Autism is a spectrum, meaning each individual will experience autism spectrum disorder (ASD) differently and exhibit different characteristics. Maintaining a nuanced understanding of ASD is essential for counselors and others who work professionally in the field. That being said, comorbid conditions are common.
According to the literature, an estimated 50 to 70% with autism will also present with attention deficit hyperactivity disorder (ADHD) (Hours et al., 2022). Therefore, counselors, clinicians, and therapists must understand the difference and the link between the conditions to improve diagnosis and treatment.
Understanding ADHD and Autism in Children
With improved diagnostic tools and awareness measure, autism is becoming increasingly prevalent in our population. Currently, the CDC estimates that approximately 1 in 31 children has ASD, with autism being 3x more common in boys than girls. It is important to note that ASD characteristics tend to be exhibited differently in boys than girls, which may account for the diagnosis discrepancy.
ADHD is more common. In a systematic review that covered over 3 million participants, approximately 8% of children and adolescents had ADHD. Similarly to ASD, ADHD was diagnosed almost twice as often in boys than in girls (Ayano et al., 2023).
The Differences Between ASD and ADHD
ASD and ADHD are different conditions that both affect executive function, albeit in different ways. Those with ADHD typically exhibit difficulty with maintaining attention as well as impulse control. These characteristics lead to challenges such as inattention, hyperactivity, and difficulty remaining focused.
Although the characteristics and signs of ASD vary vastly from person to person, they are commonly characterized by challenges with cognitive flexibility. This can include difficulty adapting to stimuli, social interactions, and social norms (Martinez et al., 2024).
The Link Between ASD and ADHD
Studies have shown that most ASD and ADHD traits remain connected to their own condition, simplifying diagnostic requirements – but not all (Waldren et al., 2024).
The Waldren et al. review suggests there is a strong association between ADHD and ASD traits, meaning there may be transdiagnostic features across the conditions. The results remained consistent across youth and adults, suggesting a reciprocal relationship between the two traits (Shakeshaft et al., 2023).
Moreover, research shows that those with ASD have a higher chance of having ADHD than those without ASD (Ghirardi et al., 2017). Despite the high levels of comorbidity between the conditions, researchers found that only 15.8% of children with ASD +ADHD had previously been diagnosed with both conditions before the study began (Canals et al., 2024).
These findings suggest that while dual diagnoses are low, it’s important to expand your diagnostic process to screen for both ASD and ADHD in children with autistic characteristics.
Improve Your Diagnostics Capabilities
With such a high co-occurrence rate between ASD and ADHD, it’s in the best interest of the children you work with to expand your diagnostic capabilities. This means being qualified to use the Attention-Deficit/Hyperactivity Disorder Test, Second Edition (ADHDT2), and ASD diagnostic tools like Autism Diagnostic Observation Schedule, Second Edition (ADOS®-2).
Learn more about helping children by adding diagnostic tools like the ADHDT2, ADOS-2, or Monteiro Interview Guidelines for Diagnosing the Autism Spectrum, Second Edition (MIGDAS™-2) from WPS to your assessment process.
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