Misdiagnosis for my child?

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Hello, I'm a parent of a daughter recently diagnosed with ADD but I'm worried that she might have had the wrong diagnosis.

I found out about the autism spectrum whilst she was in school, her teachers expressed concern about her behaviour and referred me to an article. I researched both Autism/Asperger's and ADD to find that she may match the criteria for Autism/Asperger's more than ADD, though I'm fully aware of some overlapping traits between them.

A little history about her. She's a bright child who enjoys very specific hobbies. Her fascination is drawing, she'll draw every day for hours on end and even gets into constant trouble in school for doodling in class. She specifies her interests in only one particular style. She dislikes art classes and complained that they were too 'broad' and 'boring', even if she draws every day!

Some traits that may have given her off as ADD is that she can never keep still during meal times. She had problems for several years eating meat, refusing to chew and only eat soft vegetables. She could never stay put and tends to run around between bites and stubbornly refuses to eat. However, she's a very quiet girl. She rarely talks, cries or show any expression and it feels like talking to a wall. She only has one friend at school whom she clings onto, and when I encourage her to interact with other kids she keeps to herself, either drawing or with her game console and evidently separated. This was most notable during her birthday party where she invited some school friends over, despite this she started to throw a tantrum when they touched her belongings and then shut herself off from them which unfortunately ended the party prematurely.

She complains a lot about about noise, sound, texture and smell, which I believe is another Autism/Asperger's trait. She's tends to get stressed out when wearing certain clothing like cotton or socks. She cannot stand the smell of my perfume and says that it makes her feel very sick, and she is frightened by cinemas and thunderstorms, which I think may be normal for a kid.

In class she is smart, although very lazy and absent minded as her teachers always say, and she has some issues with bullying but she is rarely aggressive. She has difficulty concentrating on her work that is both an autistic and ADD trait, however her restlessness I believe is to do with external factors. The problem I have most is that she isn't able to prioritise her tasks, and prefers to pursue her hobby over anything else.

For any of those who have read this, would it be sensible to get her retested? I don't think she fits the criteria for ADD at all.

Many thanks,
Dawn

I would get her retested at a different place - preferably with someone specializing in autism. She could have both ADD and autism - I was diagnosed both with HFA and ADD.

Yeah. If she's got both autism and ADHD, I wouldn't be surprised. Something you might not know about ADHD is that people with ADHD can sometimes fall into "hyperfocus"--a state where the rest of the world becomes totally unimportant and only the one thing you're focused on matters, often for extended periods of time. Attention deficit disorder isn't just hyperactivity and scatter-brainedness (though it's that too); it's having little control over where you want your attention to go. And sometimes, your attention just gets stuck on one thing, and you can't for the life of you switch away.

That kind of hyperfocus can be a big plus (I'm gonna bet your daughter is about ten times better than her peers at drawing, due to all that practice, right?). It can backfire, though. Just try to get to bed on time when you're so focused on what you're doing that you don't notice it's 4:39 a.m. Which, incidentally, I'm doing right now. Last I remember it was ten o'clock. And yes, I have both ADHD and autism.

Could be my imagination, but I bet that the ADHD/Autism combo is practically guaranteed to give you that tendency to hyperfocus--to get magnetically drawn to one thing, unable to switch out, totally fascinated, and most likely at the lowest stress level you'll ever experience in your life. It's one of those traits that causes problems for me, but that I can't help liking all the same, because it's part of what makes me who I am and, despite all the associated problems, gives me a good deal of pleasure in life.

So yeah, maybe she does have both. It might seem odd to want to add another diagnosis, but ADHD and autism are so closely related that some people theorize they're part of the same broader spectrum. Maybe your daughter's somewhere in the fuzzy middle ground between the two.

Thank you for the response. What set me off ADD is how quiet she is. I've read that those with ADD tend to be very loud and can constantly misbehave, but she fits the criteria of absent-mindedness and constant daydreaming.

She is a genius with art, far more experienced than any kid her age and I'm pleased how it benefits her if she should decide to pursue a career in that, however she tends to have very fickle impulses and can sway from highly motivated to severely depressed. It can be very unreliable and she is unable to stabilise her life. I'm worried about her.

