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Dr. Yogindra Vasavada
Dr. Yogindra Vasavada, Pediatrician
Category: Pediatrics
Satisfied Customers: 3030
Experience:  M.D.(ped) passed at first attempt, in practice continuously for last 37 years. Certi. in Comp
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Dear doctor, I have a son diagnosed with ADD, but as time

Customer Question

Dear doctor,
I have a son diagnosed with ADD, but as time goes by I am wondering if there are more mental issues associated with him, such as autism. He is now 12 years old, and takes prescription drug such as Aderall, and prior to this 2 other meds. The medications work well when he starts on them, then the effect diminishes as time goes by. I have done some reading about autism and I know both ADD and autism present very similar symptoms.What are obvious signs/symptoms that can differentiate one condition from the other for his age group? Please let me know, thank you.
Submitted: 6 months ago.
Category: Pediatrics
Expert:  khagihara replied 6 months ago.

Diagnostic criteria — According to the DSM-5 criteria, a diagnosis of ASD (Autism Spectrum Disorder) requires all of the following:

●Persistent deficits in social communication and social interaction in multiple settings; demonstrated by deficits in all three of the following (either currently or by history):

•Social-emotional reciprocity (eg, failure of back-and-forth conversation; reduced sharing of interests, emotions)

•Nonverbal communicative behaviors used for social interaction (eg, poorly integrated verbal and nonverbal communication; abnormal eye contact or body language; poor understanding of gestures)

•Developing, maintaining, and understanding relationships (eg, difficulty adjusting behavior to social setting; difficulty making friends; lack of interest in peers)

●Restricted, repetitive patterns of behavior, interests, or activities; demonstrated by ≥2 of the following (either currently or by history):

•Stereotyped or repetitive movements, use of objects, or speech (eg, stereotypes, echolalia, ordering toys, etc)

•Insistence on sameness, unwavering adherence to routines, or ritualized patterns of behavior (verbal or nonverbal)

•Highly restricted, fixated interests that are abnormal in strength or focus (eg, preoccupation with certain objects; perseverative interests)

•Increased or decreased response to sensory input or unusual interest in sensory aspects of the environment (eg, adverse response to particular sounds; apparent indifference to temperature; excessive touching/smelling of objects)

●The symptoms must impair function (eg, social, academic).

●The symptoms must be present in the early developmental period. However, they may become apparent only after social demands exceed limited capacity; in later life, symptoms may be masked by learned strategies.

●The symptoms are not better explained by intellectual disability or global developmental delay.

DSM-5 diagnostic criteria — DSM-5 diagnostic criteria for attention deficit hyperactivity disorder are described below . These criteria are used to diagnosis ADHD in both children and adults. Changes from DSM-IV include modifications to criterion B, which now requires that several inattentive or hyperactive-impulsive symptoms were present prior to age 12 years (prior to age 7 in DSM-IV). Some examples of ADHD symptom manifestations in adults were added to the criteria, which are described as follows:

●A. A persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development, as characterized by (1) and/or (2):

•1. Inattention — Six (or more) of the following symptoms have persisted for at least six months to a degree that is inconsistent with developmental level and that negatively impacts directly on social and academic/occupational activities:

•Note: The symptoms are not solely a manifestation of oppositional behavior, defiance, hostility, or failure to understand tasks or instructions. For older adolescents and adults (age 17 and older), at least five symptoms are required. The patient often:

-a. fails to give close attention to details or makes careless mistakes in schoolwork, at work, or during other activities (eg, overlooks or misses details, work is inaccurate).

-b. has difficulty sustaining attention in tasks or play activities (eg, has difficulty remaining focused during lectures, conversations, or lengthy reading).

-c. does not seem to listen when spoken to directly (eg, mind seems elsewhere, even in the absence of any obvious distraction).

-d. does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (eg, starts tasks but quickly loses focus and is easily sidetracked).

-e. has difficulty organizing tasks and activities (eg, difficulty managing sequential tasks; difficulty keeping materials and belongings in order; messy, disorganized work; has poor time management; fails to meet deadlines).

-f. avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (eg, schoolwork or homework; for older adolescents and adults, preparing reports, completing forms, reviewing lengthy papers).

-g. loses things necessary for tasks or activities (eg, school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones).

-h. Is easily distracted by extraneous stimuli (for older adolescents and adults, may include unrelated thoughts).

-i. Is forgetful in daily activities (eg, doing chores, running errands; for older adolescents and adults, returning calls, paying bills, keeping appointments).

•2. Hyperactivity and impulsivity — Six (or more) of the following symptoms have persisted for at least six months to a degree that is inconsistent with developmental level and that negatively impacts directly on social and academic/occupationalactivities:

•Note: The symptoms are not solely a manifestation of oppositional behavior, defiance, hostility, or a failure to understand tasks or instructions. For older adolescents and adults (age 17 and older), at least five symptoms are required.

-a. Often fidgets with or taps hands or feet or squirms in seat.

-b. Often leaves seat in situations when remaining seated is expected (eg, leaves his or her place in the classroom, in the office or other workplace, or in other situations that require remaining in place).

-c. Often runs about or climbs in situations where it is inappropriate. (Note: In adolescents or adults, may be limited to feeling restless.)

-d. Often unable to play or engage in leisure activities quietly.

-e. Is often "on the go," acting as if "driven by a motor" (eg, is unable to be or uncomfortable being still for extended time, as in restaurants, meetings: may be experienced by others as being restless or difficult to keep up with).

-f. Often talks excessively.

-g. Often blurts out an answer before a question has been completed (eg, completes people' sentences; cannot wait for turn in conversation).

-h. Often has difficulty waiting his or her turn (eg, while waiting in line).

-i. Often interrupts or intrudes on others (eg, butts into conversations, games, or activities; may start using other people's things without asking or receiving permission; for adolescents and adults, may intrude into or take over what others are doing).

●B. Several inattentive or hyperactive-impulsive symptoms were present prior to age 12 years.

●C. Several inattentive or hyperactive-impulsive symptoms are present in two or more settings (eg, at home, school, or work; with friends or relatives; in other activities).

●D. There is clear evidence that the symptoms interfere with, or reduce the quality of, social, academic, or occupational functioning.

●E. The symptoms do not occur exclusively during the course of schizophrenia or another psychotic disorder and are not better explained by another mental disorder (eg, mood disorder, anxiety disorder, dissociative disorder, personality disorder, substance intoxication or withdrawal). (See 'Differential diagnosis' below.)

Specify whether:

Combined presentation: If both Criterion A1 (inattention) and Criterion A2 (hyperactivity-impulsivity) are met for the past six months.

Predominantly inattentive presentation: If Criterion A1 (inattention) is met but Criterion A2 (hyperactivity-impulsivity) is not met tor the past six months.

Predominantly hyperactive/impulsive presentation: If Criterion A2 (hyperactivity-impulsivity) is met and Criterion A 1 (inattention) is not met for the past six months.

Does your son have Predominantly inattentive presentation? What symptoms does your son have in ASD and ADHD?

Customer: replied 6 months ago.
I'm lost... Which ones are A1 and A2?
Expert:  khagihara replied 6 months ago.

A-1 is Inattention; A-2 is Hyperactivity and impulsivity.

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