©Jared Stewart, M.Ed.
No claim is made to any of the
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Autism and ADHD
Forests and Trees…
A couple of broad (but accurate) generalizations:
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(Forest…)
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(Trees…)
A Little History
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ADHD has been around since at least 1902
Autism has been around since late 1930’s
Both have seen massive increases since 1970’s
ASD is believed to describe 1-3% of all people
ADHD is believed to describe
3-10% of all people
• Both more common in boys
• Diagnosis of ADHD is still
controversial 
Chart/map from www.cdc.gov
What is Autism?
New DSM-5 criteria:
Currently, or by history, must meet criteria A, B, C, and D:
A. Persistent deficits in social communication and social interaction across contexts, not
accounted for by general developmental delays, and manifest by all 3 of the following:
1. Deficits in social-emotional reciprocity
2. Deficits in nonverbal communicative behaviors used for social interaction
3. Deficits in developing and maintaining relationships
B. Restricted, repetitive patterns of behavior, interests, or activities as manifested by at
least two of the following:
1. Stereotyped or repetitive speech, motor movements, or use of objects
2. Excessive adherence to routines, ritualized patterns of verbal or nonverbal
behavior, or excessive resistance to change
3. Highly restricted, fixated interests that are abnormal in intensity or focus
4. Hyper-or hypo-reactivity to sensory input or unusual interest in sensory aspects of
environment;
C. Symptoms must be present in early childhood (but may not become fully manifest
until social demands exceed limited capacities)
D. Symptoms together limit and impair everyday functioning.
What is ADHD?
DSM-5 Criteria for ADHD
• Inattention: Six or more symptoms of inattention for children up to age 16, or five or
more for adolescents 17 and older and adults; symptoms of inattention have been
present for at least 6 months, and they are inappropriate for developmental level:
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Often fails to give close attention to details or makes careless mistakes in
schoolwork, at work, or with other activities.
Often has trouble holding attention on tasks or play activities.
Often does not seem to listen when spoken to directly.
Often does not follow through on instructions and fails to finish schoolwork,
chores, or duties in the workplace (e.g., loses focus, side-tracked).
Often has trouble organizing tasks and activities.
Often avoids, dislikes, or is reluctant to do tasks that require mental effort
over a long period of time (such as schoolwork or homework).
Often loses things necessary for tasks and activities (e.g. school materials,
pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile
telephones).
Is often easily distracted.
Is often forgetful in daily activities.
What is ADHD?
DSM-5 Criteria for ADHD
• Hyperactivity and Impulsivity: Six or more symptoms of hyperactivity-impulsivity for
children up to age 16, or five or more for adolescents 17 and older and adults;
symptoms of hyperactivity-impulsivity have been present for at least 6 months to an
extent that is disruptive and inappropriate for the person’s developmental level:
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Often fidgets with or taps hands or feet, or squirms in seat.
Often leaves seat in situations when remaining seated is expected.
Often runs about or climbs in situations where it is not appropriate
(adolescents or adults may be limited to feeling restless).
Often unable to play or take part in leisure activities quietly.
Is often "on the go" acting as if "driven by a motor".
Often talks excessively.
Often blurts out an answer before a question has been completed.
Often has trouble waiting his/her turn.
Often interrupts or intrudes on others (e.g., butts into conversations
or games)
What is ADHD?
DSM-5 Criteria for ADHD
In addition, the following conditions must be met:
• Several inattentive or hyperactive-impulsive symptoms were present before
age 12 years.
• Several symptoms are present in two or more setting, (e.g., at home, school
or work; with friends or relatives; in other activities).
• There is clear evidence that the symptoms interfere with, or reduce the
quality of, social, school, or work functioning.
• The symptoms do not happen only during the course of schizophrenia or
another psychotic disorder. The symptoms are not better explained by
another mental disorder (e.g. Mood Disorder, Anxiety Disorder, Dissociative
Disorder, or a Personality Disorder).
What is ADHD?
