Autism and ADHD
Autism is a neurodevelopmental disorder characterized by challenges with communication, social skills, and repetitive skills. The disease affects approximately 1 in 44 children in the United States and appears by age 2 or 3 years (Shenoy et al., 2017). The American Psychiatric Association merged the criteria for diagnosis of autism into one umbrella diagnosis of autism spectrum disorder (ASD). These disorders include autistic disorder, childhood disintegrative disorder, Asperger syndrome, and pervasive developmental disorder. To meet the diagnosis of autism, a child must have persistent deficits in each of the three areas of social communication and interaction (Centers for Disease Control and Prevention (CDC), 2020). Additionally, the child must have at least two of the four types of restricted repetitive behaviors.
A child with autism will have persistent deficits in social communication and social interaction. The child will have deficits in social-emotional reciprocity that may include abnormal social approach, reduced interests, emotions, and failure to initiate or respond to interaction (Shenoy et al., 2017). Secondly, the child will demonstrate deficits in nonverbal communication that may include abnormalities in eye contact, lack of facial expressions, and nonverbal communication. The third aspect involves challenges in maintaining and understanding relationships which may include difficulties in making friends or absence of interest in peers. Upon meeting the above criteria, an autistic child demonstrates restricted and repetitive patterns in four key areas. The first area is stereotyped or repetitive motor movements, use of objects, or speech (Shenoy et al., 2017). The child may have an insistence on sameness, ritualized patterns of behavior, and inflexible adherence to routines. Additionally, the child may have highly restricted, fixed interests and may demonstrate hyper-or hyporeactivity to sensory input or unusual interest in sensory aspects of the environment.
Attention deficit hyperactivity disorder (ADHD) is a mental disorder that causes unusual levels of hyperactivity and impulsive behavior. The diagnosis of ADHD is based on the guidelines from the American Psychiatric Association’s DSM-5. The first aspect to consider is inattention where the child has to demonstrate six or more signs of inattention for those aged up to 16 years and five or more signs for adolescents aged 17 years and above as well as adults (Cabral et al., 2020). Some of these symptoms include trouble organizing tasks, trouble holding attention, and failure to give attention in class or during other activities. The second aspect involves hyperactivity and impulsivity where the child demonstrates six or more symptoms up to 16 years and five or more symptoms for those aged 17 years and older including adults (Cabral et al., 2020). The presence of the above symptoms must be accompanied by evidence of several inattentive symptoms before the age of 12 years, presence of symptoms in two or more settings, and clear evidence that the symptoms interfere with social, school work, or social functioning.
Examining the Child
Learning how to adapt to a child with ASD is important to optimize outcomes for the patient and the healthcare provider. I will begin examining Makala by reducing unnecessary sensory input. Examining the patient should be in a quiet private room to reduce the amount of sensory overload that may affect communication. The second thing I will do is to actively involve Makala’s mother in the communication process and figure out how she communicates best. I will ask for suggestions from her mother on how I would approach her best and continue the conversation with the mother until she learns I can be trusted. During the examination, I will avoid using any instruments initially and then gradually introduce her to the instruments before using them for assessment. At this point, I will try to explain the procedure using simple language and even demonstrate the procedure using her mother to enable her to gain confidence.
Diagnosis and Referral
Diagnosis of autism and other autism spectrum disorders can be difficult because there is no medical test. According to studies, parents are the most reliable source of information about autism and other developmental issues (CDC, 2020). To ensure my suspicions about autism in Makala, I will begin by taking a detailed history and physical examination. I will specifically be concerned with developmental milestones and assess for motor, language, social, self-help, and cognitive skills. I will proceed to observe the behavior of Makala while noting the presence of symptoms that are used as criteria for an autism diagnosis. Lastly, I will use the screening tool for autism in toddlers and young children (STAT) to assess play, communication, and imitation skills to aid in confirming my suspicions (Shenoy et al., 2017). During referral, I will reassure the parent about early diagnosis and how it can help to bring better quality for the child. I will then write a professional report concerning the child’s presentation and guide Makala’s mother on how to get in touch with the local autism team.
Differentiating Autism from ADHD
Autism and ADHD can sometimes occur together and present with common symptoms like trouble paying attention, not reading social cues, and being constantly on the move. Based on the DSM-5 diagnostic criteria, children with ADHD often have difficulty paying attention to the same thing for too long (CDC, 2021). Autistic children present with a limited scope of interest and they are observed to obsess over things they enjoy. They may have difficulty focusing on things that are not interesting. Another difference may be observed in communication where autistic children have difficulty expressing their emotions and struggle with eye contact (CDC, 2020). Children with ADHD will often talk excessively, fail to wait for their turn, and blurt out answers before a question has been completed. Regarding the aspect of routine and structure, autistic children demonstrate an insistence on sameness and will want to adhere to routines or ritualized patterns. On the contrary, children with ADHD become bored quickly with structure, are easily distracted, and avoid mental efforts over tasks that require concentration.
Centers for Disease Control and Prevention. (2020). Autism spectrum disorder (ASD): Diagnostic criteria. https://www.cdc.gov/ncbddd/autism/hcp-dsm.html
Cabral, M., Liu, S., & Soares, N. (2020). Attention-deficit/hyperactivity disorder: Diagnostic criteria, epidemiology, risk factors and evaluation in youth. Translational Pediatrics, 9(Suppl 1), S104–S113. https://doi.org/10.21037/tp.2019.09.08
Shenoy, M. D., Indla, V., & Reddy, H. (2017). Comprehensive management of autism: Current evidence. Indian Journal of Psychological Medicine, 39(6), 727–731. https://doi.org/10.4103/IJPSYM.IJPSYM_272_17
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