Is this ADHD with social delay, or does it sound more like ASD?

[nature girl]

Anna LOVES being around other kids, of all ages. If there are kids around, I stop existing, she runs over and tries to join in even if the kids are teenagers or toddlers.

 

The problem is, she has some pretty major social delays. She just doesn't seem to be able to look at herself from an outsider's perspective, or see how her words are affecting other kids. She can be really rude, like she was having a conversation with a girl at lunch today and suddenly stopped and told her twice to stop talking with her mouth full, really forcefully. She had no idea how it was coming across. Another example, this morning she was telling a friend he had a hole in his head. (With his cowlick, his hair swirled to show a circle of scalp.) He said he didn't, and she said, "Yes you do!" He said, "Please don't say that anymore," and she said it again several times, after which things deteriorated quickly between them. :( She thought it was hysterical, I think she was trying to convince him it was funny without noticing or caring how he felt.

 

Last week in the playground, she was playing with an older girl, running after her, sitting when she sat. The girl said, "Could you stop copying me?" And Anna proceeded to copy every word she said. The girl was getting progressively annoyed, and I kept telling Anna to stop, but she didn't stop until I got angry with her. Again, she thought she was being funny and didn't realize how it was being perceived.

 

Related, she loves to hug her friends, and often they'll try to pull away but she pays no attention at all, just tries to hug them tighter.

 

Could all this be a social delay related to ADHD (as in, she's caught up in her own thoughts so doesn't pay attention to how others are reacting? Or impulsivity, not being able to think before she talks?) Or does this sound more like she might be on the spectrum?

 

And how can I help her mature socially? I've shown her pictures of various expressions, some pretty subtle, and she recognizes them all. She'll also react to my and my husband's emotions, so I feel like she has the capability of understanding how others are feeling, just doesn't ever look at her actions from an outside perspective. I'm so scared that as she and her friends get older, she's going to become more and more ostracized, and I know she'd be absolutely devastated to lose the friends she's made.

[Lecka]

I think that this example is not enough to say.  This could be true of either.  It would take knowing about other areas to say for sure.

 

But, with that said, if you have looked into spectrum stuff, and you are not seeing any other signs, then this sounds like ADHD.

 

I know two boys the age of my older son, who I have seen on and off medication, and for both of them, this kind of behavior is much better while they are taking medication. 

 

But if you are seeing other spectrum things, then I would say, this kind of thing could be from autism spectrum, too. 

 

By itself, I don't see this as pointing towards ASD.  If this is the thing that is either noticeable to you, or that is bothering you right now, but really there is more, then it could be one thing among many pointing towards ASD. 

 

That is just my opinion! 

 

Also, I have an understanding that social immaturity is part of ADHD.  I don't know how best to support or work with that.  It is just something I have heard.

[freesia]

I agree with Lecka that it is hard to tell from one sample and b/c social immaturity is part of ADHD. Some of the things she is doing other 5 year olds do as well and have a hard time understanding why it is wrong. They are still so young. What may take it over the top is the impulsivity and energy from the ADHD.

 

Try not to worry about her future. Take one day at a time, keep working with her and getting her the therapies that she needs. Worrying won't help the situation and your anxiety will keep you from enjoying her. You have just gotten the ADHD diagnosis. Many of the therapies are similar as ADHD is along the same spectrum. If she needs a social group at some point, provide her with one, but for now gently coach her and work on the impulsivity.

[nature girl]

Thanks, Lecka and Freesia. Lecka, it's interesting to hear you've seen a couple of ADHD kids with the same flavor of social issue, and especially interesting to hear meds can help...If so, I'll put another "pro" tickmark on my mental med pro/con list.

 

A couple of months ago after her eval, when I was trying to figure this out, I posted a list of possible signs asking for thoughts. There were just a handful of things that seemed to correspond with classic autism, but nothing definitive at all. I know it can be much harder to diagnose in girls though, and that they can be better at masking symptoms, especially when they're pretty bright. But since you've seen this kind of interaction in kids supposedly not on the spectrum, I won't take it as proof of anything.

