symptoms, either in girls or in boys, Autism symptoms are the same. There is no difference in presentation of symptoms. Maybe severity is different, but as different as two boys and two girls. But the presentation of symptoms of ADHD or of ASD, that is Autism, is very, very similar and same in both boys and in girls.

8. The Role of Genetics and Environmental Factors

Winci: It’s true that some people mistakenly believe ADHD and Autism are the result of modern lifestyle factors. Considering that ADHD and Autism have a strong genetic component, even though environmental factors may influence symptoms, how can blaming lifestyle factors perpetuate misconceptions and delay proper diagnosis and treatment?

Isha: There is a terminology called “environmental factors” when it comes to psychology and it comes to neurodevelopmental disorders or mental health as such. Environmental factors play a crucial role in symptoms in both children and in adults.

We were talking about virtual Autism in the last episode. Virtual Autism is an environmental factor when the child is put in front of the screen.
There are a lot of symptoms that has been seen in children, which is now being termed as virtual Autism.
Symptoms are similar to Autism, therefore, virtual Autism.

But environmental factors and genetic factors play a very important role. Studies have told us, we have to see seven generations almost, if one of our ancestors had a gene for Autism of ADHD, then that can manifest in full-blown Autism or ADHD in the current generation, complementing the environmental factors.

So there’s a genetic component, vulnerability to it, and we add an environmental factor to that, then yes, the severity of those symptoms can very well increase big time. I’m not very convinced of attributing a child having Autism only to genetic factors. Yes, in some cases it can be there, I’m not debating the fact that at all; in fact, science says that. But at this current moment, environmental factors and genetic factors, both are enough contributing factors together for increasing the symptoms or increasing the prevalence rate of Autism in children right now.

9. Sensory Processing Disorders: Mimicking Symptoms

Winci: Let’s focus on another area. Children with sensory processing disorders may be misdiagnosed with ADHD or Autism. How can sensory processing issues mimic symptoms of ADHD or Autism, leading to misdiagnosis? And why should a comprehensive evaluation consider sensory processing alongside other factors?

Isha: Autism, primarily diagnosis is done with a speech delay, social, emotional deficits, restricted, and repetitive behaviors.

In the criteria of restricted and repetitive behavior, one of the things that is seen in children is that they are sensitive to noise – certain kinds of noise – or they are sensitive to certain kinds of taste, or they are sensitive to certain kinds of touches. All these are sensory symptoms. That comes in one of the diagnostic criterias with Autism.

If the other two diagnostic criterias of Autism is not fulfilled in the child, then it is purely a sensory processing disorder, and it is not Autism.

As a professional like me, having 15 years of experience now, I honestly try to go by the diagnostic criteria given by DSM. If the child fulfills all the diagnostic criteria of Autism, or an ADHD, then I diagnose the child as that.

10. Understanding DSM: A Tool for Diagnosis

Winci: For the listeners and parents who might be hearing this, can you please elaborate a little bit about DSM?

Isha: So DSM is the Diagnostic and Statistical Manual of mental health, mental disorders. We are studying the five TR right now.

There is a scientific manual to it; there have been enough researches of DSM and I like to follow that.
There’s a book where all these disorders are explained symptom-wise.

So it is not a subjective evaluation that I’m giving. In fact, I’m being very, very objective. So the three criterias that is scientifically evident is there, then I diagnose the child as ASD or ADHD.

ADHD children do not have sensory processing deficits or sensory processing concerns. I have not commonly seen. But sensory concerns is always seen as a part of ASD.
But a child with sensory processing disorder may not have other symptoms, or other deficits, or concerns that the child with ASD may have.

11. Breaking Down Stereotypes and Low Expectations

Winci: It’s concerning that there’s a misconception that a diagnosis of ADHD or Autism limits a child’s potential. Knowing that early diagnosis and appropriate intervention can help children with ADHD or Autism reach their full potential, how can stereotypes and low expectations be more limiting than the disorders themselves?

Isha: Stereotypes is almost prevalent everywhere, especially in developmental disorders. If I give a diagnosis of ASD to a child, and when we are discussing the report, you can see the color of the face change of the parents. They are so worried that, “Oh my God, my child has Autism, right? Will there be a future?” The crucial part that parents don’t understand is that the fear of just the name causes a lot of anxiety in them. When we start explaining the parents how helpful early intervention is, then they start understanding, yes, there is something that can be done for this condition also.

And someway, almost, there is a myth that, when it comes to diagnosis, an ADHD diagnosis is much more better than an ASD diagnosis. For me, both are neurodevelopmental disorders. In both condition, the child needs the right amount of help. Support is needed for the child.

12. Focusing on Prognosis and Early Intervention

Rather than focusing on which condition the child has, the prognosis of the condition is available to us as theory and as knowledge in the term of diagnosis.

If we know what we are looking at, we would know how the condition can deteriorate, or the condition can get better. That is known as the prognosis.

So rather going through the stigma related to, “Okay, my child has Autism, that means there will not be any future for the child.” In fact, if the child is helped in a right time, sometimes, the severity reduces, the child goes back in the society completely, and it may reduce to a certain extent that nobody even notices that the child has these deficits. My whole concern is rather than focusing on what the society presents or what the research presents or how it is looked at, we just need to focus on how we can help the child at this moment of time.

13. Call to Action

Winci Beebee: Isha, thank you for this fantastic discussion on ADHD and Autism in children. We have covered so many important points that every parent should know. If you are a parent and you are worried about your child’s development, please don’t hesitate to reach out to us at Anannya Child Development Center. We are here to help you get the answers and support you need.

Our team of experts is ready to provide a thorough assessment and personalized care for your child.
Remember, early intervention is so important for children with neurodevelopmental disorders.

To all the parents listening, keep learning about ADHD, Autism, and other neurodevelopmental disorders. The more you know, the better equipped you will be to support your child and advocate for their needs. Every child is unique and deserves the chance to reach their full potential. Let’s work together to make sure that happens.

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