Isn't that ADHD? Whereas, people with ADD aren't hyper.

When I was trying to figure out why I am the way I am about a year ago one of the things I did was 'interview' two parents of kids with AS. One of them had been diagnosed as ADD but the mother had the same concerns as you. She went for a 2nd opinion and he was diagnosed with AS. As she learned more about AS it became obvious to her in her son. If your senses are telling you it's AS, and based on your detailed description they are, by all means get a 2nd opinion. I mean if your stomach hurt and a doctor wanted to take your appendix out wouldn't you seek a 2nd opinion? If you doubt what the doctors tell you don't accept it, the doctors don't have the same interest in your kid as you do. 'Close enough' doesn't cut it here.

She may have ADD & AS. I think there's some corss over symptoms with both?

I have used hyperfocus to self-"medicate" panic attacks in the past. I'd get so focused I'd forget everything else. More recently, I used it to bypass suicidal ideation.

It's not controllable, but I know doing certain things will spark hyperfocus. So I do those things and it happens.



ADHD and ADD are the same disorder. Some people use ADD to refer to ADHD-PI (primarily inattentive) which is often incorrectly characterized as "no hyperactivity." But someone can have five observed hyperactive/impulsive symptoms and still be diagnosed as PI (this is what happened with me). I think Dr. Russell Barkley might have suggested (this is a fuzzy memory so I could be mistaken) that people who meet the criteria for ADHD-PI but don't have any impulsive symptoms whatsoever might actually have sluggish cognitive tempo (SCT), which is not ADHD at all. SCT itself is kind of in a fuzzy place right now, as there's no real criteria for it, and very little understanding of what it is.

I was diagnosed with ADD as a child and my mom knew it wasn't the correct diagnoses because she knew I had something else going on and the treatment I was getting wasn't working. It didn't explain everything. Then I was finally diagnosed with AS in 6th grade. Sometimes I am not sure if I truly have ADD or not. My mom says I do but I seem to have outgrown lot of it. I don't take pills for it either. I haven't since 6th grade.

My brother is ADHD, my sister is ADD, and I have AS. Each individual's case (of course) is unique, but here is some information about our differences that you might find useful:

My brother and I have both been frequently accused of laziness/absent-mindedness/etc. by our teachers. We've both almost failed classes for no other reason than missing assignments. But the bigger problem for both my siblings (particularly in early elementary school) was getting tasks completed. We all tended to struggle with remembering to do assignments and turn them in, but my siblings both literally needed someone standing over their shoulder in a room with minimized distractions just to make sure they completed their homework. For my sister, reading five pages of a book could take hours as my mom kept telling her to sit down and pay attention. For my brother, getting a single page of math homework done could take the better part of an afternoon as he fidgeted or just stared off at the wall. Rewards and punishments had little affect on their ability to complete assignments. For me, once I started a task I tended to have no problem seeing it to completion. It was just the getting started that was tricky.

I think it's good that you've already tried to figure out what's causing her difficulty concentrating, as that could really key you in on exactly what is causing her trouble. Unfortunately, I think "external factors" could really be attributed to either. With my siblings, it seemed like there was always something a thousand times more interesting just over there that demanded their attention more than whatever task they needed to be focusing on. Like trying to make a kid read the newspaper in the middle of Chuck E. Cheese's. But for me, "external factors" that break my focus are often anxiety-producing or frustrating. Sounds that I can't block out, or an object moving on the far side of the room. No kid wants to stop playing and do homework, but being interrupted in the middle of a task is hard for kids on the spectrum. Our brains don't shift "modes" easily, especially when it comes to our special interests. Even if we understand the importance of studying for the spelling test tomorrow, our brains may be unable to shift into "study mode" because we're still intensely fixated on what we were doing before. Our thoughts can endlessly circle, making us appear distracted and unfocused when really intense focus is the issue.

