Friday 18 October 2013

On Correlation Between Autism and ADHD

On Correlation Between Autism and ADHD


As a clinical psychologist, I am often faced with a dilemma when diagnosing children who display clusters of symptoms characteristic of both autism and attention-deficit hyperactivity disorder. Do these children suffer from two separate conditions, or can we view the ADHD symptoms as a byproduct of a more pervasive diagnosis of autism? Young children with autism have triple the rate of ADHD symptoms compared to normally developing children. In one study, researchers asked the parents of four-to-eight-year-old children with autism if they had symptoms of ADHD (e.g. if the children were able to wait their turn, if they interrupted others when they were speaking, if they could slow down when they needed to, etc.).  Of the children with autism, 29% showed signs of comorbid ADHD, all of whom were boys. These symptoms of hyperactivity and inattention can complicate treatment of autism, but the fact that autism and ADHD go hand-in-hand for some children is not surprising. According to Dr. Andrew Adesman, chief of pediatrics at Schneider Children's Hospital ,“Something that’s going to affect the brain and cause one developmental outcome may also cause a second developmental outcome.”

In another study, researchers compared children with high-functioning autism (accompanied or not by ADHD) with non-autistic children who had ADHD. They looked at different types of memory, learning, and behavior. They found that there were remarkable similarities between the children with high-functioning autism and those with ADHD. They had similar levels of working memory and memory in general. The two groups had similar problems in all three areas that were measured. This was surprising: The researchers expected the children with autism to be more impaired when it came to remembering tasks after a delay, and the children with ADHD to be more impaired in actually acquiring new knowledge.  Additionally, they were able to contradict some previous studies that found that only complicated tasks illustrated the working memory issues in high-functioning autistic children. In fact, no significant differences between the children with autism, those with ADHD, and neurotypical children were found when it came to visual working memory. Of course, the power of the findings of this study may be weakened by the fact that the group of autistic children was divided into two subgroups – those with symptoms consistent with ADHD and those without, and also because the groups were not equally weighted by gender. ADHD symptoms, as in typically developing children, tend to affect boys with autism more than girls. The researchers did not subdivide the group of typically developing children in a similar fashion because that group all had similar levels of attention deficits. In dividing up the autistic group, it was possible to look at the way autism interacts with ADHD, because some of the children had both sets of symptoms, and some only had one or the other. The group of children with high-functioning autism and ADHD symptoms had more serious issues in their verbal working memories than either of the other two groups, including the ADHD group. The researchers found this to be interesting, because it hints at an additive effect when it comes to attention problems and autism; Those with both sets of symptoms are more impaired than those with either one alone. This is not the first time that an additive effect has been found for autism and attention issues, however, as a similar effect has been found with deficits in inhibition. Another finding of the study is that attention deficits alone could not explain the difficulty which children with autism had in the acquisition of new information. That difficulty appears to be characteristic of autism, regardless of the child’s ability or inability to regulate their attention.

These findings necessitate the development of questionnaires and treatments specifically to measure ADHD symptoms in children with autism and then help them, because their problems and symptoms may differ from those of children who have ADHD alone. Additionally, they bring attention to the fact that those with autism and attention problems at a clinical level may have further difficulties with their verbal working memory and with their ability to recall information in general. This may help the parents of autistic children better understand the issues they are facing and provide more directed and relevant help. It also explains some of the other findings on children with high-functioning autism and attention, because it appears that this is a heterogeneous group, and there would be two findings for each of the two groups; combined results may be misleading. Future research should work on developing more specific questionnaires and tests to measure this pattern, and explore whether children with high-functioning autism can benefit from working memory training and how the symptoms of ADHD may complicate the efficacy of other special instruction the children are receiving, such as social skills training.

Author Bio: Dr. Tali Shenfield is a Clinical Psychologist and Director of Richmond Hill Psychology Center. She holds a PhD in Psychology from the University of Toronto and is a member of the College of Psychologists of Ontario, Canadian Register of Health Service Providers in Psychology, and Canadian Psychological Association. When she is not busy with psychological assessments and psychotherapy, Dr. Shenfield spends time on writing professional articles on parenting and psychology topics. You can follow her on Twitter at @DrShenfield.

