The DSM-5 (the updated diagnostic manual, due to come into effect next year), has made a change to the relationship between ADHD and autism. Previously, the two conditions could not officially be diagnosed together, due to an express exclusion under ADHD, which requires that the ADHD symptoms didn’t occur during the course of a Pervasive Developmental Disorder (autism). The new ADHD criteria remove that restriction. Research (and plain good reasons) are cited for the change.
The reasons provided for the change are highly persuasive; the reasons for the initial (and continued) exclusion, are not.
Particularly noteworthy reasons for the change, are that the medications used for ADHD can be of great benefit to those with autism who have relevant issues, and that it is possible there is a specific subgroup of those with autism who present with ADHD (which appears to be about 30%) – that there may be overlapping genetic influences for both conditions. It is also possible that those who present with both ADHD and autism, have different “neurobiological and clinical correlates” than those with just autism. So the forced separation of the two diagnoses, gets in the way of potentially effective treatments, and gets in the way of truly reflecting and understanding the relationship between these two conditions, and in turn the meaningfulness of the absence of ADHD from those with only autism.
So why were they separated in the first place? Apparently a key concern was that autism would go under-diagnosed otherwise, and that those who would have benefited from autism interventions would be more likely to miss out, as the autism inattentiveness would be confused with ADHD. (One of the concerns about allowing them to now be co-diagnosed, is that the prevalence of ADHD diagnoses will increase.)
The fact is that medical professionals have already been diagnosing ADHD alongside autism (anecdotally anyway; I know of very many families who have had both diagnoses declared for their child). It’s also already widely known that some ADHD medications are helpful (and used) for the relevant issues experienced by those with an autism diagnosis. It seems that this change is just bringing autism and ADHD diagnostic rules, in line with existing clinical behaviours and the body of research in this area.
I don’t know much about ADHD, ironically what I do know about it I almost exclusively learnt through personal research into autism and through autism blogs. My own son does not appear to have ADHD from what I’ve read of the criteria. He does have many of the “inattentiveness” traits required for a diagnosis under that heading, but it is of a different qualitative sort of inattentiveness as I understand it; ways that can be, are sufficiently, and are better explained by his autism. I can clearly and easily imagine that there are cases where those ADHD criteria are met quite independently and in addition to the autism-caused behaviours. It’s an interesting distinction though, and one I intend to do further research into.
From what I understand, there is broad approval of this particular DSM-5 change. I would be interested to hear whether you think this change will impact on your own child’s diagnosis / diagnoses, and whether you think the change is a positive one. I’d be particularly interested to hear from those whose children already have both diagnoses, and what their clinicians said to them about the comorbidity when diagnosed.