Comorbidity.

Tootles does not respond on the first try of getting his attention.  Or the second, third or fourth try.  This is not an exaggeration.  This is our reality.  It is a core component of his autism.

It is also the core component of something else.  Something called Attention Deficit Hyperactivity Disorder (ADHD) or Attention Deficit Disorder (ADD).  I have seen these words mentioned in autism blogs here and there.  I never paid much attention to those posts because, hey, that’s not my kid.

He doesn’t run like he’s on a rev’d up motor.  Wait – yes he does.

Well, that’s just one thing.

His teachers don’t complain about his inability to pay attention in the classroom setting or his getting up during sitting time.  Um – I mean, yeah, I guess they do…

Well, wow.  He’s not fidgety or squirming in his seat all the time.  Maybe just 90 percent of it.  Okay – 95 percent.

He doesn’t always have difficulty playing quietly.  Except that I seem to say “What?” a lot to others when he is with me because I can’t hear them over him…

Whatdoyamean is he difficult to control in shopping situations?  Aren’t all kids?  What you mean every child does not yell “fire truck!” in the coffee house line?  Oh.

We all have difficulty waiting our turns and sure, he interrupts conversations I’m having with others, almost all the time… I didn’t think that was really any big deal.

He doesn’t have that much of a short attention span.  I just have to regain it with each and every task and instruction and comment…

Okay, maybe I should have been paying more attention to the ADHD/ADD stuff I saw posted before.

The things I have just listed above are all signs and symptoms of ADHD/ADD.  You can take a short quiz about it online here.

According to the DSM IV(current not the V with all the hoopla over the new definition of autism) ADHD is only diagnosed when “the symptoms do not occur exclusively during the course of a pervasive developmental disorder, schizophrenia or other psychotic disorder etc.”  Technically, then, when a child has already been diagnosed with a PDD – autism – he cannot simultaneously be diagnosed with ADHD.  But guess what?  ADHD/ADD is also considered a comorbid condition.  That means it is often present when autism is present.  Reconcile that without exploding your brain.  Maybe that is why we parents don’t talk much about it  – because it doesn’t get mentioned when we already have the autism diagnosis.  It’s not supposed to be.

Yes, I’ve heard it all.  We’re overmedicating our kids.  We’re looking at fad diagnoses.  That is not what this post is about.  This post is about recognizing what may be there instead of ignoring it.  How one chooses to treat what is diagnosed is a personal decision.

Because I’ve been thinking about T’s lack of focus as I posted yesterday, I had a long discussion with his EIBT behaviorist.  I wanted to know about programs to sharpen focus.  The first thing he raised to me was the ADHD connection.  He suggested that I get T tested.  He wasn’t trying to do anything nefarious.  I truly trust him and have known him for a long time.  He also agreed to implement programs designed specifically to hone and sharpen those responsive skills as well.

Fish attention - 30 seconds...

Yesterday, we visited our neurologist’s office.  In the lobby waiting room, he could not sit still.  He watched fish in a tank for 30 seconds, hid behind a couch for 15 seconds, circled a pole for a minute, walked the lobby… etc.

Child blurs hides behind furniture...

We went into the examining room.  In walked our nurse-practitioner.  T ran to stand behind her as she typed into a keyboard.  He was trying to use her keyboard and mouse.  When I called him off of that, he crouched down behind her.  She was sitting in a typical office chair.

Easy enough to remove the back of this chair.

As she and I discussed what led me to believe he might have ADHD/ADD, he flitted about the room.  He tried to turn on the water to the faucet.  He ran to the bed and then crouched back down behind her.  He then managed to unscrew her chair back and it fell to the floor.  This was all within about 60 seconds.  It was pretty clear why I was there, even if I never spoke a word.

I was in the right place.

For the right reason.

And yesterday, I learned the DMS IV was wrong.  My child does have autism.  He also has ADHD.  Now, we’ll have to treat it, if we can.  To be continued…

Ring around the pole in the lobby.

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About solodialogue

I'm a lawyer and the mom of a 6 year old boy with autism. I work part time and spend the rest driving here and there and everywhere for my son's various therapies. Instead of trying cases, I now play Pac-man and watch SpongeBob. I wear old sweaters and jeans and always, always flat shoes to run after my son. Yeah, it's different but I wouldn't change it for anything. The love of my child is the most powerful, beautiful and rewarding aspect of my life.
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24 Responses to Comorbidity.

  1. Julie says:

    The description of the fish tank was Dylan… not now. We started him on ADHD medication and what a difference.

