Difference between Asperger's and ADHD

Discussion in 'General Parenting' started by Malika, Nov 21, 2012.

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  1. Malika

    Malika Well-Known Member

    Okay, this theme interests me as it has come up in a recent thread I started. Doing a bit of reading about it on the net, I found what seems to me an excellent article by a doctor from something called the Asperger's Association of New England. He starts out by saying that the territory of the two conditions is muddy and not clear, so that certainly goes along with what IC and MWM are saying. However, my niggling gut feeling and judgement all the time is that there IS a clear, discernible difference between the two and he clarifies this for me. I'd like to post it here because I think it's so helpful and it really caused a kind of "oh, yeah, that's what I'm trying to say" lightbulb to go off.

    "The problem with the ADHD and Asperger overlap, is that at the more severe margins of the ADHD spectrum and the less extreme margins of the Asperger’s spectrum, clinicians can legitimately argue for one over the other diagnosis. Nonverbal Learning Disability (NLD) is not the only confusing label at the milder side of Asperger’s Syndrome. Many children with significant ADHD can be quite socially aberrant, lack perspective-taking skills, have severe sensory integration problems, be absolutely obsessed with Nintendo, talk constantly and too loudly, have meltdowns at the drop of a hat, be teased, and have no friends.

    Yet even in this confusing part of the disruptive disorder stew, where perhaps juvenile bipolar disorder is one click further out than severe ADHD, there are still some guidelines I use to help me sort through the Asperger’s versus ADHD dilemma. First and foremost, Asperger’s Disorder is one of the Pervasive Developmental Disorders. As hard to digest as Pervasive Developmental Disorder (PDD) has been for all of us working the Autistic Spectrum, the term nevertheless clearly and plainly denotes that children who fall into this category have developmental delays that pervade many developmental sectors. Therefore I expect, in fact require, a child with Asperger’s Syndrome to have at least a history of delays and deviations in many sectors (for example, possibly in gross motor, fine motor, sensory integration, attentional regulation, pragmatic speech, socialization, interest and play, affective modulation (e.g., anxiety and mood management), and neurocognition.

    It is not that children with ADHD do not have developmental delays, but they do not usually have the variety, the severity, and the contours that children with Asperger’s Disorder characteristically have. ADHD children can have (although certainly not always) poor social skills, but they rarely and consistently have the demonstrable defects in comprehending social reciprocity (e.g., impairments in theory of mind, understanding of complex nonverbal cues, defects in facial recognition, distortion of subtle affective displays, miscomprehension of social context and signaling , and so forth.) Children with ADHD can talk in annoying controlling ways, but the configuration of pragmatic mis-broadcasting that is so tell-tale at any gathering of individuals with Asperger’s Syndrome is really quite consummate and unmistakable. This combination of prosody, dysfluency, pitch and volume, gaze aversion, fascinating but unfunny humor, peculiar word usage, anthropomorphizing of objects, hypersensitivity to criticism, receptive distortion of tones of voice, is certainly highly variable from one individual to another, but it is often definitive in whatever unique madras pattern it appears.

    In general, children with Asperger’s Syndrome “have more” than most children with ADHD. They have more perseveration, more stereotypies, more splinter skills, more trouble telling a coherent story, and more neuro-integrative problems.

    Children with ADHD can have as bad or worse executive functioning skills as the children with Asperger’s. If their attention is very, very poor, children with ADHD can have as bad a Rey Osterreith. In fact, children with ADHD can often have verbal IQ which are much better than their performance IQs (like the Aspies and NLDers), but more often it is due to very slow processing speed, which drags down the timed tests and deflates the scoring of Performance IQ. Indeed, many individuals with ADHD share a great many neurocognitive features with children with Asperger’s Syndrome, and that is one reason why neuropsychological testing by itself is not the best way to make a diagnosis of Asperger’s Syndrome. Testing is often incredibly helpful in understanding the learning style of the child with Asperger’s, and it is unarguably essential in making a diagnosis of NLD.

