Unit V: ASD & Attention Deficit Disorders

1. Attention Deficits with and without Hyperactivity: Concept and definition

2. Characteristics of children with ADHD

3. Causes of ADHD

4. Management of ADHD

5. Educational implications for ASD children with ADHD


1. Attention Deficits with and without Hyperactivity: Concept and definition

ADHD, also called attention-deficit disorder, is a behavior disorder, usually first diagnosed in childhood, that is characterized by inattention, impulsivity, and, in some cases, hyperactivity. These symptoms usually occur together; however, one may occur without the other(s).

The symptoms of hyperactivity, when present, are almost always apparent by the age of 7 and may be present in very young preschoolers. Inattention or attention-deficit may not be evident until a child faces the expectations of elementary school.

Three major types of ADHD include the following:

ADHD, impulsive/hyperactive type. This, the least common type of ADHD, is characterized by impulsive and hyperactive behaviors without inattention and distractibility. People with hyperactive ADHD feel the need for constant movement. They often fidget, squirm, and struggle to stay seated. Children often appear to act as if “driven by a motor” and run around excessively. People of all ages may talk non-stop, interrupt others, blurt out answers, and struggle with self-control. This type of ADHD is more recognizable and more often diagnosed in children and men.

ADHD, inattentive and distractible type. This type of ADHD is characterized predominately by inattention and distractibility without hyperactivity. People with inattentive ADHD make careless mistakes because they have difficulty sustaining attention, following detailed instructions, and organizing tasks and activities. They have weak working memory, are easily distracted by external stimuli, and often lose things. This type of ADHD is more commonly diagnosed in adults and girls, and was formerly known as ADD.

ADHD, combined type. This, the most common type of ADHD, is characterized by impulsive and hyperactive behaviors as well as inattention and distractibility. People with combined-type ADHD demonstrate six or more symptoms of inattention, and six or more symptoms of hyperactivity and impulsivity.


2. Characteristics of children with ADHD

The following are the most common characteristics of ADHD. However, each child may experience symptoms differently. The 3 categories of symptoms of ADHD include the following:

·       Inattention:

o   Short attention span for age (difficulty sustaining attention)

o   Difficulty listening to others

o   Difficulty attending to details

o   Easily distracted

o   Forgetfulness

o   Poor organizational skills for age

o   Poor study skills for age

·       Impulsivity:

o   Often interrupts others

o   Has difficulty waiting for his or her turn in school and/or social games

o   Tends to blurt out answers instead of waiting to be called upon

o   Takes frequent risks, and often without thinking before acting

·       Hyperactivity:

o   Seems to be in constant motion; runs or climbs, at times with no apparent goal except motion

o   Has difficulty remaining in his/her seat even when it is expected

o   Fidgets with hands or squirms when in his or her seat; fidgeting excessively

o   Talks excessively

o   Has difficulty engaging in quiet activities

o   Loses or forgets things repeatedly and often

o   Inability to stay on task; shifts from one task to another without bringing any to completion

The symptoms of ADHD may resemble other medical conditions or behavior problems. Keep in mind that many of these symptoms may occur in children and teens who do not have ADHD. A key element in diagnosis is that the symptoms must significantly impair adaptive functioning in both home and school environments. Always consult your child's doctor for a diagnosis.


3. Causes of ADHD

ADHD is one of the most researched areas in child and adolescent mental health. However, the precise cause of the disorder is still unknown. Available evidence suggests that ADHD is genetic. It is a brain-based biological disorder. Low levels of dopamine (a brain chemical), which is a neurotransmitter (a type of brain chemical), are found in children with ADHD. Brain imaging studies using PET scanners (positron emission tomography; a form of brain imaging that makes it possible to observe the human brain at work) show that brain metabolism in children with ADHD is lower in the areas of the brain that control attention, social judgment, and movement.

Scientists are studying cause(s) and risk factors in an effort to find better ways to manage and reduce the chances of a person having ADHD. The cause(s) and risk factors for ADHD are unknown, but current research shows that genetics plays an important role. Recent studies of twins link genes with ADHD.

In addition to genetics, scientists are studying other possible causes and risk factors including:

Research does not support the popularly held views that ADHD is caused by eating too much sugar, watching too much television, parenting, or social and environmental factors such as poverty or family chaos. Of course, many things, including these, might make symptoms worse, especially in certain people. But the evidence is not strong enough to conclude that they are the main causes of ADHD.


