Is AS anything like ADHD?

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DSM Criteria:

# Qualitative impairment in social interaction, as manifested by at least two of the following:

1. marked impairment in the use of multiple nonverbal behaviors such as eye-to eye gaze, facial expression, body postures, and gestures to regulate social interaction
2. failure to develop peer relationships appropriate to developmental level
3. a lack of spontaneous seeking to share enjoyment, interests, or achievements with other people (e.g., by a lack of showing, bringing, or pointing out objects of interest to other people)
4. lack of social or emotional reciprocity

# Restricted repetitive and stereotyped patterns of behavior, interests, and activities, as manifested by at least one of the following:

1. encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity of focus
2. apparently inflexible adherence to specific, nonfunctional routines or rituals
3. stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting, or complex whole-body movements)
4. persistent preoccupation with parts of objects

# The disturbance causes clinically significant impairment in social, occupational, or other important areas of functioning.

# There is no clinically significant general delay in language (e.g., single words used by age 2 years, communicative phrases used by age 3 years).

# There is no clinically significant delay in cognitive development or in the development of age-appropriate self-help skills, adaptive behavior (other than in social interaction), and curiosity about the environment in childhood.

# Criteria are not met for another specific Pervasive Developmental Disorder or Schizophrenia.

This is not an exhaustive list of ASD characteristics. However, it's definitely more extensive than the DSM or ICD and hopefully more descriptive, too. It includes a listing of symptoms one may see in ASDs. But please note that not every autistic person is going to display every point on this list nor to a similar degree as the next. This is just a general guideline to some of the underlying issues seen in ASDs.


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LIST OF COMMON SYMPTOMOLOGY FOR AUTISTIC SPECTRUM DISORDERS:


GABA-related Issues:

1.OCD-like tendencies These symptoms are on a spectrum of their own within ASDs. They can include full-blown OCD issues or milder, undiagnosable symptoms such as preference for routine, difficulty with change, repetitive thought processes, and compulsions which may fall short of the full OCD criteria.

2. Anxiety issues The anxiety can vary wildly from sudden panic attacks to more specific phobias. Social Phobia is a common comorbid, or even a sub-diagnosable social uneasiness. Anxiety can also often focus around the OCD-like issues and involve compulsions and/or obsessive and repetitive thoughts.

3. Obsessions Despite that the DSM and many books imply an autistic person is usually only obsessed with one thing at a given time, the focus should be on the level of the obsession (no matter its duration, what is the quality of its intensity?) and/or whether it us an unusual interest; not the number of obsessions. Also, the duration can be longstanding (years) or even as brief as a single afternoon. The focus should instead be on the intensity and/or abnormality of the obsession, itself, and not the number or duration. ADHD symptoms can often make obsessional interests last shorter than “stereotypical”.

4. Self-stimulatory behaviors In some autistic individuals, this symptom is very extreme; in others, it may be subtle or even solely done in private. Stimulatory behaviors are common to all humans; however, autistics tend to stim more frequently and perhaps may or may not inhibit their stimulatory behavior simply due to social convention. Stimulatory behaviors (or rather an increase in these behaviors) is often triggered by a non-homeostatic emotional state (i.e., anxiety or excitement). However, stimming can also be a sensory-exploration and not simply a method of anxious calming.

5. Hyper- and Hypo-sensory issues These can involve any of the senses: sight, sound, touch, taste, smell, vestibular system (balance), proprioception (joint awareness; limb awareness), exteroception (skin awareness), and interoception (awareness of the inner body: organs such as stomach, bladder, bowel movements, etc.). Vestibular abnormalities, proprioception, exteroception, and interoception all seems to be fairly constant in abnormal functioning (when there is a deficit); however, the level of sensitivity of the five main senses can many times be contingent upon anxiety levels. Many autistics experience a consistent abnormality in several of these senses, but level of severity (i.e., an increase in discomfort) can be effected by anxiety levels.


Body Issues:

6. Coordination, balance, and body awareness Each of these areas can be effected. As stated above, issues in these areas are usually constant in nature and not quite as vulnerable to shifts in GABA functioning.


Cognitive Functioning:

7. Executive Dysfunction Autistics can have varying levels and combinations of EDF. Most have issues with multitasking even to the point that looking and listening can be a difficult task. Social multitasking can be an issue. Common ADHD symptoms are most often noted if not full-blown ADHD. Within this, attentional problems, organization, multitasking, and goal-oriented planning and carrying out of these plans can all be effected. Although each autistic will show varying levels of severity.

8. Language For some autistics, language can be impaired as severely as a complete inability to communicate verbally (either due to a larger language issue or just verbal motor apraxia). For others, language can be less noticeably affected. Prosody may be effected. Some autistics may exhibit monotonic speech, others may prefer to do voices, others still may have an unusual way with words. But this does not discount autistics who, through years of learning, have also come to blend fairly well, language-wise, into the world.

9. Social Issues This is the symptom which is often most obvious to onlookers or during interaction and the reason Autistic Spectrum Disorders have mistakenly been called “social disorders”. Issues in this area can range from very severe to very mild. Most autistics have difficulty in this area, although, as just stated, these difficulties can be very subtle in some and difficulty in this area is not a condemnation to lifelong solitude (many autistic people have friends, are married and have children). As a generalization, males tend to be more seriously effected in this area, especially those with Aspergers or High-Functioning Autism-- although that is not a steadfast rule to diagnose by.