    Children with Asperger’s Disorder and children with ADHD usually want to have friends. Both groups have poor rite-of-entry skills and both groups play badly. Yet both groups usually fail socially for different reasons. Their recipes for play failures have different ingredients. What often turns on a child with Asperger’s Syndrome is behavior so unusual and idiosyncratic that it can be unfathomable even to another child with Asperger’s. Children with ADHD frequently break rules they understand, but defy and dislike. Children with Asperger’s Syndrome like rules, and break the ones they don’t understand. They are ever alert to injustice and unfairness and, unfortunately, these are invariably understood from their own nonnegotiable perspective. Children with ADHD are often oppositional in the service of seeking attention. Children with Asperger’s disorder are oppositional in the service of avoiding something that makes them anxious. Both groups have serious sensory integration problems, can be uncoordinated and impulsive, and they both very much respond positively to structure and routine. The children with Asperger’s, however, crave order, hate discrepancy, and explode (or withdraw) in the face of violation of expectations. In this regard, they are enormously brittle and fragile. Children with Asperger’s are much more tyrannized by details; they accumulate them, and cannot prioritize them. Children with ADHD also have poor organizational skills, but can be much more fluid in their thinking, more inferential in their comprehension, and less rigid in their treatment of facts that they are able to organize.

    Of course these are all generalizations. There is always the child who is the exception. Whatever their profile, whatever their label, both the child with ADHD and the child with Asperger’s syndrome require us to change our assumptions about relationships and our expectations about behavior. They are both demanding, confusing, exhausting, and frustrating. Inside, each is a child who needs tolerance, our informed understanding, our thoughtful interventions, our patience, and our love."

    Ref: http://www.aane.org/asperger_resources/articles/miscellaneous/aspergers_or_adhd.html
     
  2. Sheila

    Sheila Moderator

    Interesting article. Thanks

    There are some that believe that ADHD is also on the Pervasive Developmental Disorder (PDD) spectrum.
     
  3. InsaneCdn

    InsaneCdn Well-Known Member

    That last paragraph is so bang on that I'd love to find a way to brand it to the desk of every diagnostician.

    The line between severe ADHD and less-severe Aspie is... a line in the sand, somebody's definition, of a way to distinguish. But it's hard to split hairs right at that line.

    However... a child can have more pieces out of sync and be ADHD, than an Aspie with milder symptoms of many pieces but serious social deficits. It isn't really a nice clean line of less or more severe.

    My take on ADHD and social skills? ADHD kids don't "notice" non-verbal or sometimes even verbal clues, because they act or react first, where if they stopped and thought, they would understand how they should have reacted. Aspies... either don't understand the clues, or cannot process them nearly fast enough for practical use in interaction with others.

    Our psychiatrist looks for two main clues...
    1) serious social deficits
    2) other challenges - even if minor - starting before age 3 (motor skills, speach, etc.) - obvious at least in hindsight.
     
  4. InsaneCdn

    InsaneCdn Well-Known Member

    Read something else interesting the other day... to paraphrase:

    If the child has NO motor-skills issue, then the child is not Aspie.
    It is one of the original definitions.
    So... a child can be severely impaired in many areas, but a star athlete... and they would either be ADHD or Autism Spectrum Disorders (ASD), but not Aspie.
    There is no direct ordering of severity of symptoms from ADHD to Aspie to Autism Spectrum Disorders (ASD).
     
  5. Malika

    Malika Well-Known Member

    That's interesting, IC.
    Funnily enough, for me the difference (as I perceive it in my layperson's way) centres around humour. Typically, the Asperger's person is not very humorous or has a very individual humour that is not understood or shared by people generally and is slow to "get" jokes and humour; I think of people with Asperger's as being over-literal and rather ponderous. As far as I understand it, there is no such deficiency in ADHD. Certainly J has a very quick sense of humour and is not at all flat or contained in his own world of meaning in that sense.
    But maybe this is all a very caricatured view of mine?
     
  6. InsaneCdn

    InsaneCdn Well-Known Member

    Aspies have humour... Autism Spectrum Disorders (ASD) not as much, they are the over-literal ones. Aspies take things literally especially around emotions or instructions, but there are lots of forms of humour that work for Aspies.
     
