ADHD Medication and Autism/Aspergers

This article about Autism and ADHD stems from the following question from a subscriber: ‘My son is diagnosed with PDD Autism – we have put him on Ritalin for behaviors and hyperactivity. Our family doctor feels that since the Ritalin has helped that he must also be ADHD. Could that be correct?’

As I wrote about in a previous article: Autism, Aspergers and ADHD, yes it could be correct that a child can have Autism and ADHD. In fact there is about a 50 to 60% chance of kids with autism having an ADHD diagnosis.

I do want to caution you about this kind of logic. I don’t like making a diagnosis because a medicine worked.

In other words just because Ritalin settled down some of the behavioral problems that your son was experiencing doesn’t necessarily mean that for sure your son has ADHD.

If you are concerned about the possibility of ADHD, go to a clinician who can do a thorough assessment, such as a paediatrician, psychiatrist, or psychologist. Have a thorough assessment done and see what the results are.

The medication treatments in child psychiatry are symptom specific not disease specific. This means that the medications treat symptoms, not disorders.

So if he had some hyperactivity related to Autism that may be settled by the Ritalin as Ritalin and other stimulants (like Adderall, Concerta, Metadate, Focalin, Daytrana, etc) have a clear history of helping hyperactivity and inattention in ADHD.

However, based on my experience as a Child Psychiatrist, I think it is possibe if the Ritalin is working then there may actually be a diagnosis of ADHD. However, the best practice of medicine would be to go and get a thorough assessment. This is the proper way, rather than just saying: ‘well the pill worked so it must be so’.

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Comments

  1. Hi,
    Thanks for sharing these interesting articles.
    Dxs may be very limiting as even if a kid does not fit exactly a dx , he still has a problem. A dx implies often a neurobiliogical deficit and a medical solution ,ignores possible developmental delays and incompatability between caregivers and child.
    You made the point that medication treats symptons. These same symptons may be seen across many dx’s . IMHO it would be better , if pdocs etc would concentrate on the issues facing a kid , rather than trying to fit him into a dx. Kids who have ADHD or bipolar ( I am waiting for your article on comorbidity of ADHD and BP) may both have executive function deficits. Saying that a kid has executive function deficits tells us more about a kid than saying he has ADHD. A kid can have a problem with mood regulation and yet not fit the dx of bipolar. I read a lot about parents desperate for the dx , the label instead of working on the issues below. One parent felt her kid was BP and was shocked with the Conduct disorder. My question for you.
    How closely do you follow the DSM ? Is this science or art ?

    EXECUTIVE SKILLS:
    These are the thinking skills, associated with the frontal lobe of the brain. They enable one to do the clear, organized, reflective thinking in the midst of frustration that is crucial for solving problems in an adaptive (non-impulsive) manner. The executive skills include:
    · shifting cognitive set (the ability to shift gears, to make transitions in activities and thinking smoothly)
    · organization and planning, and working memory (allow you to use hindsight and forethought to solve problems in a systematic fashion)
    · separation of affect (the ability to put feelings on the shelf to get on with the clear thinking needed to solve problems)
    When lacking, these children will have difficulty shifting from one activity to another. They will have difficulty anticipating problems. In the face of frustration, they will have difficulty staying calm enough to think clearly and will have difficulty sorting through different solutions to organize a coherent plan of action.
    LANGUAGE SKILLS:
    Language skills are incredibly crucial as it relates to one’s ability be flexible and deal with frustration. Problem solving is essentially a linguistic skill. Why? Most of the thinking and communicating that we do involves language. Language skills set the stage for labeling, categorizing, communicating and managing (metacognitive strategies) our emotions. They also kick-start problem solving by allowing us to label and communicate the problem, and do the necessary verbal give and take.
    Children with difficulty in this domain may gut hung up at any point. They may not have a rudimentary vocabulary for labeling their emotions (happy, sad, frustrated), may not be able to articulate their concerns (“I am hungry/tired”, “I am in the middle of something”) and may not have a problem solving vocabulary (“I need help”). When faced with frustration, or when trying to process situations later with the child, children lacking in this domain can often be heard saying such things as: “shut-up”, “get away” , “I don’t know”, “I don’t want to talk about it” or they may swear.

