Understanding how the two conditions intersect may, in any case, lead to improved therapies - a pressing need. “There hasn’t really been enough systematic research.” “Are we looking at one condition that’s on a continuum, or two distinct conditions? I think we don’t know the answer to that question,” says Geraldine Dawson, director of the Duke Center for Autism and Brain Development. Inattention in a person with autism, for example, might result from sensory overload, and apparent social problems in someone with ADHD may reflect impulsivity. And some behavioral research has highlighted the possibility that outwardly similar features mask distinct underlying mechanisms. But imaging studies comparing brain structures and connectivity have yielded a confusing mix of similarities and differences. A growing number of genetic studies support the notion of at least some shared causation between autism and ADHD. However tempting the ‘one-condition’ idea may seem, the evidence is far from conclusive. In this view, ADHD can occur without signs of autism, but autism always occurs with features of ADHD or other conditions, notes the team’s leader Jan Buitelaar, professor of child and adolescent psychiatry at Radboud University in Nijmegen, the Netherlands. One team in the Netherlands has proposed that autism and ADHD are different manifestations of a single condition with a range of subtypes, each having a distinct time of onset, mix of traits and progression. Given the size of the overlap, scientists are beginning to rethink the relationship between the two conditions and to look for common biological roots. An estimated 30 to 80 percent of children with autism also meet the criteria for ADHD and, conversely, 20 to 50 percent of children with ADHD for autism. But in fact, autism and ADHD often coincide. Until about five years ago, the American Psychiatric Association’s diagnostic bible held the two conditions to be mutually exclusive: Only in 2013, with the debut of the current “Diagnostic and Statistical Manual of Mental Disorders” (DSM-5), did a dual diagnosis become permissible. A doctor then prescribed a series of drugs used for attention deficit hyperactivity disorder (ADHD), even though Naftali’s hyperactivity was still considered a part of his autism those medications also failed or caused intolerable side effects.įinally, when Naftali was 7, another doctor had Naftali’s mother and teachers fill out assessments of his behavior and concluded that Naftali has ADHD as well as autism. The psychiatrist also suggested anxiety drugs. At first, his psychiatrist credited these behaviors to his autism and recommended he drink coffee for its mild stimulant effect. “He was doing everything except what he was supposed to be doing,” Wodinsky recalls. He would stare out the window or wander around the classroom. Naftali’s trouble with maintaining focus became apparent in preschool - and problematic in kindergarten. Although he has above-average intelligence, he did not speak much until he was 4, and even then his speech was often ‘scripted:’ He would repeat phrases and sentences he had heard on television. He often sat facing the corner, turning the pages of a picture book over and over again. “When he was an infant and he was feeding, he wouldn’t cry if you took the bottle away from him,” she says. He lagged behind his twin sister in hitting developmental milestones, and he seemed distant. ![]() ![]() Wodinsky says she knew something was different about Naftali from the time he was born, long before his autism diagnosis at 15 months. ![]() “Otherwise,” she says, “he’ll find 57 other things to do on the way to the bathroom.” Every morning, Avigael Wodinsky sets a timer to keep her 12-year-old son, Naftali, on track while he gets dressed for school.
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