Question:

Dear Expert,

I'm in between a rock and a hard place! My son is almost eight years old and is in a regular 2nd grade class. He has been diagnosed as ADHD since before kindergarten. It's also been suggested that he has Aspergers and/or NVLD, but we're exploring that (the more I read about it the more I'm positive he does).

Here's the problem: He has been taking either Adderall or Dexedrine since kindergarten for ADHD. His medicine does improve his attention some but a few hours after taking either of them he would get irritable, sometimes very violently. Its like a balancing act to get enough of a dosage to help with attention but minimizes the rages. When I talk to his doctor about it I feel like they're just saying, "Oh well… that's how it works." My son is not the only one with this issue! The interesting thing about these other kids I've met with this problem in that they too have an autistic spectrum disorder as well as ADHD like my son.

Could it be that the social issues (lack of understanding of other peoples feeling) & their need to control issues associated with Aspergers syndrome are being made worse by the ADHD medicine? Or could we be giving these kids too much medicine trying to curb the inattention & distractibility due to Aspergers in addition to the same due to ADHD (because there are biologically different reasons for the inattention)?

I can't find out any definite information on this problem. Who would know about this? Can you help me understand?

Answer:

Whew, this is a very complex question and one very pertinent to today's popularity of diagnosing autistic spectrum disorders and attention deficit disorders. If you look at criterion for both these diagnoses carefully, there is some overlap in the behavioral symptoms although the core "disorder" is quite different.

You are right to have these concerns about diagnosis and medication. Many medications have behavioral side effects and children with Attention Deficit Disorder do not always respond positively to stimulants. As you probably know, autistic disorders are primary disorders of relatedness and there is no known simple cure (though improvement can be noted with some interventions. Attention disorders are primarily disorders of attention and often associated with hyperactive behavior. There are a variety of medications that have been found to help "normalize" behavior of individuals with Attention Deficit Disorders. There are also a variety of other interventions that are often felt to improve the behavior, such as positive reinforcement, structuring activities and social skills training.

First let me say that neither of these disorders is "easy" to diagnose. Both of these diagnoses are made by identifying symptoms and fitting the diagnoses to the group of symptoms exhibited by a child. A child can have both an autistic spectrum disorder and a behavioral disorder. This further complicates the situation.

Were I in your shoes, I would talk with your physician about finding a physician knowledgeable about these disorders. There are often pediatric "behavioral/developmental diagnostic teams" at large medical centers. They would be the best equipped to make appropriate diagnoses and often offer follow up and treatment services.