    EMOTION REGULATION SKILLS:
    This refers to the cognitive skills one uses to control, modulate and regulate emotions, outside of the context of frustration. It is important to note that this is different from separation of affect (our ability to put feelings aside so we can think clearly in the midst of frustration).
    What do we see with children who have difficulty in this domain: chronic grouchiness, irritability, fatigue, anxiety and agitation. These chronic states make dealing with frustration difficult. These children can often find the energy to look good in certain situations, only to fall apart later.
    COGNITIVE FLEXIBILITY SKILLS:
    Children who have difficulty in this area are wired in rigid, black and white ways. They are literal and concrete in their thinking and see things as their way or the highway. They often adhere to predictable routines/rigid/inflexible rules in order to feel ok. They become totally lost when things don’t go just as they expected or the way they went the last time. Although they may be very bright verbally, they have poor skills when it comes to handling the “grays” of the world.
    Children who demonstrate these difficulties typically have great difficulty in the social arena. There is no area that requires the ability to see the “gray” more than social situations.
    SOCIAL SKILLS:
    There are two types of social skill deficits: cognitive deficiencies and cognitive distortions. What you will often see with cognitive deficiencies is poor perspective taking and appreciation of how one’s behavior affects others, poor appreciation of social nuances, and poor social repertoires (ability to start a conversation, ability to enter a group). Cognitive distortions are typically based in reality, can often be seen as overgeneralizations or misconstruing of events.

    Allan

  2. Ritalin is basically an amphetamine and as such can be addictive. Novartis promotes this as a “cure” for childhood conditions and promotes it in the schools through school psychologists and psychiatrist. The marketing program works this way: take a disability or an emotion and add disorder to it; convince schools, parents and teachers that these “disorders” are very bad and will get worse if something is not done about them now. Solution: Ritalin.
    The St Petersburg Times reports that Florida Schools have increased prescriptions for Ritalin 250% in the last 3 years.
    Novartis makes billons on this drug. A very successful marketing program, wouldn’t you agree?

  3. Hi Michael,
    Thank you for posting your comments.
    While you share a ubiquitous opinion, it is unfortunately full of misinformation.
    While the rates of medication use may be on the rise – and may be a concern in some situations, I would like to address many of the misconceptions you wrote.
    * ADHD is a real condition, based in the brain – not just ‘normal behavior’
    * Ritalin is not addictive if taken as prescribed, and actually the newer preparations which are becoming the standard of care – like vyvanse, concerta, adderall XR, Strattera – have either no or very limited addictive potential even if misused.
    * Yes, drug companies ‘market’ their medicines, but it is not part of a sinister plot. When ADHD is properly diagnosed, medication can be life transforming.
    I wish you well, and please take some more time on this blog to learn more fact based information about ADD and ADHD.
    Dr. Kenny

  4. My son has a few diagnoses: Mood Disorder-NOS, ADD, PDD-NOS. I have nervously contemplated medicating my son for such symptoms as anxiety, inattention, and decreased impulse control as these seem to be the symptoms that interfere most with learning life skills. I have on 3 occasions trialed various medications some of which are risperdal, trazodone, and concerta. All have had negative affects such as an increase in irritability, emotional upset, and visual disturbances. Is medicine really another avenue I want to continue to explore? Does medication really benefit children with these types of diagnoses or are there only a few that it helps? I want the best for my son, but I don’t want him to have to suffer the consequences everytime we try another medicine.

  5. You have a typo error: four lines from the bottom the print reads :

    “possibe if the Ritalin is working then there may actually be a diagnosis of ”

    instead of ‘possible’ which is the correct spelling .

    Teacher,

    Bonnie Winkelman , M.S. University of Kansas 1976

  6. My son has Asperger’s and ADHD (and I find myself questioning the AS sometimes) but I agree with Allan that the dx is way less important than figuring out what is wrong in the brain. I have read the Change your Brain book, but I feel like my son has difficulties in all of those areas (especially executive, but really all the rest too). We recently put him on Respiradone, but we have increased the dosage twice now and I feel like he still has pretty extreme frustration and anxiety issues. The respiradone has made a difference, but he still can’t spend more than ten minutes in a classroom with other children without having a meltdown. (He is in 1st grade) I am wondering if we should be looking at a different med, or a combination of meds? I am not sure what part of the brain we should be treating! Also of note is that the first week, my son told me multiple times how much the respiradone was helping him, and that could I please make sure he didn’t run out. It just seemed like he got used to it after one week and we haven’t regained that balance despite two increases in dosage.

