Aspergers vs. ADD, I can't tell.

Post Reply New Topic

So I'm seventeen and lately I've been trying to get a diagnosis on something. Originally it would seem like I possess more traits of ADD, but I think both my mom and the doctor are jumping completely onto that boat way to early here. Mainly, it doesn't explain my social issues, which are not caused by over-talkativeness like most ADD (FAR from it, in fact). The thing is, the reason I have relatively few friends is because I'm just shy and self-conscious. I get anxious about talking to new people and I find things like Parties tiring. I end up sitting there in the corner gazing off, wishing I was back at home, when originally it seemed like a good idea. I'm kind of known as the loner who never talks instead of the loner who talks a lot about only one thing, even though a lot of times there's only one or two things I'd like to be talking about.
But as far as the ADD goes, I definitely have those traits. I get easily bored, I daydream a LOT, and I really make bad grades in school (except for German and Music theory, in which I'm top of the class). People think I don't care or that I'm selfish, but that's never the case. That's the whole frustrating thing.
Do you guys think the two can exist in conjunction? Any other opinions?

I don't see where the confusion is. ADD is attention deficit disorder. People with ADD have a difficult time paying attention to tasks and getting them done.

AS has nothing to do with ADD.

Attention Deficit (Hyperactivity) Disorder(ADD/ADHD) is associated hyperactivity and an inability to concentrate on set tasks, behavioural problems due to a lack of discipline. It is easier to give a child a label some pills to calm them down than to discipline the child and teach them the child the difference between right and wrong. ADD is a cop out for lazy parenting and it can be outgrown as the child grows up. It is politically incorrect to discipline a child and teach him/her the difference from right and wrong. Big pharmaceuticals and medical professional make a fortune out of diagnosing and prescribing medication to treat ADD/ADHD.

AS is an Autism Spectrum disorder and is completely different to ADD/ADHD. AS is where a person has inability to socially interact with others and they have sensory sensitivity triggered off by their environments. AS is regarded as the uglier cousin of Autism. AS can be overcome by counselling, behavioural therapy, treatment and possibly be outgrown by the child over time as they learn social skills and overcome their sensitivity issues with the environment.

People with AS have sensory issues sensitivities to lights, sounds, colours, smells, etc: that do not impact people who do not have Aspergers Syndrome. People with Aspergers engage in repetitive motions like rocking back and forth or eye twitching when they are anxious by a social interaction.

Is it Asperger's or ADHD?

By Daniel Rosenn, M.D.

It would be much easier for all of us if psychiatric diagnoses fell neatly into one category. And psychiatry would be immeasurably less complicated if we had a “scientific instrument” like an MRI, X-ray or blood test which accurately and consistently assigned people into one or another diagnosis. If we only had such a lens, one of the first places we would direct our attention would be at the muddy territory shared by Asperger’s Syndrome (AS) and Attention Deficit Hyperactivity Disorder (ADHD).

Of the rash of childhood emotional disorders, ADHD is probably the most ubiquitous, spreading over perhaps as many as six to seven percent of our children; that is somewhere around 60-80 times the prevalence now commonly ascribed to Asperger’s Syndrome. It is not too surprising that so many children are first diagnosed with ADHD, (occasionally preceded by the apologetic “atypical”) several years before they circle and land on the Asperger’s tarmac.

For the clinician, ADHD has been a well-known, well-described entity for decades. In the 1990s its popularity surged dramatically, with the publication of several teacher/parent scales, computerized Continuous Process Test office programs, media publicity, and a prodigious ad campaign by the manufacturers of psychostimulants. In the ambiguous and ever-shifting arena of childhood disruptive disorders, it was comforting for parents, pediatricians, child psychiatrists, (and Borders Books) to have an entity whose descriptors in Diagnostic and Statistical Manual of Mental Disorders (DSM), were so numerous (22 at last count), declarative, and seemingly precise.

