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Delayed autism spectrum disorder recognition in children and adolescents previously diagnosed with attention-deficit/hyperactivity disorder


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I thought I'd share this article abstract as we've had several members make comments that kind of pertain.

Phenotypic elements of autism spectrum disorder can be masked by attention-deficit/hyperactivity disorder symptoms, potentially leading to a misdiagnosis or delaying an autism spectrum disorder diagnosis. This study explored differences in the age of autism spectrum disorder diagnosis between participants with previously diagnosed attention-deficit/hyperactivity disorder versus autism spectrum disorder-only respondents. Children and adolescents, but not adults, initially diagnosed with attention-deficit/hyperactivity disorder received an autism spectrum disorder diagnosis an average of 1.8 years later than autism spectrum disorder-only children, although the findings regarding the adult sample should be interpreted with caution. Gender differences were also explored, revealing that the delay in receiving an autism diagnosis was 1.5 years in boys and 2.6 years in girls with pre-existing attention-deficit/hyperactivity disorder, compared with boys and girls without prior attention-deficit/hyperactivity disorder. No significant gender differences were observed in the adult sample. We argue that overlapping symptoms between autism spectrum disorder and attention-deficit/hyperactivity disorder might delay a formal diagnosis of autism either by leading to a misdiagnosis of attention-deficit/hyperactivity disorder or by making it difficult to identify the presence of co-occurring autism spectrum disorder conditions once an initial diagnosis of attention-deficit/hyperactivity disorder has been obtained. Current findings highlight the need to recruit multidimensional and multidisciplinary screening procedures to assess for potential emerging autism spectrum disorder hallmarks in children and adolescents diagnosed or presenting with attention-deficit/hyperactivity disorder symptoms.

Kentrou V, de Veld DM, Mataw KJ, Begeer S. Delayed autism spectrum disorder recognition in children and adolescents previously diagnosed with attention-deficit/hyperactivity disorder. Autism. 2019 May;23(4):1065-1072. doi: 10.1177/1362361318785171. Epub 2018 Sep 24. PMID: 30244604; PMCID: PMC6512047.

Full article available at https://doi.org/10.1177/1362361318785171
“Gender differences were also explored…”

I surmise gender identification has a huge impact here on the professional understanding and diagnosis of both ADHD and autism. My thinking is that the male, female, non-binary, and transgender experiences would each be different and the manifestation of symptoms would be equally varied.

A heterosexual cis gender female in the United States in the 1980s absolutely did not get recognized for autism once she learned how to mask. Nor for ADHD… As I am the above stated gender, my interest is in young, quiet, shy girls who adapt very well to being unnoticed and do not often fit the outward expressions of these conditions that would otherwise demand treatment, attention, and perhaps a diagnosis.

Left untreated, the resulting mental health impacts of burgeoning self loathing and anxiety leads to a very complicated diagnostic mess rather quickly.
I was first diagnosed with ADD (ca. age 30), but that was withdrawn when I got hyper on ritalin and I passed the TOVA.
My (likely ASD1) daughter & ASD2 son were also diagnosed with ADD first.
One huge driving factor in this the actual diagnostic criteria of autism from the DSM III, published in 1988, to the DSM VI in 1994, which more than doubled the diagnostic criteria for autism and introduced the Asperger's subset diagnosis.

The DSM V removed the Asperger's diagnosis and expanded the Autism Spectrum (1 - 3).

On a side note ADD has not been in the DSM since 1988. It is all part of the ADHD spectrum. Hyperactive, inattentive, and complex (a combination of hyperactive and inattentive). Just as there is no subset of 'adult on set' ADD. It is a condition present at birth and is merely undiagnosed due to inconsistent criteria, limited resources, or other factors.

I had a formal Asperger's diagnosis, but also met the criteria for ADHD and due to label stigmata my mom and doctor only mentioned my ADHD diagnosis until I sought an autism diagnosis in college, not knowing I already had one.

Temple Grandin's new book Visual Thinking digs into the history of neurodivergent diagnoses as part of the context for the book and really does a fantastic job illustrating the progression and evolution of neurodivergence within the science of psychology.
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