Autism Spectrum Disorder (ASD) is a complex condition requiring multidisciplinary support that is specific to the person. This is particularly true given that ASD often presents alongside other neurodevelopmental conditions, sometimes referred to as “co-occurring” conditions. Due to the confusion surrounding different diagnoses, those that occur alongside ASD can sometimes go unidentified.
It is therefore important to have an understanding of what these related co-occurring conditions are – including ADHD, dyslexia and dyspraxia – which is what the following article intends to provide. Though this article gives information regarding different symptoms across different conditions, it is important to remember that presentation can vary widely between different people, and we are constantly learn more about these conditions through research.
Autism Spectrum Disorder (ASD)
ASD is a lifelong neurodevelopmental condition characterised by differences in social and communication skills, as well as in ways of thinking and in patterns of behaviour and interests. The term “spectrum” is used because autism is a highly diverse condition encompassing a broad range of skills and difficulties – the presentation of ASD can vary between individuals and the severity of the difficulties faced may also differ.
Diagnosis of ASD in the UK is commonly based on the International Classification of Diseases1 (ICD-11), though the Diagnostic and Statistical Manual of Mental Disorders2 (DSM-5) is also used widely. Diagnosis of ASD involves a detailed and person-centred assessment with a professional to determine if difficulties fit the relevant criteria, but some of the more common signs of ASD are described here.
Difficulties with social communication & interaction
Nonverbal and verbal communication are common challenges associated with ASD, such as having difficulties understanding social cues, other people’s feelings, or expressing their own emotions. There is significant diversity in how these show up, ranging from spontaneous social approaches (with poor understanding of social rules) to avoidant behaviour with little evidence of social interest. Relatedly, individuals with ASD might have difficulties engaging in social activities with peers, colleagues or family members, and sometimes in making connections with others.
Interacting socially relies on the coordinated effort of many complex skills including the ability to recognise, identify, plan, and respond appropriately to constantly changing social and emotional information3. Interpreting other people’s verbal and non-verbal communication can be particularly difficult for those affected by ASD3 e.g. facial expressions, gestures, and patterns of stress and intonation in speech. Relatedly, these individuals may show significant anxiety in social contexts, especially if they become aware of their challenges engaging with others4.
Please refer to our blog for additional information regarding challenges related to social communication and interaction.
And understand how therapeutic play can support social difficulties:
There is also the option to schedule a session with a play therapist for tailored support and coaching:
Developmental delays
Individuals with ASD may reach the common developmental milestones later than average, such as having delayed speech5 or not showing facial expressions or responding to their name by 9 months of age6.
Interestingly however, some individuals with ASD are able to hide or overcome some developmental delays, which can make these milestones problematic as a prompt for diagnosis. It is also important to remember that whilst missing developmental milestones can be an early indicator of ASD, there are also many other reasons why this might happen7.
Restrictive and repetitive behaviours or interests
Individuals with ASD may engage in restrictive and repetitive behaviours, which might be both verbal or nonverbal e.g. displaying repetitive physical body movements, use of objects, or spoken phrases.
Insistence on sameness is a common characteristic of ASD, where a strong preference for sameness in their daily routines can result in inflexible and almost ritualistic behaviours. Examples of this include:
- insistence on wearing the same clothing
- taking the same routes, and
- following exact routines8
Disruption or change to these patterns could be a specific trigger for anxiety9.
Intense interest and preoccupation with a narrow range of topics can also be apparent (known as “circumscribed interests”). These can be a source of great pleasure and engaging in these subjects can have rewarding value for individuals with ASD10. Some people with ASD may therefore have in-depth knowledge and attention to detail in certain areas where their attention is peaked, and great relevant skills.
Kindly consult our article The benefits of breathing technniques for further guidance and support in addressing elevated anxiety levels. And, the option is available to book a session with a mindfulness coach to help reduce stress and anxiety:
Sensory sensitivities
Many people with ASD experience either heightened or reduced sensitivity to external sensory inputs, meaning that they take in either too much or too little information from the environment around them11. This means may mean they are either be bothered or intrigued by certain:
- sounds
- temperatures
- textures
- tastes
- smells
- lights
- colours
For example they might avoid noises or make vocal sounds to block them out, or may be fascinated with reflections and bright coloured objects. Similarly, there seem to be some differences in sensitivity to internal bodily signals presented in ASD too. This body awareness, sometimes called interoception, relates to how an individual’s interprets their own subjective wellbeing e.g:
- feelings of thirst
- hunger
- temperature
- satiety
- heartbeat
- pain
- itchiness
Studies have suggested that individuals with ASD are able to sustain attention to internal cues over longer durations12 or even misinterpret or overlook these internal cues (showing lower body and thirst awareness for example13) – research is still building to gain a clearer understanding of this area of ASD.