The only problem is that for so many parents of truly unusual and eccentric children, it was like trying to squeeze a size nine foot into a size four shoe. The diagnosis just did not seem to capture the most important symptoms and vulnerabilities of their child. Furthermore, while the ADHD medications were occasionally enormously helpful, and the ADHD interventions in school (seating, chunking [condensing paragraphs of thoughts into a sentence], frequent breaks, added time for tests, decreased homework, etc.) almost always worked somewhat, nevertheless, by mid elementary school, it was becoming clear to many parents that something just didn’t fit.

When DSM IV opened American eyes to the concept of more ably functioning Pervasive Developmental Disorder (PDD), many children with ADHD were reassigned to the Asperger’s category. Almost ten years after Asperger’s Syndrome’s arrival, this diagnosis is now being tried on for size by more and more individuals. A legitimate worry is that perhaps, in our diagnostic zeal, Asperger’s Syndrome will become this decade’s darling, the way ADHD was the last’s, and that too many children are being jostled together under the PDD umbrella.

So how do we tell them apart? First of all, if the truth be told, both Asperger’s Syndrome and ADHD are probably themselves both spectrum disorders, with bleary margins wrapped around core characteristics that, at their heart, cannot be quantified or crystallized. How many difficulties does a child need to have “ significant impairments” in social reciprocity or language pragmatics? At what threshold does Pokemon become a “vertical special interest?” When are the inattention, increased motoric activity and impulsivity “more severe than is typically observed” in an individual of the same age? Please welcome the Australian and Conner’s Scales, their sisters, cousins and their aunts. Although numbers are harvested from these scales, they are subjective and subject to many forms of bias.

Yet, diagnostically, we do the best we can, recognizing that we are making approximations, best estimates, real-life decisions under the heat of battle, as it were. Clearly the label we use has extreme importance, and we need to make every effort to be accurate. Getting the label right is important for many reasons, not the least of which is that diagnosis often drives treatment planning, selection of medication, educational programming, and the way we conceptually and emotionally view our children.

With regard to ADHD and Asperger’s , there is a large overlap in symptomology. In my experience, roughly 60-70 percent of children with Asperger’s Syndrome have symptoms which are compatible with an ADHD diagnosis. In fact, so common are ADHD symptoms in PDD that the PDD diagnosis technically subsumes ADHD. DSM IV dictates that a diagnosis of ADHD not be given along with a diagnosis of Autistic Disorder. Nevertheless, when ADHD symptoms are present in Asperger’s Disorder and respond to psychostimulants, I frequently also specify the ADHD diagnosis to remind care-takers that these symptoms are a prominent part of the Asperger’s picture.

Interestingly, a sizeable portion of children with Asperger’s Disorder (and an even greater number of children with more severe PDD) do not have a favorable response to stimulants like methylphenidate (Ritalin, Concerta, Metadate) or to amphetamines alone or in mixture (Dexedrine, Adderall). Unlike children with more garden-variety ADHD, a large group of children with Asperger’s Disorder, regarding stimulants, either have an absent, muted, or greater adverse reaction (tics, increase in repetitive and perseverative behaviors, etc.) We often speculate that the ADHD symptoms of this group of children are being driven by anxiety, and that perhaps they do not have “classical” ADHD. Possible support for this viewpoint is that medications with anti-anxiety properties, such as the SSRIs (e.g., Zoloft, Paxil, Celexa, etc.) and the atypical neuroleptics (Risperdal, Seroquel, Zyprexa, Geodon) often seem to substantially reduce attentional and motoric symptoms which were unaffected or worsened by the stimulants.

On the other hand, a large number of children who have easily diagnosable Asperger’s Disorder and simultaneous ADHD symptoms are helped enormously by conventional ADHD medications and ADHD environmental manipulations, leading to the assumption that both disorders can co-exist in one individual. This is called co-morbidity, and it is quite common in psychiatric dysfunction. For example, a very large percentage of individuals with Tourette’s Syndrome have co-morbid obsessive compulsive disorder. As it turns out, a large percentage of individuals with Tourette’s Syndrome are also co-morbid for Asperger’s Syndrome.

