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The relationship of ADHD, Dyslexia, and Dyspraxia to Autism
Dr Elizabeth Guest
24th June 2022
It is very common for people diagnosed with autism to also be diagnosed with one or more of ADHD, Dyslexia or Dyspraxia. Autism is very strongly associated with these conditions, although you can have Dyslexia or Dyspraxia without having autism. It is less clear whether you have have ADHD without autism, or whether it is a kind of autism.
Dyslexia, Dyspraxia, and ADHD are so often diagnosed along with autism. Why is this the case?
To answer this, we need to look at Aspiedent's Autism Framework.
Aspiedent's Autism Framework
Autism is an umbrella term. For all practical purposes, there are an infinite number of ways of being autistic. Aspiedent has built an Autism Framework to capture this variation and to use as a tool to describe the autism of an individual.
Aspiedent's Autism Framework is based on the idea that the reason autistic people struggle to connect with others and fit in is because they are prevented from doing so due to underlying difficulties. This is illustrated in the diagram below which depicts key underlying issues that underpin autism.
While it is possible for just one of these categories of sensory issues, processing issues, focus and interest, and how someone thinks, to cause the symptoms of autism, this is comparatively rare. The issue has to be severe for this to happen. Having an issue in one area, does not necessarily cause the symptoms of autism.
The exception is that severe processing issues are a fairly common main cause of autistic symptoms. If someone has severe processing issues, they will not understand what is being said to them with predictable difficulties with communication and social interaction. For more information about processing difficulties in autism see our previous blog posts:
The autism of most autistic people is described via a combination of issues in the different categories. Issues in three or more categories, all interacting with each other is not uncommon.
So how does this relate to Dyslexia, Dyspraxia and ADHD?
Dyslexia comes under the heading of a sensory issue in the schema above. It is a sensory issue to do with vision: the visual system is not able to process the fine details of words and/or track words on a page into sentences and paragraphs. Symptoms can often be alleviated to a certain extent with coloured lenses, especially when there are other sensitivities to (bright) lights. Note that Dyslexia does not affect visual ability that does not involve tracking rows of small symbols that differ by fine details. So people with dyslexia can be good at sport, or manual activities.
It is not obvious why a sensory problem should create the stereotype that people with dyslexia are good at visual and spatial skills. We can think of a few possibilities.
People like success stories and the success stories will be of those who have good visual and spatial problem solving skills. Much less is written about those who feel a failure because they have not done well at school. Some of these people went into the trades and learned manual skills.
Most people have an even ability profile. If one sense does not work, then other senses often take over. In this case, the written word is difficult (or impossible) so if someone struggles with reading then they may develop their spatial and visual reasoning capabilities to compensate.
However, this will not work so well if the person has an uneven ability profile geared towards words. The written word is difficult in dyslexia, but speaking and taking in oral information aren't.
Dyspraxia is a sensory-motor issue, meaning that there are issues with sensing where the body is in space and in controlling the movement of the body. Most often the difficulty is with fine motor movement (such as required in writing).
Some non-speaking autistic people have severe Dyspraxia and difficulties controlling their bodies. The frustration of being unable to communicate leads to challenging behaviour. This challenging behaviour improves if the person has the opportunity and ability to learn to point to a letter board to spell out words. Eventually this can lead to being able to type. See books by Ido Kedar and Naoki Higashida for more details about this. But be careful not to take their experiences representative of the experiences of all non speaking autistic people.
ADHD used to be considered to be hyperactive autism and until 2013, you could not have a dual diagnosis. ADHD comes with three key difficulties:
Impulsiveness is a problem with self-regulation or in other words an issue with inhibiting and regulating emotions, thoughts, and actions. It is more than what is commonly known as a lack of will power. It is about not being able to control your emotions, not being able to think before you speak, having racing thoughts you cannot control. In effect, the difficulties make leading a normal everyday life difficult.
Self-regulation in these areas is a skill that develops during childhood into adulthood. Autistic people can have difficulty with this, even when the other symptoms of ADHD
are not present.
Attention is an issue with focus and interest. People with ADHD find it difficult to concentrate on what they are supposed to be doing without getting distracted. If they are interested in what they are doing - it has captured their attention - they will hyper-focus and it will be difficult to get them to change their focus and attention. Difficulties with changing attention, and with being able to learn only what is interesting are not uncommon in autism, even when other symptoms of ADHD are not present.
Hyperactivity is essentially a sensory issue to do with sensing of the body in space. It is the sense you need in order to climb stairs or dress yourself. Children are very active because they need to stimulate this sense in order to learn to control their body and to continue controlling their body as they grow. Hyperactive people need more stimulation of this sense.
It is not clear whether you can have ADHD without autism. Before 2013, ADHD was seen to be hyperactive autism and you could not be diagnosed with both. The following link is a discussion on this topic that concludes that ADHD might be a form of autism. See https://www.spectrumnews.org/features/deep-dive/decoding-overlap-autism-adhd/
ADHD can certainly cause difficulties with making friends. Children with ADHD are often rejected by their peers because of attention and impulsive issues the development of which has not kept up with the development of their peers. It makes children appear disruptive and immature. Children don't like other children disrupting their games.
Application to Autism
It is generally thought that Autism, Dyslexia, Dyspraxia and ADHD are separate diagnoses. Parents often feel that a diagnosis of autism doesn't explain all the difficulties of their child and therefore seek multiple diagnoses.
So why are additional diagnoses required if Dyslexia, ADHD and Dyspraxia are actually included under the broad umbrella of autism.The reason is simple: a diagnosis of autism tells you hardly anything. You need these other diagnoses to give clues as to how autism affects your child.
So your child has dyslexia as well as autism? Well there are sensory issues connected to vision. This is part of the umbrella of autism. It might be worth exploring to see if visual issues go beyond reading.
Your child has dyspraxia as well as autism? Well there are some forms of autism where dyspraxia explains the symptoms of autism. This is just part of the umbrella of autism.
Your child has ADHD as well as autism? ADHD used to be thought of as hyperactive autism. So actually this narrows down where your child is in the broad umbrella of autism.
This is why parents pursue multiple diagnoses for their child: they want to make sure their child gets the right help. But there is a problem with this: there are many aspects of autism for which there are no separate diagnoses - such a processing issues. Perhaps it would be helpful to have a diagnosis based on processing issues because this can be a major cause of autistic symptoms.
We think it would make more sense for someone getting an autism diagnosis to have an autism profile done at the same time. That way, parents will understand their child right from the point of diagnosis and that adults will understand precisely why they have been struggling. This would prevent a diagnosis of autism creating more questions than it solves.
The reason Dyslexia, Dyspraxia, ADHD and Autism are so often diagnosed together is that these conditions are subsets of the wide range of different underlying issues that cause the symptoms of autism.
In fact, Aspiedent believes that its Autism Framework is able to describe the difficulties of all neuro-developmental conditions that fall under the 'Neurodiversity' umbrella.
Because everyone is neurodiverse (because everyone is quirky in some way) we believe that our neurodiversity profile will work on anyone.
We are hoping to run a course about Aspiedent's Autism profiling tool and how to apply it in simple cases. If you would be interested in this, please get in touch by emailing us at firstname.lastname@example.org
Look out for our next blog post which details a child with Dyspraxia, dyslexia, Autism and possible ADHD. We discuss her struggles through school where all her challenges were initially put down to her Dyspraxia. An Aspiedent autism profile identified the root of her issues to support her transition to high school.