 

I just keep thinking there are additional therapies and activities we'd do if I did know she was on the spectrum, and since I know it's so important to start work with ASD kids as soon as possible, I feel like I might be missing an early window. Right now she's not in any kind of therapy other than OT, and the only thing at OT that I think has the potential to really make a difference is their 5 minutes weekly of Zones...There's only one group locally that does Social Skills workshops, but they only take kids starting at 8. I contacted a therapist who does CBT, and she said they typically only work with parents at this age, not with kids. (We already do CBT-type behavior work at home, so I don't see much point in that.) I feel like there must be more we should be doing, I just don't have any idea where to start. ABA? Some other type of behavioral therapy? Our neurologist has been no help at all in giving advice, other than to suggest starting on meds, so I feel like I'm kind of flailing on my own here.

 

[Lecka]

I don't see her as needing ABA. 

 

Just fyi, if an ABA therapist thinks a child would benefit from medication for ADHD, they would also recommend medication.  They wouldn't think that their therapy could/should replace medication.

 

I have asked about this wrt my son.  Medication is truly not recommended for him -- people truly do not think he would get any benefit from it. 

 

If they think kids would benefit, they want them to have it so they can make more progress within ABA therapy.

 

I don't really get to pick and choose, in some ways.  I don't get to say "I wish I was recommended medication instead of behavior therapy."  But maybe I do wish that! 

 

ABA is a pretty big, heavy thing.  It has ethical considerations.  It has "should I be doing this to my child" considerations.  It has "am I taking away my child's childhood" considerations.

 

It is really not a "natural" solution, as opposed to medication being "unnatural."

 

I don't exactly know your reasons not to accept the recommendation for medication, but I do wonder if "the grass is greener" if you were really at the point of looking at ABA for her. 

 

I don't think you would really be going "yes, yes, ABA" while going "no, no, medicine is bad" if you were really at the point of doing ABA. 

 

I say that as a huge proponent of ABA when it is good and ethical, but it is not a bed of roses.  It really is not. 

 

If you think the medication recommendaiton is wrong or inaccurate or something like that, that is different.  It comes across like you just don't care for it and would rather pick something else.

 

Well, I feel that way about ABA too, in a way. 

 

I definitely feel that way about OT and sensory.  I don't care for these areas.  I do them anyway with a willing spirit, b/c my kids need me to.  But I think it is woo-woo nonsense anyway, even while I see it working.  It is not what I would ever choose if it were up to me.  But I need to do what my kids need, to a pretty great extent. 

[Innisfree]

Lecka, I'm listening in here, and now I'm really curious. Can you tell me more about why ABA seems like a "big, heavy thing," and especially one that might not be entirely benign? What are the ethical considerations?

 

We're doing it because it's what the neuropsych said we should do, but it hasn't been earthshakingly effective in any way. Now, we are just getting to add more hours. Maybe that will make a difference. Or maybe it isn't really what we need----??? We also have meds. We may need OT.

 

Not trying to divert the thread, just very interested in what you mean here.

[Crimson Wife]

ABA is a pretty big, heavy thing.  It has ethical considerations.  It has "should I be doing this to my child" considerations.  It has "am I taking away my child's childhood" considerations.

 

I completely disagree with this statement. Maybe this was true about ABA 10-15 years ago, but today's ABA has evolved tremendously past its beginnings with Dr. Lovaas. What my daughter's ABA program looks like is having a really good nanny doing "purposeful play" activities. It's not "taking away her childhood" but using activities she already enjoys like arts & crafts, reading storybooks, playing board games, engaging in imaginary play scenarios, etc. to teach skills. Last week one session was doing the town "Trunk or Treat". It is time-consuming (4 afternoons/week for 3-5 hours per session) but she enjoys it.

[Lecka]

What I really mean is, if I had a choice, I would not have to deal with it.  I would rather not have to do it or deal with it.