The problem with the ADHD and Asperger overlap, is that at the more severe margins of the ADHD spectrum and the less extreme margins of the Asperger’s spectrum, clinicians can legitimately argue for one over the other diagnosis. Nonverbal Learning Disability (NLD) is not the only confusing label at the milder side of Asperger’s Syndrome. Many children with significant ADHD can be quite socially aberrant, lack perspective-taking skills, have severe sensory integration problems, be absolutely obsessed with Nintendo, talk constantly and too loudly, have meltdowns at the drop of a hat, be teased, and have no friends.

Yet even in this confusing part of the disruptive disorder stew, where perhaps juvenile bipolar disorder is one click further out than severe ADHD, there are still some guidelines I use to help me sort through the Asperger’s versus ADHD dilemma. First and foremost, Asperger’s Disorder is one of the Pervasive Developmental Disorders. As hard to digest as PDD has been for all of us working the Autistic Spectrum, the term nevertheless clearly and plainly denotes that children who fall into this category have developmental delays that pervade many developmental sectors. Therefore I expect, in fact require, a child with Asperger’s Syndrome to have at least a history of delays and deviations in many sectors (for example, possibly in gross motor, fine motor, sensory integration, attentional regulation, pragmatic speech, socialization, interest and play, affective modulation (e.g., anxiety and mood management), and neurocognition.

It is not that children with ADHD do not have developmental delays, but they do not usually have the variety, the severity, and the contours that children with Asperger’s Disorder characteristically have. ADHD children can have (although certainly not always) poor social skills, but they rarely and consistently have the demonstrable defects in comprehending social reciprocity (e.g., impairments in theory of mind, understanding of complex nonverbal cues, defects in facial recognition, distortion of subtle affective displays, miscomprehension of social context and signaling , and so forth.) Children with ADHD can talk in annoying controlling ways, but the configuration of pragmatic mis-broadcasting that is so tell-tale at any gathering of individuals with Asperger’s Syndrome is really quite consummate and unmistakable. This combination of prosody, dysfluency, pitch and volume, gaze aversion, fascinating but unfunny humor, peculiar word usage, anthropomorphizing of objects, hypersensitivity to criticism, receptive distortion of tones of voice, is certainly highly variable from one individual to another, but it is often definitive in whatever unique madras pattern it appears.

In general, children with Asperger’s Syndrome “have more” than most children with ADHD. They have more perseveration, more stereotypies, more splinter skills, more trouble telling a coherent story, and more neuro-integrative problems.

Children with ADHD can have as bad or worse executive functioning skills as the children with Asperger’s. If their attention is very, very poor, children with ADHD can have as bad a Rey Osterreith. In fact, children with ADHD can often have verbal IQ which are much better than their performance IQs (like the Aspies and NLDers), but more often it is due to very slow processing speed, which drags down the timed tests and deflates the scoring of Performance IQ. Indeed, many individuals with ADHD share a great many neurocognitive features with children with Asperger’s Syndrome, and that is one reason why neuropsychological testing by itself is not the best way to make a diagnosis of Asperger’s Syndrome. Testing is often incredibly helpful in understanding the learning style of the child with Asperger’s, and it is unarguably essential in making a diagnosis of NLD.

Children with Asperger’s Disorder and children with ADHD usually want to have friends. Both groups have poor rite-of-entry skills and both groups play badly. Yet both groups usually fail socially for different reasons. Their recipes for play failures have different ingredients. What often turns on a child with Asperger’s Syndrome is behavior so unusual and idiosyncratic that it can be unfathomable even to another child with Asperger’s. Children with ADHD frequently break rules they understand, but defy and dislike. Children with Asperger’s Syndrome like rules, and break the ones they don’t understand. They are ever alert to injustice and unfairness and, unfortunately, these are invariably understood from their own nonnegotiable perspective. Children with ADHD are often oppositional in the service of seeking attention. Children with Asperger’s disorder are oppositional in the service of avoiding something that makes them anxious. Both groups have serious sensory integration problems, can be uncoordinated and impulsive, and they both very much respond positively to structure and routine. The children with Asperger’s, however, crave order, hate discrepancy, and explode (or withdraw) in the face of violation of expectations. In this regard, they are enormously brittle and fragile. Children with Asperger’s are much more tyrannized by details; they accumulate them, and cannot prioritize them. Children with ADHD also have poor organizational skills, but can be much more fluid in their thinking, more inferential in their comprehension, and less rigid in their treatment of facts that they are able to organize.