Based on the types of symptoms, three kinds of ADHD can occur:
1. Combined Presentation: if enough symptoms of both
criteria inattention and hyperactivity-impulsivity were
present for the past 6 months
2. Predominantly Inattentive Presentation: if enough
symptoms of inattention, but not hyperactivity-impulsivity,
were present for the past six months
3. Predominantly Hyperactive-Impulsive Presentation: if
enough symptoms of hyperactivity-impulsivity but not
inattention were present for the past six months.
Because symptoms can change over time, the presentation may
change over time as well. (But ADHD is usually a life-long condition.)
Is It Real?
Lots of Overlap…
ASD
ADHD
Is it possible they are on the same spectrum?
Classic Autism
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“High Functioning” Autism
ADHD?
Symptom similarities
Personality similarities
Co-morbid disorder similarities
Genetic similarities
Treatment similarities
Sources: Kennedy, 2002; Anckarsater, et al. 2006; Kotte, et al. 2013; Polderman et al. 2014
Is it Possible to Have Both?
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Always thought to be exclusive
DSM-4 said it was not possible
Research, however, kept finding both…
DSM-5 (2013) says yes!
Tons of new research needed on
the relationships between the
two and the effects of what is
called “co-morbidity”!
Co-Morbidity
• Between 25%-66% of those with ADHD also
demonstrate significant ASD symptoms
(Mulligan, et al. 2009)
• Between 30-75% of those with ASD also
demonstrate significant ADHD symptoms
(Atwood, 2007; Lee & Ousley 2006)
Co-Morbidity
• Recent research indicates that
if only
the ADHD is identified first
• Children initially diagnosed with ADHD received
their autism diagnosis 3 years later on average
• The delay in diagnosis proved true regardless of
the child’s age or severity of autism symptoms
(Miodovnik, et al, 2015)
A Whimsical Portrait of a
Young Man with ADHD and
Autism Spectrum Disorder…
Guess the Success
• Did not speak until age 4
• Suspected of being “mentally retarded” by his doctors
• Significant learning disabilities—termed “hopeless” and “disruptive” by
teachers
• Had to be taken out of class at age 7 and home-schooled
• Unconscious of his personal appearance
• Irregular sleep patterns
• Difficulty maintaining steady employment—often fired
• Emotionally detached
• Told exaggerated stories—often altered the truth to fit his needs
• Experienced frequent anxiety and depression
• Loved to perform for others
• Distant and indulgent as a father
• Extremely easy to approach, but distant and “mysterious” even to his friends
• Neglected personal needs in favor of focused activity
• Intensely interested in science experiments
• Unaware/uncaring of the effects of his experiments/actions on others
• Perfectionistic and extremely routine oriented
• Highly ambitious—determined to be rich and famous
• Started over 100 companies and received over 1000 patents
for his world-changing inventions!
Answer: Thomas Edison
The combination of ASD and ADHD symptoms turned into a unique strength for Edison;
And Changed the World!!!
ASD in the Classroom
 Autism = Disorder of Extremes!!!
 Interruptions or over-talkative
 Non-responsive or extremely quiet
 Correcting instructor or classmates
 Mannerisms or noises (nonverbals)
 Great difficulty with “changes”/transitions
 Hygiene, dress, and grooming
 Meltdowns, shutdowns, or outbursts
 Sensory integration issues (“stimming”)
Meltdowns and Shutdowns…
• STAGE 1: RUMBLING During this stage, the student exhibits behaviors
that are minor (e.g. shaking their foot, clearing their throat, tapping their
fingers) but still out of the ordinary. The behaviors may become more
overt (e.g. threatening a classmate) as a student becomes increasingly
anxious or frustrated.
• STAGE 2: RAGE (OR MELTDOWN) During this stage, the student has been
hijacked by his or her own emotions and loses control. These behaviors
can be external (e.g. hitting or screaming) or internal (e.g. withdrawal),
and have the potential to impact the safety of that student or other
students. As a teacher, you should do everything in your power to keep
rumbling behaviors from escalating into a full blown meltdown.