Discover what occupational therapy is and how it can help you or your child cope with sensory challenges:
Alternatively, for personalised support for sensory processing training or therapy sessions, please contact our sensory OT:
Attention Deficit Hyperactivity Disorder (ADHD)
ADHD is one of the most common neurodevelopmental conditions in school-aged children with the essential features being a persistent pattern of inattention and/or hyperactivity and impulsivity at more severe degree than in typically developing children2. Depending on the primary symptoms and behaviours they exhibit, ADHD is generally classified into 3 different presentations (previously known as the different subtypes of ADHD) under the DSM-5 diagnosis2. These are predominately Inattentive, Hyperactive-Impulsive, or Combined (which meets the criteria for both presentations).
One of the most common inattentive symptoms are difficulties concentrating and narrowing attention, and being easily distracted or frequently jumping from one task to another. Hyperactive-Impulsive symptoms might include:
- difficulty waiting/taking turns
- interrupting others and blurting out
- talking or moving excessively
- squirming whilst sitting and other signs of restlessness.
Although ADHD can present itself in different ways, its features are also commonly associated with behavioural and academic difficulties14, with the relevant behaviours interrupting their education e.g. making careless mistakes, appearing unable to listen to or carry out instructions, and excessive chatting or fidgeting15.
ADHD is better recognised amongst children, more recently concentration has shifted to recognise its presentation in adults as well. Although attentional difficulties remain the most prominently reported feature of adult ADHD16, other problems are apparent when tasks being carried out involve other advanced mental processes (known as executive function). For example, compared with other individuals, adults with ADHD have challenges in:
- organising work
- regulating emotions
- managing interpersonal relationships
- show difficulties relating to working memory, switching between tasks and inhibitory control17,18,19
It is not unusual for ADHD and ASD to be mistaken for the other as both conditions may involve trouble with focus and communication in certain situations. Moreover, the symptoms of ADHD can be masked by more prominent or noticeable ASD symptoms which complicates the diagnostic process further. Research suggests that between 30 and 50% of individuals with ASD showed ADHD symptoms, and two-thirds of individuals with ADHD showed features of ASD20,21. Although these conditions have similarities and overlaps, they are still regarded as distinct conditions.
Learn how what you eat can positively or negatively impact mood and behaviour challenges, in our blog post written by the world renowned Dr Alex Richardson:
Or, if you require individual support, schedule a session with one of our registered nutritionists to help support dietary changes to improve wellbeing:
Dyspraxia
Dyspraxia, also known as developmental co-ordination disorder (DCD), is a common and complex neurodevelopmental condition which affects movement and co-ordination2. Individuals with dyspraxia most commonly have difficulty planning and organising the correct sequences of movements in order to perform a given task. Importantly, for a diagnosis of dyspraxia the difficulties with motor proficiency must not be better explained by other neurological conditions that affect movement, such as cerebral palsy or muscular dystrophy, nor by an intellectual disability.
Signs of this condition are present from a young age, such as feeding difficulties or delayed average motor milestones (like sitting-up and walking), but indicators of dyspraxia might not be recognised until a child begins school or even later.
Tasks that require balance or spatial awareness, such as playing sports or navigation, might be difficult for individuals with dyspraxia, and activities requiring gross motor skills are often impacted too e.g. jumping or running.
One’s ability to make movements using the small muscles in the hands and wrists (fine motor skills) is also often reduced, affecting the ability to grasp small objects and do things like drawing and typing.
Individuals with dyspraxia can also experience affected articulation and persistent difficulty coordinating the precise movements required to produce clear speech22.
As demonstrated through these examples, dyspraxia interferes with the performance of daily life activities, academic/school-based activities, leisure and play, and these challenges do persist beyond childhood in most cases23. Children with dyspraxia may move more clumsily and not perform as well as others their age in certain activities, whilst adults might show difficulties carrying out daily living chores like getting dressed or preparing meals.
As is the case with ASD, dyspraxia is associated with a range of physical24, psychosocial and mental health problems25,26. Many people with dyspraxia have trouble organising themselves and their thoughts, and some with memory, processing speed and time management too.
Dyspraxia is also associated with learning difficulties such as with reading, social skills and inattention27, again demonstrating this overlap with symptoms of other neurodevelopmental conditions. Research also suggests that dyspraxia can include problems with visual, tactile and auditory perception, as well as issues with body awareness28.
Dyslexia
Dyslexia is a learning difficulty that mainly causes problems with reading and writing abilities, and is estimated to affect 5-10% of the population in the UK29. It can present as issues with accurate or fluent word reading, poor decoding, and poor spelling that must have persisted for at least 6 months, despite the provision of relevant interventions2.
Difficulties in phonological processing often results in problems when breaking words down into their component sounds, and in reassembling the parts in order to read/spell them. However, more broadly than this, individuals with dyslexia may have difficulty with putting sentences together correctly and in understanding information that is written down.