Of course these are all generalizations. There is always the child who is the exception. Whatever their profile, whatever their label, both the child with ADHD and the child with Asperger’s syndrome require us to change our assumptions about relationships and our expectations about behavior. They are both demanding, confusing, exhausting, and frustrating. Inside, each is a child who needs tolerance, our informed understanding, our thoughtful interventions, our patience, and our love.

Hope this isn't to long, but simply put if you investigate ad(h)d a bit beyond "can't pay attention-can't sit still" you will find there is a lot of overlap in the symptomology.

Thrash dude, you sound like a sweetheart and a half, but I'm afraid that being shy and self-conscious is not the problem for people who have AS. In fact, a lot of people who have AS are actually extremely outgoing and gregarious. Their problem is that they just don't make personal connections very easily.

Imagine talking to someone for several hours (not that you necessarily would) and never having the sense that that person has recognized that there is a difference between you and a rocking chair. Literally. Now, if that person were to stop and think about it, you know that he or she actually would recognize that you are a person, but you don't get any sense that it would ever happen automatically or reflexively. This person literally has to concentrate, sometimes really really hard, for it to register that the human being that he or she is talking to is someone with a mind on the inside.

To make it easier, think of it almost like being the opposite of the kind of person who makes YOU feel shy and self-conscious. You know how some of those people who are ultra-charismatic seem to read you so well it's almost embarrassing, like you'll never be good enough to pass some unmentioned test? Well, imagine that the boundary that seems to be missing with these kinds of ultra-charismatic people is not only there, but it's so deeply exaggerated that it's like a gaping chasm between you and the other person. It's like you have found the polar opposite of a squeaky-voiced cheerleader.

The thing is, that doesn't mean that you wouldn't pass the test for Aspergers. A lot of people would who don't actually need the diagnosis. So what I suggest is this: consider very carefully what parts of you are actually a problem for you. Write them down. Maybe you could start keeping a journal to exercise your concentration and planning skills.

Oh, and develop a sense of discipline if you can. If you have ADHD, it's hard, but you have to try if you want to do the things you want to do. Best of luck to you, neighbor. You sound like you have good potential.

I have to say that I find it quite suprising to find this utterly offensive rubbish in here. I expect in in other places, but not in here. I have ADHD and probably AS as well. I wasn't badly diciplined or badly behaved and I wasn't medicated until I was diagnosed as an adult.

My difficulties in concentrating or sitting still are due to my brain differences, not my lack of discipline. Life with ADHD is hard enough without ignorant comments like yours.

Some people have one or the other, some people have both. It is possible that you could ADD or both ADD and AS. A lot of the symptoms cans be a bit similar, but I find for people that have either one or the other, the roots behind those symptoms are different (I mean, they are not the same, they just appear to be if you do not dig beneath the surface...such as have difficulty forming friendships, for example. Both those with AS and ADD have these difficulties in this area, but for differing reasons.) I find that people can easily have both AS and ADD; however, as separate labels, they are both very different. I have severe HFA. My niece has severe ADHD (both inattentive and hyperactive combined). Our symptoms are really nothing alike when you look into them.

I think if you feel you have ADD, then there is a reason for that, and you should not let it go until you know for sure. You may have both, or maybe you only have ADD. Where you are feeling anxious in social situations, I think that can be normal for people with and without ADD (and AS). It is possible that, whether you have ADD or AS or not, you may also have social anxiety. A lot of people with either ADD or AS also have social anxiety, and a lot do not. Keep in mind though that anxiety is not a symptom of AS, so if that is the only reason you are still considering AS, then perhaps it is ADD afterall. It is true that many with AS develop anxiety as a result of being aware of their social differences; however, it is a co-morbid with autism, not a part of autism. Even if you have AS rather than ADD, it is not because you have anxiety. That is something different that can accompany either AS or ADD or just be on its own.

