06 Sep 2023
Choosing the right assessment
I’m confused! ADHD? ASD? Combined? How do I choose the right assessment?
ADHD? ASD? These acronyms sound very similar and it can be difficult to know what the right assessment is for you or your child. At The Autism Service, we wanted to provide some more information to help you decide which assessment may be right for you.
What is ASD and ADHD?
Autism Spectrum Disorder (ASD) is a developmental condition characterised by difficulties with social communication and interaction, and restricted or repetitive patterns of behaviour or interests.
Attention Deficit Hyperactivity Disorder (ADHD) is a developmental condition characterised by difficulties with inattention, impulsivity, and hyperactivity. There are currently three recognised subtypes of ADHD: Predominantly Inattentive, Predominantly Hyperactive/Impulsive and Combined.
The causes of ADHD and ASD are complex, but research shows that there are significant differences between the brains of those with and without these conditions. These conditions are known to run in families, meaning there is often a genetic link. However, it is possible to have ADHD and/or be Autistic even if there is no one else in your family with these conditions.
ASD and ADHD are distinct conditions, but they can overlap and share some symptoms. A person can have neither, one, or both.
Ok, so what sort of things might lead me to consider an Autism assessment?
Differences associated with autism vary depending on the age, gender and intellectual ability of a person, and it is important to remember that every autistic person will have their own strengths and weaknesses. However, some of the common differences autistic people may share are:
Difficulties with social interaction.
Autistic people may find it harder to form friendships and relationships. They may struggle to understand or ‘read’ other’s feelings and intentions and as a result may unintentionally come across as blunt, insensitive, or single minded. Although autistic people may be able to talk about their interests, they may struggle with ‘small talk’ or with adapting their conversation to meet the needs of the person they are talking to.
Difficulties with social communication.
Autistic people can show differences with their use and understanding of verbal and non verbal communication. They may have a different tone, pitch or rate to their voice, or use fewer gestures or facial expressions. They may find eye contact particularly uncomfortable. Autistic people may take what others say literally and struggle to pick up on sarcasm or subtle social cues.
‘Repetitive and restrictive behaviour’.
Autistic people can often prefer predictability and sameness. They may have particular routines or rituals that they like to do each day, and changing these can cause a great deal of anxiety. Some autistic people may like to move their bodies in a certain way to help them cope or feel better. They may flap their hands, twirl, rock, or jump up and down.
Highly focussed interests or topics.
Our autistic clients often have areas of intense special interest – things that they know lots about or spend a lot of time thinking about or doing. Sometimes these interests can seem unusual or extreme to others.
Autistic people can be over or under sensitive to certain sensory stimuli such as lights, noises, smells, temperatures or touch. This can mean that they want to avoid certain situations that can feel overwhelming. Sometimes an autistic person may ‘seek out’ extra sensory input such as looking at bright lights, listening to or making particular noises, smelling and/or feeling different things, or moving their bodies more.
Anxiety, shutdowns and meltdowns. The expectations of a neurotypical society can be confusing and scary, and can cause overwhelming anxiety for an autistic person. If things become too much, an autistic person may lose control and/or completely shut down.
What sort of things might lead me to consider an ADHD assessment?
Children with difficulties with their attention can find it very difficult to concentrate on activities at school and home. They may ‘flit’ from activity to activity, avoid reading, doing their homework, or sitting through a movie. A child with ADHD will struggle to listen to instructions, meaning they require frequent prompts, reminders and redirection. They will be easily distracted by things that other people seem to be able to block out or ignore. They are often forgetful and may undertake tasks in an order that seems illogical to others.
Children with difficulties with hyperactivity and impulsivity will find it difficult to sit still and they will frequently move and fidget. Parents of younger children will often report that they run about and climb excessively, be very noisy, and are difficult to manage in public situations – due to not being able to wait their turn or manage queues. Children with ADHD often get reprimanded for talking too much in class and ‘shouting out’. They may often interrupt others or put themselves at risk because they struggle to ‘put the brakes on’.
An adult with ADHD will have experienced similar things as a child but their difficulties might look a little different now. An adult with difficulties with their attention will struggle with ‘life admin’ – they may miss paying bills, forget appointments, overlook work deadlines and lose important belongings. They often appear ‘chaotic’ and ‘disorganised’ and this can often result in difficulties in the workplace resulting in disciplinaries, or in their relationships with friends or their spouse.
Hyperactivity and impulsivity in adults can be less obvious than in children. A person will often feel a constant sense of internal restlessness, and they may struggle to switch off or ‘turn down the noise’. They might feel that they constantly need to be ‘doing’ something and people might perceive them as ‘too much’. Adults with hyperactive/impulsive ADHD may struggle to inhibit video gaming or gambling, may frequently change their interests, and may often get caught speeding or doing other ‘risky’ things without thinking through the consequences.
Don’t we all do those things? Does that mean we all have ASD and/or ADHD?!
It is important to know that many of us will, at different points in our lives, experience difficulties that can ‘look a bit like ADHD or ASD’. However, the important difference for a diagnosis is that these difficulties are causing a significant and long term difficulty for a person.
Ask any teacher and they will tell you that it is very ‘normal’ for an active five year old to struggle to sit still and concentrate in class. Similarly, repetitive behaviours are very typical in toddlers – they may play the same games, sing the same songs, ask the same questions or insist that you read the same story again and again. The difference comes when these things persist throughout development and become noticeably different to their same age peers.
As adults, we all are occasionally forgetful, say the wrong thing, or get things wrong. The difference for those with ASD or ADHD is that these things happen frequently and it can result in a person feeling ‘different’, ‘misunderstood’ with a sense of failing to fit into a ‘‘neurotypical world’ not built for them. The impact of this can be poor mental health, poor occupational success, and difficulties in their relationships.
Both ADHD and Autism symptoms sound familiar to me. Do I get an assessment for both?
As you will see above, Autism and ADHD are distinct conditions with different ‘symptoms’, However, Autism and ADHD commonly co-occur, meaning that if you are autistic you are more likely to have ADHD and vice versa.
Just to complicate matters a little more (!) when they occur together, they can look slightly ‘different’ i.e. ADHD can affect the presentation of ASD and ASD can affect the presentation of ADHD. Consequently, it is important that a careful and comprehensive assessment is completed with an experienced clinician, who will be able to see how the different conditions overlap and interact.
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