Image Credit: http://www.flickr.com/photos/ebolasmallpox/2945610839

Tuesday 1 October 2013

On Learning Strategies for Children with Learning Disabilities

On Learning Strategies for Children with Learning Disabilities

Reprint of my article published by MedHelp.org on Sept 14th

As any parent knows, learning comes in many forms and from many sources. Each learning experience is as unique as the child participating in it. This applies to those with a learning disability as much as it does for typical children, and possibly even more so. There are a couple of theories pertaining to intelligence and learning that have special significance when applied to children who are known to learn differently in one or more areas. The first of these is Gardner’s theory of multiple intelligences, which postulates that there are many different types of intelligence. These include linguistic (good with words), logical-mathematical (good with math or logic), spatial (good with maps, art, and visualization), kinesthetic (good at dancing, sports, or crafts), musical (good with patterns, music, and identifying sounds), interpersonal (good at understanding others), intrapersonal (good at understanding themselves), and naturalistic (good at identifying and understanding animals and plants). To Gardner, intelligence is more than a standardized test score, which typically only measures linguistic and logical-mathematical proficiency, and while each child has the capacity to develop each of these intelligences, they may be especially talented in one or two areas.

            This idea is something that likely makes a lot of intuitive sense to you. In fact, while this theory has not had a lot of empirical evidence to back it up yet, many school systems accept the idea of multiple intelligences and are looking to encompass more types of intelligence in their classes. Think about it: While your child may have serious difficulty reading a book or doing algebra, they are good at baseball or soccer, playing the violin, drawing, or making friends. It is obvious that some children are better at some things, while others are gifted in other areas. This is the idea that Gardner captures in his theory of multiple intelligences – that intelligence is a process created out of a person’s biological, psychological, and social influences that can be activated to create products that are of value to a culture, whether that be a physical product or an intellectual one. Some of the reforms that this idea could prompt include increasing emphasis on nature, art, and music in the curriculum, developing a child-centered approach, and developing the child’s potential, rather than forcing all children to master the same information. Educators must find ways of instruction and teaching that work for each student, in order to maximize their learning potential.

            The second theory that is especially relevant to children with learning disabilities is the idea that people are not intelligent based on any specific innate characteristic, but rather on how well they learn the material and adapt to the instructional style at hand. People’s intelligence is not just because of their potential or talent. Intelligence relies on the learning style of the child, and there are five main variables that impact learning style. There is the environment, which consists of the amount of noise in the room, the light level, temperature, and seating arrangement. There are the emotional aspects of learning, such as motivation, persistence, responsibility and amount of structure. There are the sociological aspects, such as who the individual prefers to work with, and the perceptual-kinesthetic, such as whether they learn best by hearing, seeing, manipulating the material, reading, etc., and if they prefer to stay still or move while concentrating. Finally, there are the cognitive aspects, such as how long they need to process information, and how much detail they need to understand a new concept. Those who best match their learning environment to their personal learning style are most successful at processing and retaining new material.


            Of course,  it may not be reasonable to adhere to these approaches 100% of the time. In reality, teachers cannot work solely within a child’s intelligence, or there would be children who would do nothing but music or mathematics. Similarly, in a classroom of twenty or thirty children, the teacher will not be able to accommodate each child’s individual learning style all of the time. However, when it comes to children with learning disabilities, information about the child’s particular intelligences and learning styles may be incredibly useful. After all, a child may have a learning disability in one area and be well above average in another. For a child who has a hard time with math, but may be very musically intelligent, singing the multiplication tables may help them learn. Or a child who learns best working alone, in the morning, may be able to work on their most difficult subject then. Every child is unique, but for children with learning disabilities in particular, it is critical that the parents make sure that their child’s individual strengths and needs are being attended to in school to optimize their learning. 

Image Credit: Kirsten Skiles - http://www.flickr.com/photos/70269549@N00/2688559195