 

ABA is not like "oh, it is so wonderful" outside of the context of "this is what I need to do for my son so that he can have the best life possible now and in the future." 

 

It is a big commitment.  It is a big responsibility. 

 

It is not always "natural" in the sense that ------- before we did ABA, if my son was crying, I always comforted him.  After ABA, I learned that this was honestly not the best thing for him at some times.  But, do I like to see my son cry?  NO.  I do not.  I would rather be doing some attachment-parent thing where your kids never, ever cry.  I don't like crying.  I don't like it when my kids are sad. 

 

But can I keep my kids from ever being sad?  I really can't. 

 

If my son is crying b/c he doesn't want to do something, am I really doing him a favor if I go and rescue him and let him know "the mean lady will not make you learn anything if you don't feel like it right at that moment, and by the way, here, have some candy like you want." 

 

It is a major alteration.  It is not what I would choose to do if it were up to me.

 

I also felt horrible to have my son go into special needs pre-school instead of to go to Christian pre-school.  That was something that was happening at the same time that he started ABA, and it felt like a big, heavy thing to me.  I did not like to take that step.  There was really no choice and it benefited my son completely.  But, I didn't like it. 

 

I also feel like it cut into our park time and our outings.  I made a decision to have Fridays be totally off so we could still go to the little zoo and stuff.  I felt like it cramped my stay-at-home-mom time that I wanted with my little kids, and that I got to have with my older son before he went to Kindergarten.  But having Fridays off really solved that, that was a good decision. 

 

ABA is really, really good for my son. 

 

But I do have choices about like -- what am I picking for him.  It feels like more than what I choose on behalf of my other kids.  My other kids can really tell me "I want to do soccer."  "I want to take ballet."  That kind of thing.  I am picking that for my son.  I am using some ABA time for him to do church on Sundays, and he will be in the church Christmas pageant.  But I am not picking for him to play a sport.  Maybe that is the totally wrong choice.  I am making choices like this on his behalf.  It is the kind of choices I make on behalf of my other kids, too, but it feels like he has a lot less input for his age compared to my other kids.  I also get to pick his goals/priorities at other times, and that is a heavy burden in some ways.  But at the same time, I would be prioritizing things without ABA and making those choices. 

 

But that is part of ABA for me. 

[nature girl]

ABA is a pretty big, heavy thing.  It has ethical considerations.  It has "should I be doing this to my child" considerations.  It has "am I taking away my child's childhood" considerations.

 

It is really not a "natural" solution, as opposed to medication being "unnatural."

 

I don't exactly know your reasons not to accept the recommendation for medication, but I do wonder if "the grass is greener" if you were really at the point of looking at ABA for her. 

 

I don't think you would really be going "yes, yes, ABA" while going "no, no, medicine is bad" if you were really at the point of doing ABA. 

 

I say that as a huge proponent of ABA when it is good and ethical, but it is not a bed of roses.  It really is not. 

 

If you think the medication recommendaiton is wrong or inaccurate or something like that, that is different.  It comes across like you just don't care for it and would rather pick something else.

 

Well, I feel that way about ABA too, in a way. 

 

I definitely feel that way about OT and sensory.  I don't care for these areas.  I do them anyway with a willing spirit, b/c my kids need me to.  But I think it is woo-woo nonsense anyway, even while I see it working.  It is not what I would ever choose if it were up to me.  But I need to do what my kids need, to a pretty great extent. 

 

Nobody's actually recommended meds yet (although the neuropsych mentioned there was no point in doing another eval unless she was on meds, since she did so badly attending for her first eval.) The neurologist had us make another appointment for mid-November to see where things are at, whether she's improved with the OT, and I have to say she has improved, the hyperactivity has gotten much better (and I can usually tame it when it flares), but of course she still has problems. I'm assuming the neurologist intends to discuss meds then.