    Before meds… he never sat still for more than a few seconds, his sensory needs just could not be met (his OT said if we could mainline sensory input into him she didn’t think it would be enough for him), he rarely started a conversation, he only gave one word answers to questions, couldn’t read, didn’t know all his letters and couldn’t recognize numbers past 10. Before meds, the world was flying by him and he was too busy to notice anything.

    After meds… he sat for 45 minutes while making wraping paper for a gift he made us in school, his sensory needs are so low that we didn’t qualify for an SPD study we were asked to participate in, he starts intelligent conversations with both adults and his peers, he give full answers to questions. He’s starting to read, knows all his letters both upper and lower case, is recognizing larger numbers. The first day he took ADHD medication, it became quite apparent that the world was on fast forward and the drugs hit pause for him. He was noticing things that he had never noticed before that were a constant in his environment. It has been an amazing process.

    • solodialogue says:

      I love hearing from you Julie. You are just a little ahead of us and it is really great to learn how Dylan is doing and what you are doing for him because a lot of the time, I feel like we are walking in your footsteps. T does give one word answers if he can’t get away with ignoring the question totally. We don’t have the trouble with letters and numbers but he seems to be flying by the world – rather than vice versa.

      It’s interesting how quickly he was able to grasp so much more of the world. Thank you for sharing. 🙂

  2. Kelly Hafer says:

    Hi Karen – we have the whole ADHD thing going on, too. Of course, we also have ODD, anxiety and God only knows what else. I never thought I would have a child on medication, yet now I have one who is on three: Abilify, Concerta (time-release Ritalin) and Celexa. And STILL my child cannot function in a way in which we can be confident that he is not a danger to himself or others – certainly property is destroyed on a nearly daily basis. It is sad that we have to medicate, but we need to survive this, too. At least, that’s my motto.

    • solodialogue says:

      I wondered about Ted and even searched to see if you had something in your “About” section that discussed the diagnoses because I thought he was going to fit right into Tootles’ ADD diagnosis too. I’ve been following and I love what Papa Bear has told you both on his blog and yours about the meds. I’m praying that you find the answers that fit Ted and I have confidence that you will eventually get there. What choice is there but to keep traveling down the road to the future? xoxo

  3. kcunning says:

    Good call on going to a neurologist.

    The reason many kids are over-medicated is because pediatricians, those docs that think they can cure just about anything with a pat on the head*, are often the ones writing the prescription. ADD and ADHD need to be diagnosed and treated by a specialist. If the doctor decides to prescribe a psychotropic (not always a given for every case), it needs to be carefully monitored and adjusted as the child grows, and paired with effective therapy.

    Also, blech on the DSM-whatever. Most of my psych profs rolled their eyes whenever a student brought it up.

    * Why, yes, I have had some knock-down arguments with a patronizing pediatrician in my time! How did you know?

    • solodialogue says:

      I’m with you on the blech to the DSM-whatever!! And yes, the pediatric neurologist who has seen us through so much is in our corner. We shall see if “knowing” makes a difference.

  4. Ahhhh…. comorbidity. Isn’t it just the cat’s pajamas? Our life with Little Miss has been one continuing lesson in comorbidity… and she seems to just keep coming up with new and more exciting things for us (we’re looking an an ADHD eval in March as well).

    I pray for strength for you and your husband through this process and know that you will come to the right decision for T and possible medications. You are good parents and T is a very lucky boy to have two people who are so in tune with his personality!

  5. blogginglily says:

    With Lily, the Psychologist said to repeat after three seconds. I have to constantly remind myself to count to three before repeating a request. OFTEN (for example, in the bath last night) I find that Lily will comply or listen after the second request RIGHT when I’m about to request again.

    “Lily stand up please.” I tell her to stand and forget to count.
    “Lily, please stand up.” This time I remember and count to three. One thousand one – one thousand two – One thousand th- and she stands.

    If you feel like it, try internally counting to three after each request and see if you have better luck with the delayed response than you do now. Maybe you already do that. Lily is diagnosed ADHD, btw.

    • Lana Rush says:

      My Lily’s therapists say the same thing. Too often, I forget to allow her time to process my request. It appears she didn’t hear me but her brain just takes a little longer to hear the request, absorb the information and then carry it out. When she wants to, that is….

    • solodialogue says:

      I so know exactly what you are saying. I do wait. And then wait. And then as I open my mouth, he responds. Looks like a lot of us know that “comorbidity” word pretty well now…

      • Broot says:

        This little bit is interesting because we are taught at my work that it takes 15 seconds for a brain to acknowledge it has been asked a question, 15 seconds to consider the question, and 15 seconds to formulate a response.

