348. Differentiating ADHD & ASD, Part 2 w/ Dr. Caroline Buzanko
Feb 20, 2023
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Dr. Caroline Buzanko, psychologist specializing in differentiating ADHD from ASD, joins the host for an insightful discussion. They explore criterion B to differentiate between ADHD and Autism, discuss language patterns and repetitive behaviors, and highlight gender differences in autism. They emphasize the importance of observing individuals with ADHD, autism, and neurotypical individuals to gain a better understanding. They also discuss the constant thoughts and concerns autistic individuals have during conversations. A comprehensive assessment considering various factors is crucial for individual success.
Take a trans-diagnostic approach when assessing for autism and ADHD, considering factors such as cognition, behavior, language, adaptive functioning, motor skills, sensory processing, trauma history, and family history.
Focus on understanding the child's strengths, differences, and areas for growth, rather than solely obtaining a fixed diagnosis.
Compare neurotypical girls, neurotypical boys, and autistic girls to distinguish between autism and ADHD, while understanding the wide range of presentations within both spectrums.
Consider gender differences in autism and ADHD, but be cautious in generalizing, as both boys and girls have different brain structures and sensory issues can be present in both conditions.
Deep dives
Main Ideas/Key Points/Insights 1
It is important to avoid diagnostic overshadowing and substitution, and to take a trans-diagnostic approach when assessing for autism and ADHD. Assessments should look at a wide range of factors, including cognition, behavior, language, adaptive functioning, motor skills, sensory processing, trauma history, and family history. It is crucial to evaluate the lived experiences of the individual and look for patterns of differences from typical development.
Main Ideas/Key Points/Insights 2
Assessment should not focus solely on getting a fixed diagnosis, but on understanding the child's strengths, differences, and areas for growth. It is important to approach the assessment with an open mind and avoid confirmation bias. Gathering information from infancy can provide valuable insights, as it allows us to observe behaviors and characteristics before masking and coping strategies are developed.
Main Ideas/Key Points/Insights 3
Comparison between neurotypical girls, neurotypical boys, and autistic girls is essential, as it helps distinguish between autism and ADHD. It is important to avoid comparing autistic individuals to a single fixed diagnostic profile, but to understand the wide range of presentations within the autism and ADHD spectrums. Assessment should look beyond symptom counts and focus on the overall developmental profile and impairment in everyday functioning.
Main Ideas/Key Points/Insights 4
Gender differences in autism and ADHD should be considered, but we should be cautious in generalizing these differences, as both boys and girls have different brain structures. While boys tend to show more behavioral symptoms, girls may camouflage and mask their autistic traits. Sensory processing challenges should not be used as a definitive indicator of autism, as ADHD can also present with sensory issues.
Assessment Process and Preparation
When conducting assessments for ADHD and autism, it is important to gather historical data on eye contact and engagement through videos and pictures from the child's early years. Prepping parents for the interview process helps them understand what the clinician will be looking for. Giving parents homework, such as observing their child's behavior in different situations, can provide valuable clues. Noting how the child behaves in varying social settings and under different demands is crucial. Cognitive testing often shows positive results in children with ADHD, while social skills may deteriorate during playdates with same-age peers.
Assessment Tools and Challenges
Using assessment tools necessitates caution in interpreting scores and considering individual items rather than relying solely on the overall score. Rating scales for ADHD and autism should be used strategically to avoid false positives and to assess personal experiences. Tools like the Autism Quotient, CAT-Q, Atwood's Girls Questionnaire, and RADS can offer valuable insights. Behavioral observations involving optical illusions and complex social pictures can reveal specific challenges related to context processing and social communication. Prognosis should be discussed cautiously, basing it on supportive environments and individual strengths rather than making definitive predictions.
Feedback, Recommendations, and Qualitative Focus
When delivering feedback to parents, it is crucial to convey information throughout the process rather than overwhelming them at the end. Understanding parents' stories and using them to explain their child's experiences is vital in helping them comprehend their child's diagnosis. However, predicting outcomes and future success presents challenges and should focus on optimizing support based on each child's strengths. Qualitative information gleaned from interviews and observations reveals valuable insights that cannot be solely determined through symptom counts. Looking for spontaneous behaviors, personal experiences, and behind-the-mask perspectives aids in accurate interpretation and effective recommendations.