 

I'm not really looking at therapies in lieu of meds, I don't think they're interchangeable, they address different things. It's just that I keep worrying that there may be things I should be doing that I'm not considering because nobody's discussed them with me, or told me they could be beneficial. I'm not against meds, we probably will try them eventually, I just am hesitant to start her this young (since there haven't really been studies on long-term effects) and I've been feeling like at this point it's probably not necessary. Her behaviors have improved quite a bit over the last few months, she's able to school pretty well as long as we take long breaks, well enough for K and 1st at least, maybe even 2nd. After that, and/or if we decide to put her in ps next year, we would probably try them. But meds aren't going to actually "cure" anything for her, in the way I feel OT/Zones/(other therapies we haven't tried?) might help at a deeper level by giving her coping strategies.

[Lecka]

That makes a lot of sense.  I think I had a misimpression. 

 

There are some things that I think are fine to address as kids get older.  I don't think that some things are quite so "you have to do it while they are really young."

 

For all the good of ABA, if I had a choice of not having it as part of our life, I would take that choice.  But it has been great for my son, too.  He has had a chance to form great relationships with a lot of people.  But I am not doing it just for the sake of doing it, I guess.  It is not like music or a sport where I have a big commitment as a parent, to something my child does, and it is just b/c I feel like it or it reflects my values. 

 

But we have a really good experience, too.  Still, it is not a bed of roses.  It is not all wonderful.  Sometimes I would rather be doing something else with our time, or *just not need it in the first place.* 

 

I do also feel like "eye contact" is a bit of an ethical consideration.  My son actually does not do eye contact in ABA therapy.  He is starting it more in school.  I have not said anything against it, and it seems like it is okay with him.  He just doesn't do it naturally.  The ABA therapist has said, their policy is to wait until they think the child has a greater social understanding to the reason for eye contact, instead of just teaching it as "do this."  The ABA agency also has a policy that they do not touch a child on their head or face (though they might if they are working on speech sounds).  They don't in a context of compliance. 

 

I feel like I have to worry about those things.  It is a question to ask.  I have to ask it at school.  There are a lot of things to check on and make sure that my son is being treated well. 

[Innisfree]

Thank you, I can understand that. Our issues are different, I think, from what you have, and our ABA is enjoyable for dd, generally. It all creates a different equation. Makes sense.

[Crimson Wife]

I feel like PS is a MUCH bigger lifestyle cramp than ABA. PS dropoff and pickup is the reason why my older kids can't do a lot of field trips or certain activities that I would like for them. PS is the thing that I would most like to jettison from our schedule if I had the funds to replace it with a team of specialists.

[PeterPan]

I read most of this book today and it was fascinating.  https://www.linguisystems.com/products/product/display?itemid=10369

 

Ok, it was both fascinating and overwhelming.  Jist is, it's going to go through all these areas of Executive Function like goal setting, inhibition, etc. etc.  It explores language, IEP/instructional goals, language you build toward as you move from guided to self-regulation.  Not really a how-to book of the nitty gritties of each area, more how to understand what you're seeing how to attach the right words to it, how to create a game plan.  

 

Really functional in that sense, and then of course it's overwhelming.  I sat there going OH MY LANDS THAT'S WHAT MY DS DOES for every single thing almost.  Sigh.  So now I get why the ps psych had said ds' EF deficits were obvious.   :svengo: 

 

But just because you go ok, EF deficits, doesn't mean that means you've discriminated ADHD vs. ASD.  It doesn't really matter.  Either one can have the deficits, and either way you have to treat them.  So really you're asking two questions.  One is what in the world do I do?  Two is what label should it have? 

 

Psychs will disagree, the DSM is fallible, and the whole system of diagnosis is not yet reflecting the actual genetics and the budding knowledge that's out there of subtypes.  And how even can you GET to subtypes with 100 kids having 100 different genetic anomolies???  

 

Unless the diagnosis difference will change your funding, change your access to therapies, whatever, move on.  Either way, it's going to get treated the same.  And for some kids, ADHD + social delay + cognitive rigidity + anxiety IS going to get them ASD level 1 with the next psych.  Either way, you still have severe EF deficits that have to be dealt with.