  7. SomewhereOutThere

    SomewhereOutThere Well-Known Member

    Asperger's unlike other Autism Spectrum Disorders (ASD) disorders do not have delays. That's part of why Asperger's is seperate. My Autism Spectrum Disorders (ASD) son has a GREAT sense of humor. In fact, a lot of it is word play and irony. He does "get" jokes. My son, however, was first diagnosesd with Pervasive Developmental Disorder (PDD)-not otherwise specified or atypical autism, which may be closer to ADHD than Aspergers. Not sure. Seen a lot of kids dxd. with ADHD who seem spectrumish. Doesn't matter as long as they get the right help.

    Questiin: How do we know if a child is acting up to seek attention or out of fear? Also not all kids diagnosed with either ADHD or Autism Spectrum Disorders (ASD) are oppositional.

    After the first four years or so, my son was pretty easy. Quirky, but easy :)
     
  8. Malika - Thank you for sharing that. Some very interesting and enlightening information there. I find this conversation fascinating as I mostly believe difficult child is ADHD but there is Autism Spectrum Disorders (ASD) in my family as well.

    I look at my nephew who is Autism Spectrum Disorders (ASD) and I look back at difficult child and I there is a distinct difference between them but similarities as well. You can get to know my nephew and say "Yes, he is Aspie or Autism Spectrum Disorders (ASD) - they haven't made the distinction yet." But I can't say that with difficult child.

    I'd be interested to know what types of sensory integration problems are common in ADHD and Autism Spectrum Disorders (ASD). Are they the same or different?
     
  9. whatamess

    whatamess New Member

    From the information I've read over the years, I don't believe you can parse out adhd from Asperger's. The executive function deficits of add/adhd are a part of Asperger's/Autism Spectrum. I feel like every other post new people put up I immediately see Asperger's or autism written all over it. I have not felt like that at all with your posts about J, Malika.
     
  10. InsaneCdn

    InsaneCdn Well-Known Member

    We were told that ADHD or Aspie plus anxiety led to oppositionality... not the ADHD or Aspie traits, but how they handle anxiety. Not all kids with these dxes have the high-anxiety issue. I'm starting to wonder if many kids with anxiety have this problem - if it's just straight anxiety that drives it.

    I haven't found this on the net, but in older books, some have wondered if Aspie and Autism Spectrum Disorders (ASD) are the result of brain hemispheric specialization - Aspie being one side, Autism Spectrum Disorders (ASD) being the other, making the two dxes quite different. Would be interesting to know what happened to that theory.
     
  11. Malika

    Malika Well-Known Member

    Yes, that's interesting. Certainly a lot of the professionals who have seen J up to now have diagnosed him with anxiety only, saying they are not willing to commit to an ADHD diagnosis because he copes in school settings. On the other hand, the Moroccan paediatrician (trained in France) who knew him since his earliest babyhood was clear from VERY early on that he was hyperactive and that people who told me otherwise were just giving me soft soap. No-one has ever thought he had Asperger's or Autism Spectrum Disorders (ASD), though.
    What are J's difficulties?
    He doesn't want to listen to what grown-ups say, often thinking his own way is best and just doing it, despite what he has been asked or told. However, he only displays this high degree of oppositionality with me - with other figures of authority he mainly complies with occasional incidents of mild opposition.
    He is extremely hyperactive, constantly moving, climbing, clambering, running. However, he sits still and concentrates when he is playing with his various figurines in imaginative play, which he does a lot of at home, and at school - though I am sure he still fidgets and moves around more than others. Professionals who have dealt with ADHD kids have told me that at school they often run riot, unable to cope at all.
    He is extremely emotional and reacts dramatically to disappointment, frustration, being thwarted. This actually seems to be getting worse, or more intense. Again, this drama queen is on display much more at home than at school.
    Looks like a lot of the problem is with me :) Actually I think a one-parent home really doesn't suit him as he constantly wants to take power, as it were, as if he were the man of the house. He would be less anxious and more stable and secure in a setting with two parents and other children. I think that would help him find his role as a child more easily. Gosh, didn't realise I was going to type those last words and realise I have come up with a diagnosis of sorts for his oppositionality....
    Asperger's or ADHD? To me the difference seems clear even though I understand everyone is saying it isn't, and I do respect your combined knowledge and experience. The component of anxiety in some ADHD kids makes it look like Asperger's perhaps?
    I do know this is going to get harder and harder as J gets older and I am going to feel more and more inadequate as the sole caregiver. I wish we had that damned UK nationality and could take off to forge a life for him in Morocco.
     
