Geraldine Dawson, PhD, Professor of Psychiatry in Behavioral Sciences and Director of the Duke Center for Autism and Brain Development, Duke University, talks about the link between ADHD and Autism.
Interview conducted by Ivanhoe Broadcast News in October 2017.
When we hear of autism and we hear of ADHD, a lot of people we feel they are just two separate conditions in their own world and that one that does not affect the other; but that is not the case, is it?
Dawson: No, actually forty to sixty percent of children with autism also have Attention Deficient Hyperactivity Disorder or ADHD. We do not really understand why it is that these two very common childhood conditions overlap so frequently, but what we do know is that when children have both autism and ADHD, they often struggle; and they have more difficult outcomes. We want understand the connection and develop better methods of early detection and also treatment.
Where would you say Dr. Dawson do the challenges lie? Maybe you should define ADHD for people who do not know exactly what that is, and if our children are more apt to be diagnose with autism earlier; or the ADHD earlier then does that cause a problem determining the other?
Dawson: Well what we know from previous research is that if you are a child with autism who also has ADHD you are less likely to get a diagnosis of autism. In fact, those children are thirty times more likely to be diagnosed with autism after age six. Now what that means is that they are missing out on these very important early years when we know that early behavioral intervention is so important for improving kids’ outcomes.
Is that what your study here at Duke, which received a very big grant from the National Institutes of Health, is that what you guys are trying to determine, what is the exact goal of the study?
Dawson: There are three goals of this project; one goal is focused on early detection. Because we know that when children with autism also have ADHD, there are more likely to be missed, we want to understand why. We are going to be following close to 9,000 children from the community as they enter into the primary care here at Duke, and providing early screening, and then following them longitudinally, and some of those children will have autism, some will have autism plus ADHD and some will have ADHD only. Then we are going to look backwards and try to understand what were those early symptoms that distinguished kids in those different groups.
Talk to us about the symptoms that parents may be seeing and how early on would they be seeing these symptoms for both?
Dawson: Autism mostly affects how we relate to other people and we know that, when a young toddler is developing autism, the child is much less likely to pay attention to people, to make eye contact, and to be noticing social cues; ADHD, on the other hand, is more of a general problem with paying attention to all kinds of information, to be able to sustain your attention when you are engaged in an activity. So both conditions affect the way we pay attention to the environment. When they are combined together, the child is not able to pay attention to important information in the environment, which we know is critical for social development and cognitive development
So this is stressful to begin with for these parents but this can be very stressful for the parent to deal with both conditions with their child and I guess really to maintain daily life?
Dawson: One of the projects that we are going to be conducting will help us to understand how ADHD affects the ability of the child with autism to engage in a behavioral intervention. We know that early intervention is so important for children with autism and early intervention requires that you are paying attention to other people. That is how we provide intervention. When a child with autism has ADHD, is the child able to engage in behavioral intervention in the same way that a child with autism who does not have ADHD does? We are interested in whether the ADHD is affecting how kids benefit from a well validated early intervention. We plan to assess whether treating the ADHD symptoms will allow the child with autism to better benefit from early intervention.
The ADHD has to be recognized and treated first before they can benefit from any autism therapy intervention in a sense?
Dawson: That is the theory that we are testing, that one of the reasons why children who have both autism and ADHD are having poorer outcomes is because they cannot benefit from early intervention in the same way; that their attention problems are getting in the way of their ability to engage in early intervention. The question we will address is, if we can treat those ADHD symptoms, can we help children engage in behavioral intervention and then have better outcomes.
The therapies or treatments for these kids; are we talking medication and therapy or what are we talking about?
Dawson: We are going to carry out a study in which all children will be provided with early behavioral intervention. Parents will be provided with coaching in a model called, The Early Start Denver Model, which my colleague, Sally Rogers, and I developed. This is an intervention that involves teaching parents how to use strategies throughout their daily life that helps children with autism socially engage with other people and to develop language and play skills. Half of the children in the study will also receive a medication that helps with their ADHD symptoms, and we want to find out whether that combination of behavioral intervention with the medication that addresses the ADHD symptoms will allow kids to better respond to the early behavioral intervention.
Does it affect one gender more than the other?
Dawson: In both conditions boys are more commonly affected then girls. However, we are learning in the area of autism that perhaps we are missing girls. Recent research finds that girls may show milder symptoms, or at least their symptoms are not as noticeable. So we still do not know whether this preponderance of boys is because there are actually more boys, or because we have just been missing more signs in girls; but currently, we do know that many more boys are diagnosed with autism than girls.
Is there hope that these children can grow to be happy and productive?
Dawson: Currently, what we know is if a child has both autism and ADHD, their outcomes are likely to be worse than a child with autism alone. They are more likely to struggle in school and have trouble developing friendships. Our program of research will focus on very early detection and early intervention, including both behavioral interventions, as well as a medication. Our goal is to improve kids’ outcomes. And we are very hopeful that by finding these kids early and providing the best intervention we can, they will be able to really flourish and develop those friendships and do well in school.
And if you are a parent Dr. Dawson, you suspect something is going on with your child and you do not know exactly, but if you hear this story and you think possibly one or the other or both, what should you do?
Dawson: If you are a parent and you are noticing that your child might have symptoms of autism and that means that your toddler or preschooler is not paying attention to people or developing social relationships, perhaps having a delay in their language development, or showing symptoms of ADHD, which includes having difficulties in sustaining your attention, and having trouble staying seated, perhaps being overly active, we really encourage you to participate in the study or talk to your pediatrician so you can make sure to get your child the help they need.
If your family is not in this area is it possible to become part of the study?
Dawson: We will be recruiting kids from North Carolina, as well as all the adjoining states and if people are interested in being part of the study we suggest that they check our website, The Duke Center for Autism and Brain Development, or contact us directly by calling 888-691-1062 or emailing us at autismresearch@dm.duke.edu .
END OF INTERVIEW
This information is intended for additional research purposes only. It is not to be used as a prescription or advice from Ivanhoe Broadcast News, Inc. or any medical professional interviewed. Ivanhoe Broadcast News, Inc. assumes no responsibility for the depth or accuracy of physician statements. Procedures or medicines apply to different people and medical factors; always consult your physician on medical matters.
If you would like more information, please contact:
Samiha Khanna
Geraldine Dawson
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