 

The book was not bad.  Not Ross Greene or chocolate and cocoa, but when I could read it for free it was worth reading.  It expanded my mind on the concept of EF, and actually it sort of blew it.  Because there's a harder thing you have to back up and see, which is that the EF portions of the brain are processing the information received through the temporal, occipital, and whatever.  In other words, you have to build skill in those areas (visual processing, auditory processing, tactile processing) and chill those before the child can even BE in a position to work on EF.  So visual is like VT.  Auditory is your dyslexia stuff, etc.  Tactile is the SPD.  While those are a raging mess, the dc isn't even in a position to work on the EF.  The book describes it as phases.  In order to get to the most complex tasks (taking in auditory, visual, and tactile information, processing it, making a plan, implementing the plan), you have to have those systems working well in the first place.

 

[texasmama]

It could be either ADHD or ASD OR it could be both, as they are often comorbid.

[Lecka]

That is a good point.

 

Separately, I am going to add that I felt like I was splitting up my twins.  They had been in pre-school together, and then I could have switched my daughter to the special needs pre-school, but I didn't want to pull her from her friends and she was in a good situation for her.  But, I split them up into different pre-schools, and that was hard, but the right decision.  Then, to have one twin doing ABA and one not, even though she was included in many activities and could go in the room and participate as she chose, well -- it was not for her, it was for my son.   

 

That is just a heavy thing.  It is not exactly "ABA is heavy," now that I think about it more, but it is a big reason that ABA was heavy, especially when I was starting it.  

 

Once it was our routine -- it was not like that so much.  But it was a pretty heavy thing to be doing at the beginning.  

[sbgrace]

It could be either ADHD or ASD OR it could be both, as they are often comorbid.

 

This is what I was going to say. I think it can be harder to tease out at young ages too for non-experts/parents. If you can find an autism diagnostic person that works with high functioning kids, I really think they would be able to answer yes or no on autism.

 

Zones sounds like a good thing/it sounds like there are regulation issues.

 

There is a book called The Unwritten Rules of Friendship that I thought of when reading your post. It's worth a purchase I think. It's very practical, and addresses the sort of things she's doing. http://www.amazon.com/The-Unwritten-Rules-Friendship-Strategies/dp/0316917303You don't need a diagnosis to address the issues.

 

FWIW, those are the sort of things my very social child with both ASD and ADHD does. The ASD is definitely part of the it for him, but Ritalin does help with those behaviors.

[PeterPan]

I think you're going to find some of her behaviors (like the copying, like...) are a sort of stimming, of trying to organize herself, of dealing with the dysregulation of the SPD.  Working on the EF stuff is actually jumping the gun.  My ds's brain waves calm down and his repetitive motions and behaviors calm down as we keep working on the SPD.  So you can say ok, that behavior was because she was in Yellow Zone, so I'm going to have her go do a strategy to get back to green.  Fine, but you just made cognitive (volitional, all on her end) something that was happening in the first place maybe because of the SPD.  Yes Zones wants you to back up and work on perspective taking, but EVEN THAT is executive function!!  

Brain lobes.jpg 495×366 pixels  Here, see if that works.  So the book wanted you to work on them in phases, first getting the temporal, occipital, and parietal clicking.  Then you target the *pre-frontal* with simple connection of those three to EF.  THEN you go for the full shibang, integrating the incoming information with processing and with making a plan and implementing the plan.  

 

I know you've had trouble getting OT you felt confident in.  I'm just saying I would keep working on that, because the evidence is that you need to work on how the information is even going in and being processed before you can start applying it in sophisticated ways.  That's why you're seeing this gap between what she can parrot and what she can apply.

 

[nature girl]

Thank you for the discussion! I know ASD and ADHD are often comorbid, my question wasn't an either/or because I'm 100% certain she has ADHD, was just wondering whether these social issues could be a result of solely ADHD, or pointed toward something more (which apparently they don't necessarily.) And maybe it doesn't matter, if we'd be treating what we've seen in the same way, my concern like I said earlier is that there may be pieces we're not going to be able to touch with our current approach.

