There has been much speculation about whether ASD and ADD are related disorders, or if they simply appear co-morbidly. There is one core deficit that both disorders share which can make the two appear similar or “related”—a deficit in executive functioning, or “executive dysfunction.”
What is Executive Functioning?
Executive Functioning is the higher-order brain process that is responsible for being able to work towards our goals. It is the process that is responsible for planning, sequencing, prioritizing, shifting attention, and completing. When this important self-regulatory system is in deficit it makes it difficult to take steps towards a goal while incorporating information and making adjustments along the way.
What Does It Mean to Experience Executive Dysfunction?
Many people on the autism spectrum, experience executive dysfunction, as do those who have ADHD. When in deficit it can inhibit one’s ability to reach goals. These goal reaching issues can be similar to sensory processing issues, similar to when your auditory system is unable to filter out background noise, or hone in on a particular sound when required. There is no filter; everything comes at you at the same time, fawning for your attention—now.
Without a “filter,” there is no hierarchy of importance in these sounds, meaning the sound of a voice speaking is of the same importance to the auditory system as the sounds of the traffic in the background, and, therefore, seemingly as loud and distracting. The person’s voice blends into the backgrounds sounds. It is disorienting, and makes all the sounds and words blend together. This is particularly problematic if you are stressed, distracted, or overloaded in any way. Making progress towards goals is very similar to this experience when you live with executive dysfunction. All the steps required to make progress towards a specific goal gets jumbled together. This leads to trouble deciding what to do next (sequencing) in order to move yourself closer to the goal because all the tasks needed to be completed, are of equal importance (prioritizing), and need your attention—now (no filter). This deficit or executive dysfunction hinders your inability to sequence, and prioritize effectively.
Executive Dysfunction Appears in Both ASD and ADHD
Could it be that the two disorders appear so similar at times because they share a core deficit? Focus and inattention problems are shared by both ASD patients and ADHD patients. Both groups can have difficulty prioritizing, sequencing and completing, as well as, have difficulty with emotional control and adaptive behaviors. These can also lead to socialization problems, which can appear to be similar to that of those on the autism spectrum.
Many times adults and children with autism spectrum disorders will also receive a diagnosis of attention deficit disorder (ADD), or attention deficit hyperactivity disorder (ADHD). The co-morbidity rate of the two disorders tends to be extraordinarily high. In these cases it is unclear whether those with autism have two distinct disorders, or whether the impulsivity and executive dysfunction characteristic of ADHD is merely another symptom of the autism spectrum disorder. One thing that is clear is both disorders are hallmarked by clear deficits in the areas affected by executive function.
How Are Autism and ADHD Different?
ADHD is primarily a disorder which effects self-regulation and executive functioning. Autism spectrum disorders are bio-neurological developmental conditions that are characterized by problems communicating and relating to others, and a need to follow rigid routines and to engage in repetitive behaviors or language. These children have social developmental delays that are evident in their speech, lack of imaginative play, and are unresponsive to the calling of their names. They have difficulty expressing empathy, or understanding humor. A child with ADHD may struggle socially, but they will remain engaged and understand the dynamics of a social situation (empathy, humor, social clues, facial expressions, and body language)—the dynamic the ASD child does not intuitively comprehend.
It is important to remember that many psychological or developmental disorder of childhood can look like ADHD, including autism. It is often the first diagnosis that a doctor thinks of when seeing a child that has difficulty sitting still in school, or having attention and focusing problems. However, it takes a thorough evaluation by higher trained professionals to adequately diagnosis a child with an autism spectrum disorder. If you suspect your child, who has been diagnosed with ADHD, may actually have an autism spectrum disorder, speak to his/her physician and request a comprehensive neuropsychological evaluation.