July 27, 2022

Why Some Children on the Autism Spectrum Are Misdiagnosed with ADHD

Asperger’s Syndrome no longer exists as a standalone diagnosis. But many of the symptoms associated with this type of Autism Spectrum Disorder are mistaken for ADHD along the way. Find out if your doctor is on the right path.

By Eileen Costello

Asperger’s and ADHD

Most children with symptoms formerly associated with Asperger’s Syndrome, an autism spectrum disorder, receive an ADHD diagnosis — or misdiagnosis — before a pediatrician concludes that it’s AS. The symptoms of autism spectrum disorders and ADHD overlap. Most children on the autism spectrum have symptoms of ADHD — difficulty settling down, social awkwardness, the ability to focus only on things that interest them, and impulsivity.

Asperger’s Syndrome and Autism

Although symptoms formerly associated with Asperger’s Syndrome are part of on the autism spectrum, the symptoms are often milder than those of some forms of autism. More severe forms of autism are often diagnosed in the first two years of a child’s life, but symptoms formerly associated with Asperger’s Syndrome are usually diagnosed at a later age. A major reason for that is while children with AS may have moderate delays in the speech development, most AS children communicate by age three.

Cause of Asperger’s Syndrome

Researchers don’t fully understand what causes symptoms formerly associated with Asperger’s Syndrome, although there seems to be a strong genetic component.

Signs of Asperger’s Syndrome

Children with symptoms formerly associated with Asperger’s Syndrome, like all individuals on the spectrum, have difficulties in three areas: communication, social interaction, and restricted interests. A child with AS might have some or all of these symptoms; however, symptoms are often less severe than in a child with autism. The following is a breakdown of each type of impairment.

Communication Impairment

  • Speech development may be normal or somewhat delayed, but difficulties arise in the functional and social use of language for communication
  • Impaired use of nonverbal behaviors, including eye contact, body language, and social expressions

Poor Social Interaction

  • Failure to develop age-appropriate peer relationships (inability to understand the social give-and-take of friendships)
    Most children with symptoms formerly associated with Asperger’s Syndrome want to make friends, but they don’t know how.
  • Failure to seek out others to share enjoyment, interest, and achievements (such as sharing a good grade on a test)
  • Lack of social and emotional reciprocity (not enjoying being with others just for the sake of being together)

Restricted Interests

  • Narrow interests that are abnormal in intensity and focus (a single TV show, the Titanic, or an unusual object such as a vacuum cleaner)
  • Rigid adherence to nonfunctional routines and rituals (following a strict protocol when leaving the house to go to school)
  • Stereotyped repetitive motor mannerisms (pacing)

Why Parents Miss the Signs

Parents may be slow to pick up on symptoms formerly associated with Asperger’s Syndrome in their child. Its subtle combination of clues that leave parents wondering if anything is wrong or if the symptoms are part of their child’s personality. When a child goes to preschool, social difficulties become more evident. Typically, AS kids are unable to make friends, have a hard time reading other people or understanding humor.

Evaluation for Asperger’s Syndrome

If you suspect your child has symptoms formerly associated with Asperger’s Syndrome, consult with a developmental and behavioral pediatrician, a child psychiatrist, or a psychologist with expertise in the autism spectrum. The evaluation will likely involve observing your child and talking to you about his development, social interaction, and communication skills. Your child may undergo several tests to determine her level of intellect and academic abilities.

Treatment Options

Most children benefit from early, specialized interventions that focus on behavior management and social-skills training: learning how to interpret gestures, eye contact, tone of voice, humor, and sarcasm, for example. Cognitive behavior therapy may help them manage obsessive behavior and anxiety. About half of children with symptoms formerly associated with Asperger’s Syndrome will be treated with medication.

School Accommodations

Schools are getting better at providing services for children with symptoms formerly associated with Asperger’s Syndrome. Many offer pragmatic language therapy, which helps a child learn the basics of social interaction. Parents should make sure that social skills accommodations are part of their child’s IEP. With the right accommodations, you can help your child learn to advocate for himself as he approaches adulthood.

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