 

The book was not bad.  Not Ross Greene or chocolate and cocoa, but when I could read it for free it was worth reading.  It expanded my mind on the concept of EF, and actually it sort of blew it.  Because there's a harder thing you have to back up and see, which is that the EF portions of the brain are processing the information received through the temporal, occipital, and whatever.  In other words, you have to build skill in those areas (visual processing, auditory processing, tactile processing) and chill those before the child can even BE in a position to work on EF.  So visual is like VT.  Auditory is your dyslexia stuff, etc.  Tactile is the SPD.  While those are a raging mess, the dc isn't even in a position to work on the EF.  The book describes it as phases.  In order to get to the most complex tasks (taking in auditory, visual, and tactile information, processing it, making a plan, implementing the plan), you have to have those systems working well in the first place.

 

This is interesting. Of these, the only issue Anna has is sensory, and I think that sensory is pretty mild. There are times it interferes, in exciting situations she does get over-excited, but in our everyday environment I don't see it affecting her much. Maybe though (just thinking out loud here) in social situations she gets to that excited, overloaded place and can't regulate her interactions? If so, will sensory work eventually keep her from that overexcitement, and take her to a place we'd never be able to get to with social skills training alone? IDK, maybe? But again in the scheme of things, sensory doesn't seem to be ALL that big of an issue for her. She's not bouncing off walls, and (just realizing this) doesn't plow into me or throw herself on couch pillows like she used to.

 

And in talking to the OT therapist last week, she said her main goal right now is helping Anna with motor planning...they don't really do any sensory work. I do heavy work at home, and that's all she's getting sensory-wise.

 

I think you're going to find some of her behaviors (like the copying, like...) are a sort of stimming, of trying to organize herself, of dealing with the dysregulation of the SPD.  Working on the EF stuff is actually jumping the gun.  My ds's brain waves calm down and his repetitive motions and behaviors calm down as we keep working on the SPD.  So you can say ok, that behavior was because she was in Yellow Zone, so I'm going to have her go do a strategy to get back to green.  Fine, but you just made cognitive (volitional, all on her end) something that was happening in the first place maybe because of the SPD.  Yes Zones wants you to back up and work on perspective taking, but EVEN THAT is executive function!!  

Brain lobes.jpg 495×366 pixels  Here, see if that works.  So the book wanted you to work on them in phases, first getting the temporal, occipital, and parietal clicking.  Then you target the *pre-frontal* with simple connection of those three to EF.  THEN you go for the full shibang, integrating the incoming information with processing and with making a plan and implementing the plan.  

 

I know you've had trouble getting OT you felt confident in.  I'm just saying I would keep working on that, because the evidence is that you need to work on how the information is even going in and being processed before you can start applying it in sophisticated ways.  That's why you're seeing this gap between what she can parrot and what she can apply.

 

The copying wasn't stimming or echolalia, she just was trying to be funny...On top of that I think she felt hurt by the girl telling her to stop following her around, and was reacting to that. But I see what you're saying, that if her brain is all over the place in certain situations, she won't be able to control herself in those situations, even though she knows how to use the Zones tools. (And she's still a long way from applying those tools on her own, knowing when she needs them and being able to calm herself down enough to use them. At this point it's all at my direction, I don't see that changing anytime soon.) Maybe continuing the sensory diet will eventually help her get to that place...I just wish there were more definitive answers, because the diet still seems so woo-woo to me.

[texasmama]

IMO, her social issues are pretty severely affecting her life.  I agree with PP's who said that at this age, it is difficult to tease out what is going on.  At 6, my ASD kid looked like a shy kid with severe SPD.  It took until puberty to see his deficient theory of mind.  He did have moderate anxiety, as well, which is the reason we homeschool.  His separation anxiety about going to school in first grade could not be overcome with all of the tools I had in my tool chest.  He still does not have life-changing social issues, but the deficient theory of mind comes out in intimate family relationships.  His anxiety is much better, and his moods have stabilized in general.  He had a lot of anger during the first two years of adolescence.  As an adult, he will likely appear to be a shy, quiet person but not an unlikeable one.  He does not have ADHD.