Signs of dyslexia usually become apparent when a child begins school and starts focusing on learning how to read and write, perhaps through:
- poor or inconsistent spelling
- slow reading/writing speed
- confusion regarding the ordering of or specific letters e.g. writing letters the wrong way round such as “b” and “d”
From a social perspective, dyslexia can also present difficulties in communicating and participating in activities that require reading and writing. By affecting someone’s ability to read fluently, spell accurately, and comprehend written material, dyslexia can also hinder academic success for individuals without sufficient support in place. It seems, however, that most students with dyslexia may be able to compensate for their reading problems and can achieve at a normal rate of study30.
Our understanding of dyslexia has extended, beyond being principally a reading difficulty, to encompass wider information processing difficulties, particularly with working memory. Working memory is the part of the memory system that allows us to temporarily store an impression of sensory information (such as sights or sounds) for short period of time after it has gone, but also allows us to mentally work on this information. Good working memory is needed for reading and spelling well, because the person needs to hold the information “in their head” to take apart and analyse sounds in words, but it is relevant to other skills too. The main memory-related difficulties which an adult with dyslexia report are in:
- listening skills
- note-taking
- speaking and writing succinctly
- time management
- organisational skills31
Relatedly, poorly organised written work, and trouble planning, writing and meeting deadlines for essays, letters or work reports are seen in some older individuals with dyslexia. Notably, however, despite sometimes being challenged by these sorts of tasks, people with dyslexia often have great skills in a range of other areas, for example in logical or creative thinking, design and problem solving.
For further information we highly recommend reading Dyslexia Guidance, by Martin Turner and Philippa Bodien which provides practical support with learning difficulties in reading and writing.
For further information and advice please see our ‘Support and Strategies’ pages:
Disclaimer – This summary is for insight and educational purposes. Identifying with any symptoms or behaviours mentioned should not be taken as a substitute for a formal or clinical diagnosis of these complex conditions – please talk to a qualified health professional or GP if you are seeking a diagnosis or specific ASD, ADHD, dyslexia or dyspraxia support. It is also important to remember that every individual is unique, and a diagnosis alone is also not an adequate basis on which to determine an individual’s potential, abilities or needs.
References
1. World Health Organization, 2019. ICD-11 for Mortality and Morbidity Statistics.
2. American Psychiatric Association, 2013. Diagnostic and Statistical Manual of Mental Disorders: DSM-5. 5th ed. Arlington, VA, USA. American Psychiatric Publishing Inc.
3. Corbett, B.A., Qualls, L.R., Valencia, B., Fecteau, S.M. and Swain, D.M., 2014. Peer-mediated theatrical engagement for improving reciprocal social interaction in autism spectrum disorder. Frontiers in Pediatrics, 2, p.110.
4. Briot, K., Jean, F., Jouni, A., Geoffray, M.M., Ly-Le Moal, M., Umbricht, D., Chatham, C., Murtagh, L., Delorme, R., Bouvard, M. and Leboyer, M., 2020. Social anxiety in children and adolescents with autism spectrum disorders contribute to impairments in social communication and social motivation. Frontiers in psychiatry, 11, p.710.
5. Nitzan, T., Koller, J., Ilan, M., Faroy, M., Michaelovski, A., Menashe, I., Meiri, G. and Dinstein, I., 2022. The Importance of Language Delays as an Early Indicator of Subsequent ASD Diagnosis in Public Healthcare Settings. Journal of Autism and Developmental Disorders, 1-10.
6. Miller, M., Iosif, A.M., Hill, M., Young, G.S., Schwichtenberg, A.J., & Ozonoff, S. 2017. Response to name in infants developing autism spectrum disorder: a prospective study. The Journal of Pediatrics, 183, 141–146.
7. Centers for Disease Control and Prevention (CDC). Child development basics: healthy development. https://www.cdc.gov/ncbddd/childdevelopment/facts.html
8. Bishop, S.L., Hus, V., Duncan, A., Huerta, M., Gotham, K., Pickles, A., Kreiger, A., Buja, A., Lund, S. and Lord, C., 2013. Subcategories of restricted and repetitive behaviors in children with autism spectrum disorders. Journal of Autism and Developmental Disorders, 43, 1287-1297.
9. Ozsivadjian, A., Knott, F. and Magiati, I., 2012. Parent and child perspectives on the nature of anxiety in children and young people with autism spectrum disorders: A focus group study. Autism, 16(2),107-121.
10. Sasson, N.J., Dichter, G.S. and Bodfish, J.W., 2012. Affective Responses by Adults with Autism Are Reduced to Social Images but Elevated to Images Related to Circumscribed Interests. PLoS ONE, 7(8), 42457.
