Autism or ADHD in Children: What Parents Can Look For

Why parents often wonder about both

Many parents reach this question after a teacher's note or a hard stretch at home. A child who cannot sit through dinner, melts down at transitions, or struggles to join other kids at recess could fit the descriptions of either condition.

That overlap is real. The Centers for Disease Control and Prevention (CDC) lists hyperactive, impulsive or inattentive behavior among characteristics many autistic children have. On its ADHD pages, the CDC lists autism spectrum disorder among the most common disorders that occur together with ADHD. So the honest answer to autism or ADHD is sometimes both, and sometimes neither.

Signs that can show up in both

Here is where the two can look the same from the outside, especially at home or in a classroom.

• Attention: the CDC describes children with ADHD as easily distracted and having trouble following instructions. Autistic children may also seem not to listen, or be hard to pull away from what they are focused on
• Activity and restlessness: squirming and fidgeting are listed for ADHD, while the CDC notes that some autistic children flap their hands, rock or spin
• Friendships: the CDC lists difficulty getting along with others for ADHD, and trouble noticing other children and joining their play for autism
• Feelings: the CDC lists unusual mood or emotional reactions among autism characteristics, and notes that children with ADHD are more likely than other children to develop anxiety or depression

What tends to differ

Professionals look past the behavior to what drives it. An expert consensus statement published in BMC Medicine recommends a detailed developmental history that looks at when difficulties started, how they changed, and where they show up, because this helps tell ADHD, autism and other conditions apart.

1. 1The kind of attention difficultyA review in Frontiers in Psychiatry quotes the observation that attention problems in autism tend to be more of the not listening and difficulty shifting focus type than the short attention span and easily distracted type. The consensus statement adds that concentration problems may be less obvious when a child is absorbed in a favorite topic.
2. 2Why a routine mattersThe CDC describes autistic children as getting upset by minor changes and needing to follow certain routines. For ADHD, the CDC describes something different: trouble organizing and finishing tasks and forgetting details of daily routines, rather than distress at the change itself.
3. 3How social difficulties lookThe Frontiers authors describe children with ADHD as often boisterous, talkative and eager to interact. The CDC's autism signs focus on differences in sharing interests, using gestures, pretend play and noticing how others feel.
4. 4Sensory experienceThe CDC lists unusual reactions to the way things sound, smell, taste, look or feel among autism signs. Sensory differences are part of how autism is described, not ADHD.

Timing and age

The CDC notes that autism can sometimes be detected at 18 months of age or younger, and that a diagnosis by an experienced professional at age 2 can be considered reliable. Many children, though, are not diagnosed until much later. ADHD signs start in childhood, and the CDC explains that it is normal for children to have trouble focusing at times. With ADHD, the symptoms continue and cause difficulty at school, at home or with friends.

The consensus statement recommends that young children first identified with autism keep being watched for ADHD as they grow, because the two are usually diagnosed at different ages. It also notes that girls may be under-identified for both.

If your child is under 3, start with your pediatrician. The CDC notes that a developmental evaluation for a young child is most often done through a local early intervention agency.

Our free autism signs checklist can help you decide whether to talk to someone. It is an informal checklist, not a screening test, it is not validated and it cannot diagnose.

Why a good evaluation looks at both

The CDC states that there is no single test for ADHD, and that other problems, such as anxiety, sleep disorders and certain learning disabilities, can have symptoms similar to ADHD. It also notes that there is no medical test, such as a blood test, for autism, so doctors look at a child's developmental history and behavior.

The consensus statement recommends that both conditions be considered when one is present. It also cautions evaluators not to count the same behavior toward both conditions unless it is clearly different in quality. In practice, that means asking for detailed examples from parents and, where possible, teachers.

An evaluation is a careful look at your child's strengths and challenges. It may find autism, ADHD, both or neither, and nobody can tell you the result ahead of time.

If your child is in crisis or talking about harming themselves, call or text 988, or call 911. Locascio Wellness does not provide emergency services.

How we can help

Locascio Wellness offers a child and teen autism evaluation and a child ADHD evaluation, carried out by secure video. Evaluations are offered only to people physically located in Pennsylvania, West Virginia or Arizona, and a parent or guardian arranges the evaluation and takes part. If you are wondering about both, say so at the start. An evaluation usually involves an intake appointment, then one or two sessions, then a written report, which at the moment is usually ready about a month after the first evaluation appointment.

Evaluations are private-pay, with a sliding scale available; see what evaluations cost. To start, use the short evaluation request form and tell us your child's age, or book a free 15-minute consultation on our booking page.

We do not offer an autism therapy service, ABA, speech or occupational therapy, and we do not prescribe medication. Therapists on our team offer child therapy for worries, big feelings and confidence, and ADHD therapy for focus, routines and frustration, by secure video with a therapist licensed where you live. A diagnosis may also open other supports that families arrange with their doctor or school. Whatever the answer, understanding how your child's mind works can make everyday life easier to plan around.