 

Since you are targeting the sensory issues already (and these can come out emotionally as well as physically), I would probably put my resources into the emotional regulation, in addition to doing a ton of social stores and role playing about peer interactions.  Your descriptions of her consistently show a kid who will not be liked by peers because of her behaviors.  Six year olds are pretty forgiving with social interactions, but if she is putting off same-age peers consistently as it seems she is, then her behaviors are pretty severe and off-putting to others and need daily work.

[Storygirl]

So....I'm curious. Do people with ADHD sometimes have trouble with theory of mind? Does a deficiency in theory of mind suggest an ASD diagnosis over ADHD with social delay? Is the social delay that ADHD kids have related to theory of mind?

 

Do theory of mind deficiencies and ASD go hand in hand, or are there people who have trouble with theory of mind who do NOT have ASD?

 

I hope this is not derailing your thread, Anna's mom. It's something I've been wondering about.

[texasmama]

So....I'm curious. Do people with ADHD sometimes have trouble with theory of mind? Does a deficiency in theory of mind suggest an ASD diagnosis over ADHD with social delay? Is the social delay that ADHD kids have related to theory of mind?

 

Do theory of mind deficiencies and ASD go hand in hand, or are there people who have trouble with theory of mind who do NOT have ASD?

 

I hope this is not derailing your thread, Anna's mom. It's something I've been wondering about.

Those are the million dollar questions, IMO.  Truly.

 

There is so much overlap between ADHD and ASD that it can be hard to tell.  I sound like a broken record, but in my experience, it is sometimes hard to tease out exactly what is going on with a younger kid, like pre-puberty.  After puberty, things kind of shake out a bit, and a person is more easily diagnosed.  The more subtle the issues, the more difficult the diagnosis.

 

In my opinion, deficient theory of mind is unique to ASD.  I view the social delays and overall immaturity seen in ADHD without ASD differently than deficient theory of mind.  Also, I think inherent in the ADHD dx is social delay.

 

And where does the norm end and a pathological, treatable process begin?  My dh is very disorganized and loses everything.  I don't think he has ADHD (and has never been hyperactive a day in his life), but who knows?  Did he just grow up in a chaotic household with poor models and was neglected while I grew up with two very organized parents?  Who can say?

 

I go round and round in my head about whether or not ADHD meds would help my ASD son.  I don't think so.  Who can say for certain about that, either?  He is disorganized and loses his belongings, but he is functioning fairly well unmedicated, though he works at a snail's pace.  Could he pick up the pace with meds?  Would it make one whit of difference?

 

These are the questions that I toss around and do not seem to come up with any answers.

[Storygirl]

Thanks, texasmama. I've been wondering a lot about the whole theory of mind thing. DS11 failed the theory of mind testing, but he was not diagnosed with ASD, so I've always wondered. I need to do some more research, I think.

 

It's interesting what you say about puberty. DS11 was a pretty atypical preschooler, and then he grew out of some of his more unusual behaviors and into more obviously ADHD and SPD issues. Now that he is getting older, we've been seeing new things that reveal his difficulty understanding social things. He's uneven in his ability to fit in with peers -- sometimes he seems to function typically, but then odd problems crop up. I do think his social differences will become more obvious as the kids around him mature in a pattern that differs from his.

 

[Storygirl]

Anna's mom, we're working on having DS11 evaluated for ASD, because we have questions, too. A few people on the boards have directed me to look right at the DSM 5 diagnostic criteria, and I found it really helpful.