11. Ben-Sasson, A., Gal, E., Fluss, R., Katz-Zetler, N. and Cermak, S.A., 2019. Update of a meta-analysis of sensory symptoms in ASD: A new decade of research. Journal of Autism and Developmental Disorders, 49, 4974-4996.
12. Schauder, K.B., Mash, L.E., Bryant, L.K. and Cascio, C.J., 2015. Interoceptive ability and body awareness in autism spectrum disorder. Journal of Experimental Child Psychology, 131, 193-200.
13. Fiene, L. and Brownlow, C., 2015. Investigating interoception and body awareness in adults with and without autism spectrum disorder. Autism Research, 8(6), 709-716.
14. Daley, D. and Birchwood, J., 2010. ADHD and academic performance: why does ADHD impact on academic performance and what can be done to support ADHD children in the classroom?. Child: care, health and development, 36(4), 455-464.
15. https://www.nhs.uk/conditions/attention-deficit-hyperactivity-disorder-adhd/symptoms/
16. Bálint, S., Czobor, P., Komlósi, S., Mészáros, Á., Simon, V. and Bitter, I., 2009. Attention deficit hyperactivity disorder (ADHD): gender-and age-related differences in neurocognition. Psychological Medicine, 39(8), 1337-1345.
17. Brown, T.E., Romero, B., Sarocco, P., Atkins, N., Schwartz, E.J. and Rhoten, S., 2019. The patient perspective: unmet treatment needs in adults with attention-deficit/hyperactivity disorder. The Primary Care Companion for CNS Disorders, 21(3), 25767.
18. Boonstra, A.M., Oosterlaan, J., Sergeant, J.A. and Buitelaar, J.K., 2005. Executive functioning in adult ADHD: a meta-analytic review. Psychological Medicine, 35(8), 1097-1108.
19. Thorell, L.B., Holst, Y., Chistiansen, H., Kooij, J.S., Bijlenga, D. and Sjöwall, D., 2017. Neuropsychological deficits in adults age 60 and above with attention deficit hyperactivity disorder. European Psychiatry, 45, 90-96.
20. Davis, N.O. and Kollins, S.H., 2012. Treatment for co-occurring attention deficit/hyperactivity disorder and autism spectrum disorder. Neurotherapeutics, 9, 518-530.
21. Leitner, Y., 2014. The co-occurrence of autism and attention deficit hyperactivity disorder in children-what do we know?. Frontiers in Human neuroscience, 8, 268.
22. https://dyspraxiafoundation.org.uk/dyspraxia-children/
23. Blank, R., Barnett, A.L., Cairney, J., Green, D., Kirby, A., Polatajko, H., Rosenblum, S., Smits‐Engelsman, B., Sugden, D., Wilson, P. and Vinçon, S., 2019. International clinical practice recommendations on the definition, diagnosis, assessment, intervention, and psychosocial aspects of developmental coordination disorder. Developmental Medicine & Child Neurology, 61(3), 242-285.
24. Cairney, J., Hay, J., Veldhuizen, S., Missiuna, C., Mahlberg, N. and Faught, B.E., 2010. Trajectories of relative weight and waist circumference among children with and without developmental coordination disorder. Canadian Medical Association Journal, 182(11), 1167-1172.
25. Harrowell, I., Hollén, L., Lingam, R. and Emond, A., 2017. Mental health outcomes of developmental coordination disorder in late adolescence. Developmental Medicine & Child Neurology, 59(9), 973-979.
26. Omer, S., Jijon, A.M. and Leonard, H.C., 2019. Research Review: Internalising symptoms in developmental coordination disorder: a systematic review and meta‐analysis. Journal of Child Psychology and Psychiatry, 60(6), 606-621.
27. Harrowell, I., Hollén, L., Lingam, R. and Emond, A., 2018. The impact of developmental coordination disorder on educational achievement in secondary school. Research in developmental disabilities, 72, 13-22.
28. Christmas, J. and Van de Weyer, R., 2019. Hands on Dyspraxia: Developmental Coordination Disorder: Supporting Young People with Motor and Sensory Challenges. Routledge.
29. British Dyslexia Association, 2021. https://www.bdadyslexia.org.uk/dyslexic/what-is-dyslexia
30. Olofsson, Å., Taube, K. and Ahl, A., 2015. Academic achievement of university students with dyslexia. Dyslexia, 21(4), 338-349.
31. Grant, D. 2010. That’s the Way I Think – dyslexia, dyspraxia and ADHD explained. Abingdon: Routledge.
Disclaimer: The views and opinions expressed in this blog post are those of the author and do not necessarily reflect the official policy or position of any professional organization or guidelines. The information provided is for educational and informational purposes only and is not intended as a substitute for professional advice, diagnosis, or treatment. Always seek the advice of your therapist or other qualified health provider with any questions you may have regarding a medical or mental health condition.