  7. I was diagnosed with ADHD-1 (inattentive) It used to be just ADD which I believe is a more appropriate term. I take Ritalin which truly improves my ability to focus. After discovering Asperger’s about a month ago I’m convinced that my problem may lie closer to AS. However, I believe ADHD-1 is much closer to Asperger’s and could be why the two are often misdiagnosed. ADHD-1 should be not be combined with ADHD but rather put on the Autism spectrum where it would more logically fit, but I guess maybe it’s not a PDD by itself. A few years ago I had taken Lexapro for what my Dr. diagnosed as Dystimia – a mild ongoing depression. While on Lexapro I could actually carry on conversations with others and even follow along and participate in the conversations. Do anti-depressants help with social symptoms of AS?

  8. Hi,
    My 25 year old son says that his 15 year old brother, who is diagnosed with asperger’s, used to smile normally and make eye contact better. He thinks concerta might be causing this side effect. Can you reassure me that this is the asperger’s, not the concerta?

  9. My son is just now 21 years of age with a diagnosis of Asperger syndrome. He was approximately 7 or 8 years of age when diagnosed. approximately 7 months ago he had a meltdown of sorts after taking respiridol (sp.) for some months. He was given scripts for trazodone and zyprexa at alternating times at that time. Today he has been hospitalized for the last few days pending a psychiatric evaluation. Side effects which can occur from using trazodone, any one of which should be reported immediately to a doctor, include mood or behavior changes, anxiety, trouble sleeping, impulsive, irritable, agitated, hostile, aggressive, restless, and hyperactive—my son exhibits all of the signs. Trazodone related?

  10. HI-
    My 10 year old son has a diagnosis of Aspergers. He has difficulty with his executive functioning and also attention/ focus issue only in the area of reading and writing. These are the areas he struggles greatly with in school and needs frequent redirection when expected to complete a writing piece. Special Ed. teacher is insisting the only course to take with him is to medicate him because she is out of ideas. He has seen other professionals ( neurologist, psychologist) none of which are seeing the issue to the extreme she is saying it is. My question is, are there ways to help children refocus without medication? Are there techniques that could be used in the classroom to assist with this? Thank you-
    John

  11. Dr. Kenny- My 12 yr. old son is diagnosed with AS and ADHD. He started Vyvans a month ago but is constantly clearing his throat now. His dosage was just increased and it got worse. He used to take concerta, but developed bad facial tics. Because of how socially awkward he is, I don’t want tics to make his middle school experience worse. He has become overweight so we hoped the stimulant would help that, but it also has an anxiety factor, which is hard for a kid with AS. He’s high functioning, but needs help focusing. I just don’t know what to do. Is there anything you can suggest?
    -Laura

  12. Hi,My sn Jacob is 8 and has Autism and ADHD!! He is nonverbal and hyperactive and very agressive.We have tried a least 15 different meds,Risperdal,clonodine,ritalin,focalin,dextromethophine,aderall,kapvay,ativan,patches and many more…we still cant find the right one.Heeither falls asleep or is out of control or crying all day long and i am looking for input from anyone that can help or has been in this situation and has found something useful or helpful..

  13. I am help raising my great-nephew who has autism and is almost ten years now. In recent times my nephew has gotten to a point that his attention span at doing something has gotten extremely worse. He now goes through a daily routine of screaming and become physcially un-controllable because he seems to be bored. His doctor has recommended that we try some ADHD medication on him but unfortunately we been told that this type of medication only comes in pills. We cannot get him to swallow a pill. Is there any type of ADHD that comes in liquid form? If not, is there any recommendation of how we can get him to take the pill, such as grinding it up and mixing it with his favorite drink. Any help would really be appreciated.

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