• STAGE 3: RECOVERY During this stage, the behaviors have stopped, but
the student is not yet ready to learn new material. Do not punish!!!
ASD Sensory Issues
Students with ASD often experience significant challenges from
simply being in the classroom as a result of sensory issues!!!
• Too Much or Too Little?
• Major source of Meltdowns
• Think in terms of “replacing” rather than “extinguishing”
• Behavior (“Stimming”) Sensory issue Possible Strategies
Examples:
• Chewing gum vs. constant nose-blowing
• Carpet swatch under desk or “fidget” item vs. picking at skin
• Doodling on paper vs. head down during lecture
ADHD in the Classroom
• Inability to pay attention/listen
• Distracted by external stimuli
• Wanting to leave the room
• Attendance poor or not at all
• Poor organization
• Loud and disruptive
Dr. Tony Attwood:
“ Professionals and service agencies
tend to see children and adults with
[these disabilities] who are having
problems that are highly conspicuous
and difficult to treat or resolve, and
this may lead to an overly pessimistic
view of the long-term outcome.”
The Complete Guide to Asperger’s Syndrome, 2007; emphasis added
ADHD Strengths
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Great imagination
Creative
Leadership Abilities
Risk taker
Persuasive
Animated
Hyperactivity (Productive)
Impulsivity (Decisive)
Exciting Presenters
Intuitive
Spontaneous
Trusting (sometimes too much so)
Forgiving (sometimes too much so)
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Sense of Humor
Passionate
Flexible
Curious
Fun-loving
Adventurous
Sensitive
Warm Hearted
Musical
Artistic
Incentive driven
Visionary
Idealistic
ASD Strengths
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Powerful learning style strengths (implicit; vis/spat.; log/math; naturalistic; etc)
Exceptional rote memory (often vast stores of facts and figures)
Exceptional visual abilities (static spatial, illusions, patterns, colors, etc)
Exceptional auditory abilities (hyperconnected auditory brain centers)
Superior ability to process/locate information
Laser-like focus of energies/attention on topic of interest
Highly deductive/analytic
Strongly logical—able to make more rational decisions than NT’s
Ability to put ideas together in a unique manner—highly creative
Exceptional ability with puzzles, mazes, and word games
Ability to thrive on routines and clear expectations
Valuable employment characteristics: persistent, accurate, logical, reliable
Five times more likely than “neurotypicals” to have perfect pitch
Ten times more likely to have savant skills (music, art, calculation, etc)
Great honesty and respect for rules
Deep concern, caring, and love for “safe” beings
Deep curiosity and desire to learn (usually prefer independent learning)
Idealism and a strong sense of right and wrong/social justice
Often natural leaders
Perfectionism
Exceptional ability to systematize
Sources: Attwood (2007); Baron-Cohen (2008); Dolan et al (2008); Happe (1999); Heaton et al (2008); Grandin (2008); Remington et al (2012);
Reser (2011); Samson , et al (2011); Stewart (2007); Xiong (2012)
“Recent data…suggest it’s time to start thinking of autism as an ADVANTAGE in some spheres, not a
cross to bear.” ~Dr. Laurent Mottron, University of Montreal
Challenges when you have both…
• Individuals with dual ASD & ADHD are more impaired
• Challenges of one can cancel out Strengths of the other
• Higher risk for personality disorders in adulthood
• More research needed!!!
• There may also be unforeseen positives
• Distraction may be worse (perhaps more
reasons for the brain to lose focus?)
• Distraction is bad enough for so-called
“neuro-typicals” in the Age of Distraction
Sources: Saccani, et al (2013); Anckarsater, et al (2006)
The Age of Distraction (“Pearls Before Swine” by Stephan Pastis)
Forests and Trees…
“Differential Diagnosis”
Some Questions to ask:
• Why are they not paying attention?
– ADHD = distracted, racing thoughts, often external
– ASD = processing, deep thought, usually internal
– Both = Sensory issues (more extreme in ASD)
• What are they paying attention to?
