We know, and we understand a lot. But who knows how far we are from knowing it all, or if that’s even possible? And if the subject that we approach is a mix between the two specters – a neuropsychiatric condition – even the concept of diagnosis changes. Neuropsychiatry deals with mental disorders attributable to diseases of the nervous system.
A patient who has Autism Spectrum Disorder or Attention Deficit Hyperactivity Disorder is not ill. He is suffering. His diagnosis is not a disease, and it is a disorder. Moral and social issues are at stake. But is it possible that this so because we don’t understand them, thus cure them?
A disease could and should be cured. But for the two disorders, there is no cure. There is only an improvement in the quality of life of the patients and the people around them. No palliative treatment works for all the ADHD patients, nor all Autism Spectrum Disorder ones. They can’t be cured because they can’t be yet understood.
How do you begin to understand it, when hundreds of biological abnormality or genetic mutations, most often in combination, can cause it? And they have other contributors too. Until now, the large spectrum of possible causes couldn’t be narrowed to create a clear line of diagnosis. Autism can’t be accurately diagnosed. It is a spectrum disorder or a behavioral disorder. It’s the same case with ADHD.
What is a spectrum disorder?
A spectrum disorder is a mental disorder that includes a range of interlinked conditions. They can extend to include singular symptoms and traits. They are considered a spectrum because there appears to be not a unitary disorder but rather a syndrome composed of subgroups.
Spectrum means a group of conditions that is qualitatively distinct in appearance but believed to be related from an underlying pathogenic point of view. The different elements of a spectrum either have a similar appearance or are thought to be caused by the same underlying mechanism.
Still, how can they be diagnosed? It looks like everything narrows down to the good common sense of the medical practitioner. He can gather information about patient behavior, and he can consult the textbook. But in the end is its capability to observe, test, and evaluate the patient, and the disorder’s subtleties. The clinical and personal experience might make a difference. Because blood tests or technology such as MRI, CT, don’t help much. The most consistent finding in both disorders is reduced activation of the front and side brain regions, the frontal and parietal lobes.
For years, the textbook – Diagnostic Statisticians’ Manual – stated that ASD and ADHD couldn’t be co-diagnosed. It was either one or the other. In the latest fifth version edited in 2013, things changed. The co-diagnosis is allowed. It’s a lottery. Around 50% of children diagnosed with ASD could also be diagnosed with ADHD. Mutually, approximately 15% of children diagnosed with ADHD could be also be diagnosed with ASD.
What do autism and ADHD have in common?
Pretty much everything necessary: behavioral signs and symptomatology. Anxiety and depression are common in both conditions. But also, in almost every psychiatric disorder, so that doesn’t help the diagnostic process either. Both autism and deficit of attention cause the inability to engage, to empathize, to differentiate social cues, or facial expression.
People suffering from either of the two are impulsive, can’t make or keep up with a plan; they are not cognitively flexible, nor can they perceive pragmatic language. They have learning disabilities in writing, reading, or motor skills.
The treatment is focused on controlling impulsive behavior and improving attention. Ritual and patterns seem to be the most useful approach. Permanently reinforce the desired behaviors, consistent quality sleep, engaging in regular exercise. One can’t help but wonder: where to? What will the next version of the Diagnostic Statisticians’ Manual say about the two spectrum disorders correlation?