There is no overlap. ADD/ADHD and AS are as different as strawberries and magnolias.

Anyone who thinks they are similar does not have a firm grasp on either.

Hmm, Asperger's is a cluster of stuff. Personally, I find them confusing.

Do you exclude ADD type effects from the core of aspie traits? Inattention, poor concentration, executive dysfunction (I'm not even sure where that goes)

What about sensory processing problems, is that aspie, ADD, or something separate?

If you wouldn't mind delineating them properly for me, that would be great.

Last edited by Moog on 23 May 2011, 11:47 am, edited 1 time in total.

Perhaps you could explain why I score so high on AS screening tests then?

I'm diagnosed with both.

Those aren't AS related traits. If a large number of people with diagnosed AS now express such traits, it's simply due to sloppy diagnosing and the tendency to label all difficult little boys as having AS, much as it used to be the practice in the 90's to label them as having ADHD.




There are various different types of processing deficits and they cannot be lumped into one category. While processing issues may underly many ASD's and some may mimic ADD, they can also be stand alone, and in the case of a sensory processing disorder mimicking ADD, it should be noted that it isn't actually ADD in that the person doesn't actually have an issue paying attention to things, but the person is unable to process relevant information in an efficient and productive way despite focused attention to it.



I did not mind at all. I hope you found it helpful.

On a side note, as a person with OCD, I used to take note of how many "professionals" loved to tell me that OCD was a spectrum and everyone had their little "OCD traits" as if OCD was merely an amplification of such things and within everyone was the fluidity to shift spontaneously or with the right behavioral influences from quirk to clinical disorder. I suppose this was partially a misplaced attempt to make me feel like I wasn't so different (as if I cared or had any need to not be different). They loved to consider Tourette's Syndrome as part of that "OCD spectrum" and a frightening number of "professionals" only understood OCD for what they could perceive externally and would diagnose people as having mild cases of OCD based what were actually obsessions, compulsions, of an entirely different pychopathology of OCD.

What is becoming more clear, however, is that OCD and Tourette's Syndrome, while similar, and sometimes co-morbid, have very definite boundaries in that genes have no been identified that correlate with Tourette's Syndrome that don't correlate with OCD and most people with OCD never developed Tourette's Syndrome despite the severity of their disorder nor the broadness of their symptoms. So much of this proposed spectruming was only superficial or assumed or imagined or inferred from poor understandings on the part of the professionals.

In the few cases where OCD and TS is actually co-morbid within an individual it's possible the person inherited genes for both, or one, or acquired both or the other through some physical damage to the brain such as infection, autoimmune response or accident or surgery induced trauma.

Research is currently underway to find genes responsible for OCD.

I conclude, most of this supposed spectruming is human sloppyness.

Thank you, Chronos.

I think you have to think about how you were in early childhood. From reports from my parents, I displayed unusual abilities and Little Professor traits from the age of 2...

and when I got into the ages of socialization, ie 4 or 5 I clearly remember starting to have problems already which got worse as I got older and my social environment became more complex but I remained at the same level.

I had inattention and problems with keeping still along with the social problems and attention to fact and detail.

So anyone who is unsure whether they have AS should examine how they were in childhood, and look at lists of AS traits and figure out which ones they do and dont have. Asking parents and relatives can be helpful too.

Also, there is a bit of cognitive dissonance happening- it is hard to see own AS at times and you can be blind to it whereas it can be plainly obvious to others.

Some of the things that personally affected me that led me to believe of an ASD.

Were you diagnosed with AS? You could have both, or you could have AS-like symptoms but really have ADHD. People taking online screening tests may not distinguish between AS and ADHD symptoms that are similar (they may appear to be one or another, but they do not understand the roots of each syndrome to know for sure which one they have.) This does happen. I knew someone who was certain he had AS. Turns out he has severe ADHD. The psych explained why to him, and then this person understood how he misunderstood his own symptoms for AS. It is possible to have both though.