Children with ASDs and Additional Diagnoses: ADHD, Anxiety, Depression, Bipolar Disorder

My 11 year old son was first diagnosed with ADHD. A year later, his diagnosis was changed to PDD-NOS. The missing piece was the education portion. The school that he was in at the time was viewing his non-compliance and being a willful and difiant act and that basically he had, as they put it simple ADHD - not that there is anything really simple about that disorder either.

When they performed their academic testing they found him to be of average intelligance, with average skills that were even across the board. Example; In Math he scored a 101 - which is dead solid in the middle of the average range.

The first doctor who evaluated our son left the academic testing to the school to do. he focused on testing in the areas of ASD. In his report he went on for three and half pages about how our son met the criteria for high functioning ASD and how that diagnosis would describe all of his symptoms, however he stayed ont he fence because of the information that the school was relaying to him.

The second doctor imediately did his own academic testing and foound there to be huge discrepencies between his findings and the those of the schools. Example; In the area of Math he found his score to be a 51, a sharp contrast to the 101 that the school and found. Given a more accurate academic profile, he quickly arrived at an ASD disgnosis of PDD-NOS.

On the home front, we had struggled with things with our son and had that erry feeling that something wasn't quite right from the age of 2 or so, but not understanding the nature of high functioning autism and how these kids present a little bit differently than typical autism kids do, we just muddled throug year after year not putting all the pieces together and dealing with each thing as it came along.

It was odd, in some ways he seemed to be behind, but then in others he seemed to be way ahead. There were som odd behaviors and, what I now know to call, sensory issues, but he displayed some emotion and he sought to share experiences (to a degree anyway), but he hit all of the early mile-stones dead on the money. We knew something wasn't quite right, but couldn't figure out what, so we didn't know what questions to ask his doctor.

Once we acquired the proper knowledge about high functioning autism, we quickly put the pieces together and got to work on contacting the needed professionals to help us sort it all out.

So the delay in our sons diagnosis was lack of information on both our part and the part of the school.

I have two children on the spectrum. My son who is 10 has been dx'ed with adhd first then bipolar and now after 4 years of having the bipolar dx's they also add asperger. They say he actually has both disorders. My daughter who is 3 was originally dx'ed with disruptive behavior disorder as a young 2 year old and she was dx'ed with this twice until we found someone who actually listened to us and dx'ed her with PDD,NOS.

Getting to both of them being dx'ed was a long road of ppl telling me either one was to young and she is only behind she will catch up to my son who everyone overlooked until we found someone who could actually reach my son.

Lisa

My son just turned 9 and has had 5 separate diagnosis in the past 4 1/2 years we've sought help for his behaviors: ADHD, Mood Disorder (NOS), Bipolar, Oppositional Defiant Disorder, Asperger's. The child psychiatrist ruled out bipolar disorder and mood disorder since he feels like Evan's outbursts and destructive behaviors are directly a result of a stimulus or sensory issue.
Last year, my son was on 5 meds at one time for the BP and ADHD diagnosis and the psych doc we had at that time wanted to add another. She really did not do much for us. That's why we have searched to find a pdoc who really listens. And after 3 child psychiatrists, we've finally found the 4th and hopefully last one the most qualified, the most receptive to us, and most professional!!!

When I look back on it now, my son has always had issues with flapping, the way his socks fit, outbursts if we were in a crowded area, etc that I never really singled out as Asperger's type stuff. I only looked at the behavioral outbursts as a rage from a bipolar viewpoint. We've always known the ADHD was there. But I am confused about something.

I thought I read somewhere that if a child is diagnosed with Asperger's that a separate diagnosis of ADHD cannot be made due to the similarities of inattention and hyperactivity that are or can be displayed in Asperger's. Has anyone else read this?

Hi Ortgeist, and welcome.

I will try to answer your question about ADHD and Asperger's -- can they both be diagnosed in the same person?

Here's what the Diagnostic and Statistical Manual -- IV (the psychiatric bible) has to say:

Under ADHD: "Attention-Deficit/Hyperactivity Disorder is not diagnosed if the symptoms of inattention and hyperactivity occur exclusively during the course of a Pervasive Developmental Disorder."

(In other words, if you have already figured out you're dealing with an Autism Spectrum Disorder, and you see inattention and hyperactivity occurring with it, you don't make a separate diagnosis of ADHD, but accept those traits as part of the Autism Spectrum Disorder.)

Under Asperger's Syndrome: "Symptoms of overactivity and inattention are frequent in Asperger's Disorder, and indeed many individuals with this condition receive a diagnosis of ADHD prior to the diagnosis of Asperger's Disorder."

Here, they are acknowledging how often these symptoms of hyperactivity and/or inattention appear in individuals with Asperger's, and that these may have been previously diagnosed (misdiagnosed?) as ADHD.

What I do not know is the nuances of how psychiatrists diagnose these two clusters of symptoms in practice. For example, I have heard professionals speculate that ADHD and ASDs may be part of the same spectrum. I have also heard debates about whether true ADHD is something different than the inattention found in Asperger's. (For example, if a child is zoning out on his special topic, is he inattentive in the ADHD sense, or some uniquely autistic sense?)

One thing is for certain. A large number of children with a diagnosis of Asperger's have been diagnosed with or treated for ADHD at some point in their lives -- 74% of those ages 10-17, according to the IAN data.

See the chart illustrating this here:
http://www.iancommunity.org/cs/ian_research_questions/attention_and_mood_issues

You can also read about attentional issues and ASDs here in our Challenging Behaviors section. Look for the article entitled Restricted Interests: Obsessions, 'Special Topics,' and Attention Deficits.

My youngest son, 8, was misdiagnosed quite a few times. When he was 18 months he was not sitting up, walking, or talking much. The dx was he's overweight and every child developes differently. I have 3 other children (boys) who hit all the milestones. When he was 2,3,and 4 there was problems with speech and not answering when called, lining up toys but not playing with them, hardly no talking and no sentence structure. The dx was hearing and communication diffencey. When he started school at 5, it was behavior problems, because he would roam around the classroom, not listen to the teacher, all he would do is scribble, and no eye contact. When he was 6, I had the school Child Study Team evaluate him, he was put in Special Ed/ inclusion classes. the doctor and child study team/cst agreed it was ADHD. He was put on ritlin then concerta. But they were saying that he was borderline mentally retarded with communication problems. He started receiving OT, PT, speech, and group therepy. After going to a new school at he age of 7, the CST noticed that he had autistic tendacies, like hiding under tables, roaming around the room, no socialization, covering his ears at loud noises, repetative behavior, as well as ADHD and communication problems. A neuologist came to the school and said it was PDD-NOS and ADHD. He still takes Concerta but at a high dose, 54mg. and Clonidine to help him sleep at night. Without the Clonidine no gets any sleep. In shcool he still receives OT, speech, and counseling. He is currently in an Autism Class for 3rd graders. When I was pregnent with him I was under alot of stress. I was working the 10pm to 7am shift and was handling some toxic chemicals, like paints, bug sprays, and weed killers, I worked at Wal-mart in PA. Then I was put on bed rest, when I was 6 months along and the umbiblical cord was almost folded in half. I still wonder if that could have caused problems with his development.

Please, please, please, do not take the blame for this. You are one in 150 women with a child with autism. Do you think we all worked crazy hours and worked with chemicals? They ( the scientists) or whoever, have to take the focus off the mothers. we end up tking the responsibility when all goes to hell,so give yourself a break.