– ADHD = something with high feedback/novelty
– ASD = something in line with special interests
• Why are they struggling socially?
– ADHD = impulsivity or hyperactivity
– ASD = lack of interest or ability to process non-verbals
(Davis & Kollins, 2012)
ASD, ADHD, or Both?
Behavior Issue
More Like ASD
Could be Either/Both
More like ADHD
Friendships
Not terribly interested in making
friends, tends to be socially
anxious or see peers as objects
Bullied (or a bully); Lonely—
avoided by peers; Perceived as
overbearing; Often interested in
performing for others
Makes friends easily, but loses
them quickly; Likes to “show
off”
Video Games
Likes to focus on the rules,
setting, and mechanics of the
game; often shows repetitive or
asocial quality to their play
Plays games for hours; Difficulty
regulating interest; Seems
obsessed or addicted
Likes the instantaneous
feedback, high stimulation, and
fast pace of the game; often
sees it as a way to socialize
Reciprocity/
Sharing
Creates for self first; often
neglects basic social reciprocity
Perceived as rude or anti-social;
Interrupts; Grabs objects
Trouble waiting for turn or for
instructions; blurts out answers
Poor planning
and organization
Gets stuck in the details; lacks
“big picture” or ability to see
main ideas; loses track of time
pursuing special interest
Difficulty with deadlines;
difficulty “caring” about the
expectations of others
Difficulty keeping track of
assignments/materials; difficulty
seeing the steps; forgets about
commitments/appointments
Movement/
Motor issues
Repetitive, rhythmic, selfstimulating movements; poor at
sports; stiff or uncoordinated;
doodles constantly; anxious
Constantly moving or fidgeting;
Poor handwriting; “sloppy”
work; difficulty staying seated;
hits others; trouble
relaxing/slowing
Movement more coordinated
and energetic; movement aids
concentration and executive
function; good at sports
ASD, ADHD, or Both?
Behavior Issue
More Like ASD
Could be Either/Both
More like ADHD
Nonverbal
difficulties
Poor eye contact; rigid posture;
inexpressive face (flat affect); needs
lots of personal space
Mismatched or unstylish
clothes; poor hygiene and
grooming; fails to read others’
body language
Often touches or invades
others’ personal space; misses
facial or body cues because of
inattention
Verbal
difficulties
Monotonous or odd prosody; uses
words that are “wrong”;
Very quiet; talks endlessly about the
same subject(s); echolalia
Excessive talking; interrupts or
injects self into conversations
that may or may not involve
them; quotes movies/TV a lot
Switches topics frequently;
Makes constant ongoing
comments/noises/narration;
Asks people to repeat
information/instructions
Perseverative
Interests
Fascinated with inherent systems;
stereotypical fixation on movement,
objects, rules, maps, schedules;
difficulty with change
Capable of focusing for hours
on areas of interest;
hyperfocused
Often “burns through” an
interest and moves on to a
new object of hyperfocus
Dangerous/Risky
Behaviors
Doesn’t understand the physical or
social consequences/context; Is
hyperfocused or hyperstimulated
Seems oblivious to danger;
tendency to be accused of
stalking and/or harassment
Makes decisions impulsively,
without taking the time to
think through the
consequences
Poor grades
School and schoolwork is high
stress; gets caught up in the minute
details and perfectionism
Learning disabilities; Dislikes
school; Dislikes group work;
Lots of incomplete or missing
assignments
Loses assignments and
materials, starts a project but
doesn’t finish, unable to
spend the time needed
DEALing with Inappropriate Behaviors
1. D
• ABC’s (antecedent, behavior, consequences)?
• Sensory/Biological factors?
• Purpose of behavior? (what were they TRYING to do?)