Before I received my diagnosis, I actually thought that my brother was more likely to have AS than me. We both tend towards intense, narrowly focused interests that we can pursue for hours each day, unlike my sister who gets bored with even tasks she enjoys after an hour or so. My brother even gets incredibly upset and can throw tantrums when interrupted like AS kids are typically described as doing. But while my brother and I can both hyperfocus, that's only part of a larger picture. "To the exclusion of other tasks" has a more specific meaning than "favorite activity." I read obsessively as a kid. At school, I read every possible moment. I read in homeroom. I read while reciting the Pledge (and got in trouble). I read while walking down the hall. I brought my book to the bathroom. I did my assignments, but the moment I finished I picked up my book. This got me in more trouble than anything, since at that age my teachers tended to give us our assignments in pieces (i.e. do one problem, go over it as a class, do the next). I always finished long before my classmates, and when I was done I immediately picked up my book. I was considered a "distraction" to the other students and was frequently banned from reading in class. My brother may have been the one who could identify a backhoe from a bulldozer, but I was the one who had the truly obsessive interests.

So, as you can see (and might already know), the differences between ADD/ADHD and AS can be very subtle. My brother and sister did tend to have many of the same problem areas as young children (they're 14 and 16 right now), they have always been radically different. My brother is somewhat socially awkward, highly intelligent, not at all athletic, and occasionally moody and temperamental. My sister is the exact opposite: very popular and social, very athletic, highly temperamental, and with mood swings befitting any sixteen year old (ex)cheerleader. Yet they both had very similar behavioral problems in their very different lives. The point I'm getting to is that you can't discount a measure of personality. I've never had the temper problems commonly associated with AS. My brother and I are both socially awkward, but he doesn't have the peculiarities and difficulties that I have.

If your daughter is in fact autistic, some of her problem areas may become more noticeable with age. Many of us on the high-functioning end go from "quirky" gifted kids in elementary school to children with noticeable problems in middle and high school. It's not that our autism gets worse so much as that our social abilities don't grow as rapidly as other kids', leaving us left in the dust and noticeably different. ADD kids, on the other hand, typically have less problems as they get older and learn to adapt (though some behavioral issues can persist). As your daughter gets older, she'll also be better able to express to you how she feels. I always knew there was something different about me, but it wasn't until middle school that I realized there was something actually "wrong" with me, and not until just recently that I could really put my finger on what that was. By the time I was thirteen, I was already obsessively researching personality disorders to find out why I was so different. Of course, I never told my parents, but that was definitely a sign that I was struggling and needed help.

While it wouldn't hurt anything (except maybe your wallet) to get your daughter retested, much of the diagnosis is going to hinge not on what the doctor sees, but what you observe as the mother. The doctor will not have the benefit of seeing your daughter in her daily environment. Unfortunately, you don't fully get that privileged either. School behavior and home behavior can be radically different. Learning how your daughter acts in a school setting can be vital to understanding the bigger picture of your daughter's behavior.The key to autism is that it is a triad of impairments: social impairments, unusual communication style, and obsessive behaviors or interests. Sensory issues can exist without autism. OCD can exist alongside social troubles. Is one key problem causing trouble in a variety of areas, or does your daughter have a variety of problem areas? While the diagnostician can help give you a lot of clarity on this matter, it is most likely going to be up to you to determine if your child is socially impaired or just socially awkward, if she's just unique or struggling with unique difficulties.

The biggest piece of advice I could give you would be not to rush. My siblings were both facing extreme behavioral problems in school. Their diagnosis and the subsequent help (and medication) they received was key to getting them through elementary school without expulsion or getting held back. The problems I had in school were much milder and generally situational, like moving. While I probably could have benefited from an earlier diagnosis, I didn't need one like they did. If your daughter isn't currently in a situation where she needs immediate help to get through school or to make changes in her home/social life, take some time to sit back and observe her based on these questions your forming. Take what you know about both autism and ADD to help her in her problem areas. The biggest benefit of a diagnosis (if your child doesn't need the accommodations or medical help it brings), is the knowledge you then have to help your child. Arm yourself with that knowledge, and then seek a diagnosis if you feel it's necessary.