22/10/2018 Understanding ADHD and ASD: Similarities and Differences Dr. Lindsay Bates, Registered Clinical Child Psychologist ASD Team Leader, Erica Baker Psychological Services Ms. Melissa Gendron, Psychologist (Candidate Register) Erica Baker Psychological Services Most people are familiar with the terms AUTISM or ASPERGER’S, but the term, AUTISM SPECTRUM DISORDER is not as widely recognized or understood What IS In 2013, a revised version of Autism the Diagnostic and Statistical Manual of Mental Disorders (DSM) was released, the DSM-5. This (controversial) revision Spectrum changed the way autism is classified Disorder and diagnosed. anyway? Although the ‘official’ diagnosis of ASD has changed, the ‘old terms’ do still continue to be used (e.g., Asperger’s syndrome, HFA, Autism). 1 22/10/2018 Past & Current Terminology Autism DSM-5 Spectrum (2013) Disorder (ASD) PERVASIVE DEVELOPMENTAL DISORDERS DSM-IV-TR Asperger’s Disorder (2000) Autistic Disorder PDD-NOS Childhood Disintegrative Disorder The ‘basics’ re: ASD … ASD is a lifelong, neurodevelopmental disorder that affects how people communicate and relate to others. The range and intensity of disability varies, but all people affected by ASD have difficulty with communication, social interaction, and restricted or repetitive interests and behaviours Autism is referred to as a ‘spectrum disorder’ because the symptoms and characteristics can present themselves in a variety of combinations and degrees of severity, ranging from mild to severe. ASD is reported to occur in all racial, ethnic, and socioeconomic groups and the overall incidence rate is relatively consistent around the globe. 2 22/10/2018 The ‘basics’ re: ASD … Social-Emotional reciprocity: difficulty with back-and-forth conversation, reduced sharing of interests, emotions, difficulty initiating and responding to social interactions Nonverbal Communication: poorly integrated verbal and nonverbal communication; abnormalities in eye-contact and body language; lack of use and understanding of gestures; lack of facial expressiveness Relationships: difficulty developing, maintaining, and understanding relationships; difficulty adjusting behaviour to suit various social contexts, challenges in imaginative play, absence of interest in peers Restricted/Repetitive Behaviour: repetitive motor movements, use of objects, or speech; insistence on sameness, inflexible adherence to routines; Highly restricted/fixated interests; Hyper/Hypo-reactivity to sensory input Sex differences in ASD ASDs show a striking male bias in prevalence, with approximately 4 affected males for every 1 affected female. This prevalence difference has been consistent over time and populations, strongly implicating the involvement of sex-specific biological factors in ASD etiology. A male preponderance is not unique to ASD - studies have reliably documented greater prevalence of ADHD and other developmental conditions in males compared to females. Current research suggests that prevalence rates may be less striking than once believed (at least 2:1–3:1) The 4:1 male bias may be partly due to the under-recognition of females (particularly higher-functioning who tend to show increased functional social behaviour and less obvious repetitive behaviours), sampling bias, and issues of diagnostic instruments. 3 22/10/2018 A definitive cause of Current research ASD is not known. indicates that ASD likely There are no develops from an established biomarkers interaction between for ASD, although there genes and the is evidence to support environment, resulting shared biochemical in a disruption to markers with other typical brain disorders, such as development early in A brief note ADHD. life. re: causes of ASD… Recurrence risk in siblings is about 2 - 10% Twin studies suggest (although as high as 20% 60 – 90% heritability. when considering broader ASD phenotypes) You can’t ‘bad poor catch ASD parenting’ nutrition What cable tv / cell phones / car seats pollution DOESN’T videogames cause ASD pesticides 4 22/10/2018 Side note… Celebrity mom and (previously vocal anti- vaxxer), Jenny McCarthy, retracted her claims that vaccines cause autism in 2014 … but the damage was already done 5 22/10/2018 Other myths re: ASD … individuals with the ‘rainman’ ASD is a disorder ASD are not myth of childhood social individuals with ASD can be ASD are individuals with outgrown intellectually ASD are violent and/or cured disabled Prevalence rates This year the National Autism Spectrum Disorder Surveillance System (NASS) released a first reporting of national data and information of Autism Spectrum Disorder (ASD) in Canada. The findings of the 2015 NASS report focuses on those aged 5– 17 years, from six provinces and one territory: Newfoundland and Labrador, Nova Scotia, Prince Edward Island, New Brunswick, Quebec, British Columbia and the Yukon. 