  6. Jen says:

    We went through this with K at around the same age. Her hyperness and attention issues were pretty bad. We tried a non stimulant drug, but it made K rage, and we have been told stimulant meds are not a good fit with kids on the spectrum. As she has gotten older, things have settled and I noticed her inattention was more of a foggy state than add, and her hyperness is more stimmy/sensory. I only realized this bc Ben is the poster child for ADHD and how he is, is so much different. I can look at him and see ADHD and look at K and see how it’s her autism. The drs we see here don’t seem to believe in co-morbidity when it comes to autism, either, and people seem to be split. Of course, this is just our experience and god knows I generally have no idea what I am talking about…ha. Hopefully you find something that does work for him!

    • solodialogue says:

      Thanks Jen. I wondered about the differences between boys and girls on the spectrum. When medication was discussed with us, our neurologist prefers stimulants for high functioning kids with low aggression and other drugs for kids who manifest aggression to “slow them down”. For T, I see inattention to the outside world because he is deep in thought about something else and less of a foggy state – although occasionally, I will see fog and wonder if that is an absence seizure. The sure “tell” for the ADHD for T came when he actually unscrewed the chair back in less than 60 seconds and it fell to the floor. That was a pretty comical moment…

  7. Lana Rush says:

    Your visit to the neuro sounds just like every doctor visit I’ve ever been to with Lily. In fact, if it’s an appointment that’s going to be mostly talking and if I’m planning on hearing anything at all, I drag my husband with me so one of us has “Lily duty” and the other can coherently communicate with the doctor and absorb the information. It’s simply astounding how much havoc a 5 year old can wreak in a short amount of time. I’m almost 100% sure that Lily has ADHD. In fact, I’m not sure that that diagnosis wouldn’t be more accurate than the autism diagnosis. Your last two posts are making me think it’s time to get this checked out. Sigh….

    • solodialogue says:

      It’s funny you say that because usually, I have a back up at the doctor appointments too because someone has to have “T” duty so we can understand what the doctor is saying. This one I did solo. Click the link and take that short test. You’ll know…

  8. akbutler says:

    so yes, yes, yes, and yes to all of it for my 5 year old too. a few weeks ago at his developmental appointment, she told us we’d probably be looking at an ADD diagnosis coming too, and to do a neuropsych appt next year (since he had just gone through a whole battery of testing through school she wanted to wait). She reminded us that ADD isn’t about deficit of attention, but more about hyperfocus of attention to the detriment of other things. And yes, that’s my kid.
    Up until this weekend, I would have said hold off to meds for my kid. But if he needs it to help him cope with his world, then it might be the way for us to go.
    Comorbidity. A long word with a lot of heavy meaning. Right there with you.

    • solodialogue says:

      We do all have something in common here, don’t we? Each child is individual but they are united in this. How each of us deals with knowing that diagnosis is a personal thing. Since we are new on this path, I’m going to wait to talk about treatment. Thus, the “to be continued”. I don’t know enough yet to talk about it.

  9. Pingback: Almost Wordless Wednesday. | Solodialogue

  10. You’re so right that our sons are similar in how they have a lot of the ADHD symptoms. I have resisted getting my son tested because I don’t know/see how a diagnosis will help him. I guess it would force his teachers to make accommodations for him but right now (as you know) the teacher he has is working with us even without a diagnosis or an IEP. We’re not interested in medication (at this time) so I don’t see the rush to make it official. Not to mention that I’m tired of going to the doctors. We go a lot with my younger son. Is that bad parenting? Maybe in the summer I’ll get my older son tested. I’m sure it’s a matter of time before the school will require it.

  11. Lisa says:

    My son also has Autism and ADHD, even though the neuropsych wouldn’t co-diagnose, our report states the clinical nature of Tate’s ADHD, and we were referred to a pediatric psychiatrist. We tried a lot of therapy first, and ultimately medicated for the attention/focus. We have seen significant improvement with meds. Good luck!

  12. Flannery says:

    I don’t care what the DSM says, I live this every day.

    Connor’s ADHD is bad. I remember vividly, our first doctor appointment after he started medication. It was at the OT’s office (privately paid – not through school). We got there a few minutes early, and I sat down to wait. After a couple of minutes I started crying. I realized that I had not sat down in a waiting room since Connor could walk. Not ever. He was always on the move, into things, opening doors, etc. I had to be up and right behind him constantly, to keep him out of trouble. But now, he was playing quietly with the toys in the waiting room.

    Perspective, that’s what it gave me. If you do end up choosing to try medication, you may very well find yourself coming unhinged, as you get a glimpse of your child behaving normally, and not bouncing everywhere. I can’t imagine what it must feel like to be them, to not be able to stop yourself.

  13. eof737 says:

    Yu are being proactive for your child and that is what matters. Damn the opinions of naysayers. Please keep us posted. 🙂

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