10. Sleep Disturbances Many autistics have issues with sleep. Often it is a difficulty with sleep (i.e., getting to sleep) or staying asleep. This possibly has to do with some of the common serotonin dysfunction in ASDs. Sometimes it can be an OCD-like issue regarding repetitive thoughts and the inability to “wind down”.

11. Talent areas Many autistics seem to have splinter skills, talents, even prodigious talent areas. The areas most noted are: music, art, mathematics, languages, memory, visuo-spatial skills, writing, and analysis of information. Though this list is by no means exhaustive.


Medical Issues:

12. Autoimmune dysfunction More recent research supports the notion that a portion of ASDs may involve an autoimmune component. These immune components can include IgA Deficiency, IgG or IgM Deficiencies, Rheumatoid Arthritis, Hypothyroidism, gastrointestinal issues such as Celiac Disease, Irritable Bowel Syndrome, nondescript gluten allergies, casein allergy, lactose allergy, other sinus-related allergies, and asthma. As further research is performed, other related issues may continue to arise.


Common Comorbids:

13. Common comorbid conditions: ADHD/ADD, OCD, Depression, Central Auditory Processing Disorder, Learning Disabilities including Nonverbal Learning Disorder, Dyslexia and other disorders of written or verbal expression, Tourette's and other Tic Disorders, Bipolar Disorder, Psychosis (most often noted in the teenage or early adult years), Schizophrenia, Epilepsies, various apraxias, Prosopagnosia and other perceptual disorders (e.g., depth perception), various synaesthesias, and a host of others. For some, addictions can also be an issue.


Family Genetics:

14. Family genetics In most ASDs, it seems many genes are involved; therefore, it is likely these characteristics did not arise out of the blue. Like any other phenotypic expression, most often if a child exhibits some characteristic, members within his or her family will express similar characteristics. A “Broader Autistic Phenotype” can often be seen within these families (i.e., Shadow Syndromes). Although in females these expressions may be subtler due to a possible genetic suppression that female-sex-specific genetics may wield, so in looking back on the family the possibility of this sex-specific suppression needs to be kept in mind.

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The individual with ASD often exhibits inappropriate or abnormal emotional responses to various events encountered day to day. It is important to understand, that the spectrum of response may vary from a total unresponsiveness, to an over reaction or outburst with little provocation.

To clarify the “unresponsive reaction” the observer may notice that during events that typically should result in a response, the event seemingly “washes over” the ASD individual or that the ASD individual internalizes their emotions, appearing equally unresponsive, subdued, or in extreme cases; slips into a catatonic like state or falls asleep. It is important to distinguish, that this unresponsiveness will appear as either the event had no effect on the individual (they lack awareness) or it evokes a “shutdown”.

Conversely, with seemingly little provocation, the ASD individual may over react, or seem unable to control the intensity of their emotions. It may come across as an overly strong reaction, rage, a tantrum or a nervous breakdown. It is important to note, that this will also occur for other emotions other then anger, such as sadness.

Sometimes the ASD individual has a tendency of gravitating to one side of the spectrum more then the other. For those that tend to over react, they may appear to suffer from “Emotional Dysregulation”. For those who usually show no emotion, they may be labelled with:
Aexithymia (inability to verbally express emotion)
Apathy, (a lack of emotional reactivity)
or Emotional repression (subconscious but motivated denial of emotion).

Notwithstanding, the ASD individual may not always lean towards one pole or the other concerning emotional reactivity. Some may swing wildly between the two ends of the spectrum, unable to “regulate” their feelings. This may come across as “bipolar” to the untrained observer.

One important difference between this form of ASD Emotional Dysfunction, and Bipolar is that the response is emotionally driven as an inappropriate reaction to events, not an overall predominating mood or chemical imbalance. The individual is unlikely to exhibit periods of psychoses or extreme mania, although many may appear to be suffering with rapidly cycling “hypo-mania”. Great care needs to be taken in determining if the ASD individual actually suffers from Bipolar or not. Self diagnosis is not recommended, as co morbidity of BP and ASD has been reported. Make sure that the ASD individual with symptoms of BP is seen by a professional who is knowledgeable with both disorders.

The school psychologist at my son's school is adamant that my son does not have AS it is just his ADHD. She has seen all his paperwork from Emory University on him, all his paperwork from his doctor but she tells me all the time how she feels. He actually does not have an autism dx at school because of how she feels. His dx is just ADHD, which he does have.

The Emory diagnosis would be a good one. They use a multi-discplinary team. The school has an agenda and you son is eligible for many more services with AS than ADHD. They can't deny him his DX if he has a proper DX by a team like Emory. Just tell the school psych you trust the professionals at Emory more than her opinion. She's an adult and can learn to deal with it.

Well what is funny is that the school is the one that hired Emory to come and do the observation. They don't just take the dx from the doctor. I have not pushed the issue with his IEP saying AS because he is getting the services that he needs. If he wasn't then it would be an issue. Her comment was.... Don't label him if you don't have to. Which I thought was rather interesting considering her position and job at the school. If there ever is an issue that he is not getting what he needs from the school system then it will be time to change.

Well what is funny is that the school is the one that hired Emory to come and do the observation. They don't just take the dx from the doctor. I have not pushed the issue with his IEP saying AS because he is getting the services that he needs. If he wasn't then it would be an issue. Her comment was.... Don't label him if you don't have to. Which I thought was rather interesting considering her position and job at the school. If there ever is an issue that he is not getting what he needs from the school system then it will be time to change.