  12. InsaneCdn

    InsaneCdn Well-Known Member

    I'd love to have those professionals meet my extremely-ADHD K2... who was as quiet as a mouse in the corner... and never made a single problem for anybody. The problem? She's ADHD-inattentive, and her body was at school but her brain was everywhere else. Distracted by every noise, every movement, and by her own thoughts. ADHD is NOT solely defined by hyperactivity... but ADHD with hyperactivity is more typically the out-of-control kind of hyper.

    For J - even his "hyper" can be anxiety driven. Maybe even related to some form of insecure attachment... not your fault, and very difficult to address...
     
  13. SomewhereOutThere

    SomewhereOutThere Well-Known Member

    I don't think professionals are all on the same page with ADHD vs. Aspergers. And some kids are iffy. It seems that France does not really like to diagnose kids with anything. In the US, who knows what diagnosis. J would have? in my opinion it doesn't matter as long as the child is getting the necessary help.

    Autism Spectrum Disorders (ASD) and ADHD, if they are not on the same spectrum, both do lead to executive function disorders and this is a difficult problem. This link explains executive function problems in ADHD and Autism Spectrum Disorders (ASD). Of course, kids don't usually have EVERYTHING symptom.

    http://www.milestonemom.com/how-to-...n-with-adhd-autism-and-learning-disabilities/
     
  14. InsaneCdn

    InsaneCdn Well-Known Member

    MWM... Given that many doctors aren't on the same page on some basic MEDICAL dxes... it's no wonder that the more difficult neurological brain issues are hard to come to agreement on!
     
  15. Insane - That is my easy child daughter. She is not extreme ADHD but she is definitely ADHD - Inattentive. This is how we describe it..... It's like your brain is running around in your head from thought to thought to thought like a 2 year old. You keep telling it to come over here and 'do this' but it just won't listen.

    At least that's how it is in my head and easy child's.
     
  16. InsaneCdn

    InsaneCdn Well-Known Member

    Which is why K2 and I are both on medications...

    K2 on medications = pretty much a typical teen (ADHD kids "think" differently, so she does still trip on that... teacher asks a question and she mis-interprets it... )
     
  17. DammitJanet

    DammitJanet Well-Known Member Staff Member

    Jamie is poster boy for classic adhd emphasis on the H especially when young. He just had the wind knocked out of his sails recently when he had to go to Hailie's teachers conference and the teacher was pointing out Hailie's problems but she noticed Jamie fidgeting in the chair. She asked him if he had ever been diagnosed with anything and he told her yes, ADHD but he had grown out of it when he entered HS. She gently told him that he hadnt. She pointed out all the little things he was doing while he was sitting there were signs of ADHD. He asked her if him losing his gear and other stuff was also signs and she told him yes. He was shocked. I have no idea why because I have been telling that to him for years but I guess coming from someone else just hit him harder or he listened to someone else differently than mom.

    Personally I am thinking his daughter may be more of a combo of anxiety and Obsessive Compulsive Disorder (OCD) than adhd but I have no clue if I can ever convince them to take her to be tested. She may have to get a whole lot worse before anything gets done.
     
  18. InsaneCdn

    InsaneCdn Well-Known Member

    JMO, but... anxiety plus Obsessive Compulsive Disorder (OCD) plus ADHD-ish stuff plus maybe a bit of ODD = ... probably Aspie.
    If she is... I hope she gets a diagnosis within a couple of years, because it makes a big difference on the outcome.

    And yes: having ONE parent with ADHD increases the risk of any of ADHD, Aspie or Autism Spectrum Disorders (ASD).

    (sorry, Jamie... you are doomed... you WILL have at least one kid with spectrumish-challenges, one way or the other!)
     
  19. HaoZi

    HaoZi Guest

    My Kiddo is both Aspie and ADHD. And yes, she's both. Oh boy is she both!
     
  20. TerryJ2

    TerryJ2 Well-Known Member

    Very interesting!
    My son is both, for sure.
    And maybe a mood disorder on top of it.
    I like the explanations in the last graf, too.
     
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