6 22/10/2018 Key findings … Among children and youth 5–17 years old, the combined prevalence of ASD for the year 2015 was 1 in 66 (15.2 per 1,000). Males were diagnosed with ASD four times more frequently than females. NASS found that 1 in 42 males and 1 in 165 females aged 5–17 years old were diagnosed with ASD. Among those diagnosed by 17 years of age, 56% had received their diagnosis by 6 years of age; 72% had been diagnosed by 8 years of age; and less than 10% were diagnosed after 12 years of age. The 2015 overall prevalence of ASD in Nova Scotia was 1 in every 68 (of 5–17 year olds). ADHD stands for: Attention-Deficit/Hyperactivity Disorder Most people are familiar with the terms ADHD and ADD, but the official term, ADHD is what is used today. What IS In 1987, a revised version of the Diagnostic and Statistical Manual of Mental Disorders (DSM) was released, the DSM-III. This revision ADHD dropped the hyperactivity distinction. anyway? Then subsequent DSM’s added subtypes/presentations: ADHD - Inattentive, ADHD - Hyperactive, and ADHD - Combined. Although the ‘official’ diagnosis of ADHD has changed, ‘old’ language continues to be used (e.g., ADD - Attention-Deficit Disorder). 7 22/10/2018 The ‘basics’ re: ADHD … ADHD is a persistent pattern of inattention and/or hyperactivity that interferes with functioning or development. Inattention: lacking persistence, difficulty staying focused, disorganization, etc. Hyperactivity: excessive motor activity when inappropriate, talkativeness, etc. Impulsivity: hasty actions that occur in the moment without forethought that have the potential for harm to the individual; social intrusiveness (e.g., interrupting, disruptive behaviour) Symptoms have to be persistent (more than 6 months) to a degree that is inconsistent with developmental level and that negatively impacts directly on social and academic/occupational activities. Symptoms cannot be due to defiance, oppositional behaviour, or failure to understand tasks/instructions. Additional information re: ADHD ADHD is a neurodevelopmental disorder that begins in childhood. Several symptoms must be present before age 12. Symptoms vary depending on the context within a given setting. Symptoms may be minimal when the individual is receiving frequent rewards, under close supervision, in a novel setting, engaged in especially interesting activities, has consistent external stimulation (e.g., screens), or interacting one-on-one. Associated features may include low frustration tolerance, irritability, and/or mood lability. ADHD is more frequently diagnosed in males than females (approximately 2:1 in children, 1.6:1 in adults). The prevalence is about 5% in children and 2.5% in adults. 8 22/10/2018 Current research Very low birth weight indicates that ADHD conveys a 2-3x risk for likely develops from an ADHD. Smoking during interaction between pregnancy has been genes and the strongly linked, as well environment resulting as pregnancy and birth in a disruption to complications, brain typical brain damage, toxins, and development early in infections. Risk Factors life. of ADHD The heritability of Twin studies of children ADHD is substantial. with ADHD show that ADHD is elevated in the family first-degree biological environments of the relatives. ~50% risk children contribute parent to offspring. very little to their Twin Studies show 60- individual differences in 80% heritability. ADHD symptoms Myths re: ADHD … ADHD is not a Children with ADHD are ADHD is a disorder over-medicated real disorder of childhood (Most evidence from research (Long-term studies of children studies suggest that levels of (Cases date back to 1775 and treating ADHD with medication are since over 10,000 research diagnosed with ADHD show that ADHD is a lifespan disorder) either appropriate or that ADHD is studies have been published) undertreated) Poor Parenting causes Girls have less severe ADHD is over- ADHD ADHD than boys diagnosed (Twin studies of children with ADHD (Research studies are reporting on show that the family environments (The vast majority (9 out of 10) of the substantial impairments girls of the children contribute very children have been diagnosed by experience, often to the same little to their individual differences practitioners using best practice extent as boys) in ADHD symptoms) guidelines) 9 22/10/2018 According to DSM-IV-TR, an individual could not be diagnosed with ADHD if they had a diagnosis of a Pervasive Development Disorder (PDD). One of the reasons for the prohibition of a comorbid diagnosis of autism and ADHD was that the severity of ASD placed it above ADHD in the diagnostic hierarchy. Epidemiological, clinical, and neuroimaging findings led to a revision of the ADHD exclusion criteria in the DSM-5 (2013). Now, ASD is no longer an exclusion criteria - both ASD and ADHD can be diagnosed together. 30 - 60% youth with ASD also meet criteria for ADHD – ADHD has been described as the most common occurring diagnosis with ASD. ASD & ADHD: Diagnostics 30 - 80% youth with ASD also meet criteria for ADHD – ADHD has been described as the most common occurring diagnosis with ASD. 20 – 50% of youth with ADHD also show features of ASD ASD & ADHD: Diagnostics 10 22/10/2018 It is not uncommon for children to first be diagnosed with ADHD. Studies have found that an initial diagnosis of ADHD may be associated with delayed ASD diagnosis (older than 6 years of age).