The Big 3: Autism, Aspergers, ADHDAugust 13, 2012
| Autism, Aspergers Disorder and attention deficit hyperactivity disorder are being diagnosed in children more often - making them seem almost as common as the cold. (One in 88 children in the U.S. has been identified with an autism spectrum disorder and parents report that nearly 10 percent of school-age children have ADHD.) While these "Big 3" of developmental disorders have some overlaps and similarities, each has its own distinct symptoms that are diagnosable around certain ages.
Aspergers and Autism disorders are very similar in that the primary difficulties are in social communications and interactions, according to Dr. Douglas Vanderbilt, a physician at Children's Hospital Los Angeles' Developmental-Behavioral Pediatrics Department. Typically, an early sign that a child may have Aspergers or autism is a lack of eye contact, even before age 1, Vanderbilt said.
Autism and Aspergers are also connected because many believe Aspergers falls on the autism spectrum disorder scale, Vanderbilt said. In a controversial change, the next edition of the Diagnostic and Statistical Manual of Mental Disorders is expected to collapse Autistic and Asperger disorders, as well as others, into one diagnosis called Autistic Disorder, he said.
"Some people argue [Aspergers] is still separate and they have more of a nonverbal learning disability," Vanderbilt said. "But if the primary deficit is in social communication, then you're more than likely on the autism spectrum."
Aspergers has generally been seen by professionals as a milder form of autism in which language is better developed. Like autism, there are varying degrees of Aspergers, Vanderbilt said. People with Aspergers may speak fine, but have difficulty understanding humor, may take turns-of-phrases (like "two heads are better than one") literally and will often have a pedantic way of speaking - as if they are lecturing, Vanderbilt added.
People who have autism or Aspergers often withdraw from others, possibly because it's easier than engaging in difficult social interactions, Vanderbilt said. Another symptom is engaging in repetitive behaviors, thoughts or movements - like lining up cars or discussing memorized bus schedules.
Studies that have looked at the younger siblings of children diagnosed with an autism spectrum disorder show that symptoms can be discernible early and can sometimes be seen in first birthday videos and photos, Vanderbilt said. Because autism is genetic, it is common to study and screen siblings.
An autism diagnosis can be made as early as 18 months to 2 years, Vanderbilt said. The American Academy of Pediatrics recommends screenings at 18 and 24 months, while the Early Developmental Screening Initiative, developed by First 5 LA, calls for an earlier screening at nine months. Vanderbilt said early screening and intervention can make a difference in a child and family's life, so it is critical that concerns are discussed with the pediatrician.
The common thread between autism, Aspergers and ADHD is that they all cause difficulties interacting with peers, Vanderbilt said, which can make living with these disorders more unbearable without the proper intervention. There are no medications for autism or Aspergers as there are with ADHD; but all three can be treated, at least to a point, with services like counseling and therapy.
People who have ADHD are, in some ways, opposite of those with autism or Aspergers. "They are fun to be around because they have boundless energy," Vanderbilt said of those with ADHD. "They are very distractible, which is cute and typical in young kids, but difficult when older." Children with ADHD can have a hard time maintaining relationships with their peers because they don't often play nice and will have impulse control issues that cause them to grab toys or be "all over the place," Vanderbilt said.
Typically, ADHD is not diagnosed until 4 or 5 years at the earliest, since it could be difficult to discern between the activities of a typical toddler and that of a child with ADHD, Vanderbilt said.
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