4. Management of ADHD

Specific treatment for attention-deficit/hyperactivity disorder will be determined by your child's doctor based on:

·       Your child's age, overall health, and medical history

·       Extent of your child's symptoms

·       Your child's tolerance for specific medications or therapies

·       Expectations for the course of the condition

·       Your opinion or preference

Major components of treatment for children with ADHD include parental support and education in behavioral training, appropriate school placement, and medication. Treatment with a psychostimulant is highly effective in most children with ADHD.

Treatment may include:

·       Psychostimulant medications. These medications are used for their ability to balance chemicals in the brain that prohibit the child from maintaining attention and controlling impulses. They help "stimulate" or help the brain to focus and may be used to reduce the major characteristics of ADHD.
Medications that are commonly used to treat ADHD include the following:

o   Methylphenidate (Ritalin, Metadate, Concerta, Methylin)

o   Dextroamphetamine (Dexedrine, Dextrostat)

o   A mixture of amphetamine salts (Adderall)

o   Atomoxetine (Strattera). A nonstimulant SNRI (selective serotonin norepinephrine reuptake inhibitor) medication with benefits for related mood symptoms. 

o   Lisdexamfetamine (Vyvanse)

Psychostimulants have been used to treat childhood behavior disorders since the 1930s and have been widely studied. Traditional immediate release stimulants take effect in the body quickly, work for 1 to 4 hours, and then are eliminated from the body. Many long-acting stimulant medications are also available, lasting 8 to 9 hours, and requiring 1 daily dosing. Doses of stimulant medications need to be timed to match the child's school schedule to help the child pay attention for a longer period of time and improve classroom performance. The common side effects of stimulants may include, but are not limited to, the following:

o   Insomnia

o   Decreased appetite

o   Stomach aches

o   Headaches

o   Jitteriness

o   Rebound activation (when the effect of the stimulant wears off, hyperactive and impulsive behaviors may increase for a short period of time)

Most side effects of stimulant use are mild, decrease with regular use, and respond to dose changes. Always discuss potential side effects with your child's doctor.

Antidepressant medications may also be administered for children and adolescents with ADHD to help improve attention while decreasing aggression, anxiety, and/or depression.

·       Psychosocial treatments. Parenting children with ADHD may be difficult and can present challenges that create stress within the family. Classes in behavior management skills for parents can help reduce stress for all family members. Training in behavior management skills for parents usually occurs in a group setting which encourages parent-to-parent support. Behavior management skills may include the following:

o   Point systems

o   Contingent attention (responding to the child with positive attention when desired behaviors occur; withholding attention when undesired behaviors occur)

Teachers may also be taught behavior management skills to use in the classroom setting. Training for teachers usually includes use of daily behavior reports that communicate in-school behaviors to parents. Behavior management techniques tend to improve targeted behaviors (such as completing school work or keeping the child's hands to himself or herself), but are not usually helpful in reducing overall inattention, hyperactivity, or impulsivity.


5. Educational implications for ASD children with ADHD


·       Whole-class interventions (whenever possible) to avoid singling out one child

·       Behavioral modification tactics

·       Regular backpack cleanouts

·       Weekly summaries for caregivers

·       Clearly posted classroom rules

·       Immediate feedback, positive or otherwise

·       Monitoring child for attention difficulties or frustration with a particular assignment

·       Regularly scheduled physical activity throughout the day

·       Token economy (positive reinforcement system) 

·       504 Plan or IEP

·       Inconspicuous administration of any in-school medication

·       Regular meetings with parents/caregivers

For many years, doctors were hesitant to diagnose a child with both ADHD and ASD. For that reason, very few medical studies have looked at the impact of the combination of conditions on children and adults.

The American Psychiatric Association (APA) stated for years that the two conditions couldn’t be diagnosed in the same person. In 2013, the APA changed its stanceTrusted Source. With the release of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), the APA states that the two conditions can co-occur.

In a 2014 review of studies looking at the co-occurrence of ADHD and ASD, researchers found that between 30 to 50 percent of people with ASD also have symptoms of ADHD. Researchers don’t fully understand the cause for either condition, or why they occur together so frequently.

Both conditions may be linked to genetics. One study identified a rare gene that may be linked to both conditions. This finding could explain why these conditions often occur in the same person.

More research is still needed to better understand the connection between ADHD and ASD.