So, the local psychologist has basically told us to see a "specialist" to try to tease things out but gave us provisional diagnoses to work with the school in the meantime. DS scored above the diagnostic criteria on the CAST assessment (Childhood Autism Spectrum Test), scored a 92.9% likelihood of ADHD on the Conners Continuous Performace Test II, and scored almost double the minimum diagnostic criteria on the SCARED assessment (Screen for Anxiety Related Disorders). Now we're waiting to hear back about getting an appointment elsewhere.

So, basically, he appears to have all the problems that we have seen him having. Now the questions are: Which diagnosis is the primary diagnosis? Is one of the diagnoses causing symptoms that are showing up as a different diagnosis? Can we manage one without exacerbating the other?

All in all more answers just lead to more questions and on we go again...

I hear you. Do get to the specialist, do whatever further testing they recommend, and then have a long conversation where you tease these things apart. That specialist should be prepared to help you make a plan for addressing these issues both inside and outside school.

I always feel better with a plan, and you're on the way to having one! Things are going to get better with more knowledge in hand.

DeeDee

While it is possible to carry a PDD/ASD, ADHD, and a specific anxiety diagnosis concurrently...it would usually not be diagnosed that way. Anxiety, compulsions, rigidity, social anxiety, and oversensitivity are often components of the PDD and ASD...as is inattention, restlessness, hyperactivity, and poor impulse control.

Fleshing out the PDD/ASD side will help tremendously in determining which lens to view the anxious/ADHD behaviors.

My DS8's diagnoses is PDD-NOS, ADHD & GAD. My understanding is that the ASD/PDD-NOS diagnosis is primary by definition. The others are specified merely because the symptoms of them rise to a level that interferes with "normal" life, as it were.

As for treatment, your only option is to treat the symptoms. DS takes a med to help control his mood (Risperdal), and another to control his impulsiveness (tenex), and goes to one on one cognitive behavioral therapy, and just started group therapy. It was recommended he get pragmatic language therapy from an SLP as well, but we haven't found one yet.

I think it's just a matter of starting with whatever symptom/issue that's causing the most pain/trouble.

Ah, this my son. Throw in a language processing disorder and they're the same kid (although the ASD and GAD are not official, but highly suspected by all involved... diagnoses are still pending).

I start with the issues that occur concurrently. For example, ASD and ADHD also cause anxiety, so I try and teach emotional resiliency (breathing, counting to calm down, etc.)

It's hard because all three can cause similar behaviours. I don't think managing one makes the others worse, unless you are treating the ADHD with a stimulant which can cause problems for the ASD and anxiety.

My solution for my DS is to focus on foundations that are relevant to all three (structure, diet, exercise, positive feedback, self esteem building, etc etc - you get the idea) and then I address the behaviours as they occur. I'm also to the point with my DS where I'm giving him opportunities for independence (i.e. making his own snacks, that sort of thing), so that he's learning skills and confidence. His ASD behaviours are the least prevalent... his major Achilles heel is the "off task" ADHD piece. SUCH a giant thorn that one is.

vwmommy how old is your son? What are his biggest issues at this point?

The "off task" behavior is also an ASD issue: not taking other people's (teachers') priorities as his own, a person with ASD is more likely to not do the predictable or desired thing.

DeeDee

Yup... this is a good example of how similar behaviours can be caused by all three issues. This is interesting, though - would you treat "ASD off task" the same as "ADHD off task?" For my DS the answer appears to be yes (he's pretty flexible and easy to redirect), but that may not be the case for all, depending on the child and the severity of each issue.

Some 'symptoms' you treat the same, others you don't.

In our case ADHD-like symptoms are treated the same, regardless of a secondary ASD diagnosis, save for the meds (non-stimulants seem to work better than the normal stimulants).

Anxiety-like symptoms, IMO, should be handled differently with an ASD kid. Their anxiety is often very logical and well thought out, so combating it has to be as well. For us, personally, we actually handle his anxiety pretty much opposite from how I think you'd handle it with a non-ASD kid. We are very blunt and un-sympathetic to his anxieties (his are usually about abstract things like not making straight A's is going to mean he'll be homeless as an adult). We make straight-forward local arguments as to why he shouldn't be worried about whatever he's worried about and that seems to work a lot better than being sympathetic and understanding.

I think, if a child has ASD it needs to be taking into consideration whenever you are working with any ADHD or anxiety symptoms, but it doesn't always mean you should do anything different than you would with a neuro-typical child.

If you coddle irrational fears, you admit they're real. I'm with epoh. That therapist didn't know much about unreasonable anxiety.

We don't make authority threats, but we work through likelihood of things coming to pass (very helpful that DS understands statistics). We talk about thinking mistakes like "catastrophizing" or "overestimating."

Also: we sometimes look at the worst possible scenario, and make a plan for dealing with it. If you are quite sure you have a path forward even in the worst scenario, you know you're going to be okay. (I don't know if that would work for all kids, but it is a known CBT treatment.)

DeeDee

It was the neuropsych who actually confirmed my husband's idea to be firm with DS during his anxiety and meltdowns. The Neuro said because he's so intelligent you need to shut those things down or he'll use them to manipulate... to get out of situations he doesn't want to have to deal with, or work he doesn't want to do, whatever. Since we started being firm and blunt (and his teachers as well) his 'meltdowns' have basically disappeared!

I will say, he does take meds to help control his mood.. if he wasn't taking anything at all, I'm not sure we'd be as harsh/strict as we are, but we know his meds help keep the worst of the freaking out at bay, so his meltdowns are under his control.