2. E
• Comprehension or communication deficits
• Physical/Biological Factors (health, pain, comorbid, etc)
• Sensory Factors (hyper/hypo stimulation, boredom, etc)
3. AL
• Facilitate Communication! (student, family, & educational team)
• Teach social/emotional coping skills as well as academic skills
• Therapy as necessary (CBT, ABA, Group, etc)
Effective Interventions:
1. Work with a provider that knows enough about ASD
and ADHD to differentiate behaviors
2. Differential diagnosis can help identify a specific
target and its likely source – E.g., Differentiate what is
ADHD v. ASD and then measure either the specific
ADHD or ASD symptoms during intervention
3. Choose evidence‐based interventions for your target
behavior (use online resources for most up-to-date)
4. Not a bad idea to try to focus on interventions that
will work for BOTH conditions! 
Effective Interventions:
•  Interventions for
combined ASD/ADHD
are still untested
•  Interventions
effective for each are
readily available
• Try combinations
based on the target
symptom(s)!
Effective Interventions For BOTH:
Instructional Strategies
1. Antecedent intervention strategies
2. Scaffolding/Task Analysis
3. Explicit instruction
4. Literacy strategies
5. Active-learning strategies
6. Graphic organizers
7. Video Modeling
8. Self-Management
(Fluery et al., 2014)
Effective Interventions For BOTH:
Antecedent Interventions:
1. Priming
2. Academic Modifications
3. Visual Supports/Schedules
4. Planners/Organizers
5. Environmental Modifications
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Environmental Modification
Arrangement and seating
Color
Lighting
Temperature
Distractions
Stimulation Level
Effective Interventions For BOTH:
Behavioral Strategies
1. ABA
2. “Home Base”
3. Token Economies
4. Social Skills Training
5. Planned Distractions
6. Relaxation Techniques
7. Problem Solving Systems
8. Procrastination/Delay Systems
9. Know when/how to disengage!
10.Occupational Therapy and/or Sensory
Integration Therapies (“Mindfulness”)
Effective Interventions For BOTH:
Home-coordinated Strategies
1. Homework supports
– Build in rewards
– Build in breaks (20/5 Timer)
– Set times/places (low distraction)
2. Planner supports (reinforce the system)
3. Sleep supports (sleep hygiene, Melatonin)
4. Teacher supports (invite teacher to home!)
5. Medication supports (make sure it’s addressed)
Pharmacotherapy
• Most ADHD medications have also shown to be some
help with ASD symptoms (though not as effectively)
• Methylphenidate (brand names: Concerta, Methylin,
Medikinet, Ritalin, Equasym XL, and Quillivant XR)
• Amphetamine/phenethylamine (brand name: Adderall)
• Atomoxetine (brand name: Strattera; better for both?)
• Guanfacine (brand name: Estulic, Tenex, and Intuniv)
(Davis & Kollins, 2012; Saccani, 2013)
Medication Concerns…
If you can get the results without it… avoid it. But if you can’t, the positives
seem to outweigh the negatives.
Other Effective Intervention Tips :
• Use the “Rule of 2”
• Get your MBA— “Master of Being About”
• Find ways to say YES [but] (avoid “No”, “Stop”, and
“Don’t”) –focus on what it is you WANT them to do!
• Always give PURPOSE for desired actions
• Teach SYSTEMS that break down tasks for specific results,
and help them to run these independently
• Social Stories (often in the form of videos)
• PRAISE – PRAISE - PRAISE! (make things feel GOOD!)
• Pick your battles!
• Don’t forget Sleep, Exercise, and Diet!
The Ziggurat Model
Developed by Dr. Ruth Aspy and Dr. Barry Grossman, 2008
1. Take care of
issues first
2. Set up
appropriate to the student (and
tied to their interests, if possible)
3. Set up
to make
the task more easy, concrete, and comprehensible
4. Use
to make sure that the steps of the system are
the right size and taught in the right order (& include supports)
5. Finally, you are ready to
!
Some Closing Thoughts…
1. See through the behaviors to see
the disorder symptoms
(your
plans to address the symptoms)

• Remember: Kids want to do well! If they
believe that can succeed at a reasonable
request, they will usually try!
Thank You For Your Time!
• If you missed something, or want copies or
whatever, please feel free to contact me! 
• jareds@svacademy.org