 

You can find the DSM wording here: https://www.autismspeaks.org/what-autism/diagnosis/dsm-5-diagnostic-criteria

 

And here is a really helpful guideline for what kind of behaviors would fall under each section of the criteria: http://depts.washington.edu/dbpeds/Screening%20Tools/DSM-5%28ASD.Guidelines%29Feb2013.pdf

 

 

 

[kbutton]

So....I'm curious. Do people with ADHD sometimes have trouble with theory of mind? Does a deficiency in theory of mind suggest an ASD diagnosis over ADHD with social delay? Is the social delay that ADHD kids have related to theory of mind?

 

Do theory of mind deficiencies and ASD go hand in hand, or are there people who have trouble with theory of mind who do NOT have ASD?

 

I hope this is not derailing your thread, Anna's mom. It's something I've been wondering about.

 

This might answer your question--the Social Thinking folks kind of cut across labels and identify social communication profiles. I read this a long time ago (and will re-read it now), and my kids were young enough that it was hard to place them. I am kind of going over this again. 

http://www.socialthinking.com/Articles?id=1de1f8d14d224378a237029e6346389d 

 

I have an example of social thinking that I think would qualify as not ASD-specific and is related to ToM, but not in the way we usually think of it. It's based on my own experience with people I know who have ADHD, suspected and confirmed. Try walking down a narrow sidewalk in a novel environment with at least 4 people who have some kind of executive function/ADHD/ASD issues and several who do not (it's best if you can do this a few times over the course of a vacation with the same people so that you can see it plays out even after the group has established some operating principles). You need a small sidewalk for best results--big, wide, city sidewalks kind of skew this. It's enlightening. It's almost impossible to actually walk without having a collision. The NT members of the group bear the brunt of avoiding the collision--they seem to be the only ones that understand that they have to share the sidewalk, walk in a semi-straight line, keep pace with a partner so that people are not walking on top of one another. and to be sure that people coming from the opposite directions don't have to bail to the side off the sidewalk. I will admit that sidewalk courtesy is a dying art (coming from a completely walkable small town with small sidewalks used as transportation to actual places like the store to suburbia when sidewalks are kind of paths to nowhere to look nice, keep you off the road, and maybe help you exercise). The people how have trouble with social thinking may eventually adapt to a consistent group, but when you change it up, add a new person, etc., it will throw everything off again. NT people have to work out the logistics too, but it comes much more easily, and they will fall into a rhythm, reorder the group for optimum results, and then stick with it each time they go somewhere with that group. 

 

Other article that might help:

http://www.socialthinking.com/Articles?name=Social%20Thinking%20Social%20Learning%20Tree

http://www.socialthinking.com/Articles?name=Updates%20on%20Social%20Thinkings%20Cascade%20of%20Social%20Attention

http://www.socialthinking.com/Articles?name=Problem%20Solving%20Is%20At%20the%20Heart%20of%20Social%20Thinking

[Storygirl]

Thanks for the links, kbutton! There is really good info there. My brain is only working halfway today (sick), so I'll have to re-read later.

 

Your first link, though, just goes to a blank page, so I don't know what article you meant.

[kbutton]

http://www.socialthinking.com/Articles?id=1de1f8d14d224378a237029e6346389d

 

Maybe this will work. I don't know why it truncates the links sometimes.

[Crimson Wife]

So....I'm curious. Do people with ADHD sometimes have trouble with theory of mind? Does a deficiency in theory of mind suggest an ASD diagnosis over ADHD with social delay? Is the social delay that ADHD kids have related to theory of mind?

 

Do theory of mind deficiencies and ASD go hand in hand, or are there people who have trouble with theory of mind who do NOT have ASD?

 

I hope this is not derailing your thread, Anna's mom. It's something I've been wondering about.

 

At the conference I attended a few weeks ago, one of the presentations was on ToM problems in the deaf & hard-of-hearing. According to the presenter, dhh kids have difficulty developing ToM because they miss out on so much auditory information, especially overhearing things. I would imagine that kids with ADHD experience similar problems of missing out on information (though due to a lack of attention rather than not being able to access it).