Is it ADHD or ASD or ODD?

On 12. August 2018

Many of us have difficulties with telling these three distinct disorders apart, due to their overlapping symptomology on self-control and emotional dysregulation. In this article, I try to give you the easy way to tell them apart, to help you get the right treatment …

WHAT’S THE DIFFERENCE?

ADHD is a specific neurodevelopmental disorder, ASD is a general neurodevelopmental disorder and ODD is a behavioral personality disorder.

ADHD causes one to perseverate, ASD causes one to hyperfocus and ODD causes one to become defiant, when asked to stop an ongoing activity which one finds highly rewarding, to do something which is not equally as rewarding

CORE DIFFERENCES

The core differences between the three can be summed up as;

If you have ADHD, you can’t change your behavior (perseveration)

If you have ASD, you can’t change your behavior (hyperfocus)

If you have ODD, you won’t change your behavior (defiance)

Persons with ADHD may know that they have to stop playing the computer game to get ready for school on time, but they are unable to stop their behavior due to neurochemical processes in their brain, not functioning as expected.

Persons with ASD may know that they have to stop playing the computer game to get ready for school on time, but they are unable to stop their behavior due to lack of ability to stop their need for sameness, repetitive behavior, behavior used to limit anxiety and discomfort.

Persons with ODD know that they have to stop playing the computer game to get ready for school on time, but they are unable to stop their behavior due to their inability to self-regulate their behavior, because they do not care for future consequences, and prefer to continue the activity that gives them a positive reward in the now.

UNDERSTANDING AND TREATING ADHD, ASD and ODD

Understanding the difference between ADHD, ASD and ODD is crucial in providing the right treatment for each disorder, in order to limit the impairment the person with the disorder experiences. It is very difficult to distinguish these disorders from one-another and this often leads to inefficient coping strategies in parenting of the child with either of these disorders.

ADHD is a specific neurodevelopmental disorder that is present from birth and chronic. ADHD can be treated with medication that eliviate the 30% lack in age-appropriate development of inhibition and self-control. This option is not available in regards to ASD and ODD.

ASD is a general neurodevelopmental disorder, that is present from birth and chronic. ASD can sometimes be treated with medicines that regulate the sensitivity toward stimuli, like Guanfacine, which can reduce the internal stress and thereby limit the anxiety and aggression seen in ASD. NOTE: This is not scientifically proven yet, but we know from our community at ADDspeaker that especially people with ASD with co-morbid ADHD experience great improvement in their ability to self-regulate emotions, when medicated.

ODD is not a neurodevelopmental disorder, it is a behavioral disorder, rooted in learned behavior, which can be treated with therapy. ODD symptoms can be treated with ADHD medication, as these can regulate behavior, but medicine do not change the underlying root cause, which is behavior and which is a very complicated process that involves the social component of interaction between parent and child (50% of all parents of children with ADHD have ADHD themselves, often untreated), which requires that both parent and child needs to be diagnosed, and medicinally treated, as well as given special behavioral modification training, designed to change the interaction between parent/child.

PERSEVERATION

Perseveration is a symptom of ADHD which can be defined as:
Inability to stop an ongoing activity, caused by lack of self-control.

In ADHD it is caused by neurochemistry, mainly dopamine, which governs the behavior of a person with ADHD in a particular high degree. When emerged in an activity with a high degree of immediate consequences, rewards, a person with ADHD can’t stop doing what makes them feel good inside, like playing a computer game, although they cognitively understand that they have to stop, they are physically unable to do so. This is due to the lack of age-appropriate development of inhibition and self-control due to neurodevelopmental delays in the physical brain. A person with medicinally untreated ADHD have a 30% delay in age-appropriate inhibition which is the root cause of the perseveration.

A person with ADHD can’t change their behavior, even if they wished to themselves.

HYPERFOCUS

Hyperfocus is a symptom of ASD (not ADHD) which can be defined as:
Inability to stop an ongoing activity, caused by lack of self-control.

In ASD it is caused by the general neurodevelopmental impairment of inhibition, across all areas of functioning, resulting in rigid behavior of preference for sameness, repetition of tasks, not due to neurochemistry, but due to anxiety and fear of change. A person with ASD can’t change their behavior, not due to unwillingness, but due to inability.

A person with ASD can’t change their behavior, even if they wished to themselves.

DEFIANCE

Defiance is a symptom of ODD (not ADHD or ASD) which can be defined as:
Inability to stop an ongoing activity, caused by lack of self-control.

In ODD it is caused by a behavioral pattern of unwillingness to follow external instructions due to a lack of respect for authority. Defiance toward changing behavior is the root cause of the inability to stop an ongoing task, which the person finds rewarding, based on their personal belief that they do not need to follow instructions from others. ODD is not rooted in physiology, but solely in psychology.

A person with ODD can change their behavior, but they won’t.

CONCLUSION

In conclusion, we can determine that the Inability to stop an ongoing activity, caused by lack of self-control differs in root cause and treatment, across the three different disorders, and therefore it is crucial to determine which disorder is causing this behavior in order for us to adequately understand and treat the symptoms as best as possible, mainly to reduce the impairment of the person suffering from ADHD, ASD or ODD, secondly to increase the parental management skills, so as to improve the overall life quality for the person with ADHD, ASD or ODD and their families.

This conclude this short introduction to differences between ADHD, ASD and ODD, the underlying topic of interest have to be self-control in regards to ADHD, ASD and ODD. If you wish to gain more insight into this complicated, but crucially central area of understanding human behavior, I have included som additional reading for you to explore.

Thank you for your time and attention!

/ADDspeaker

ADDTIONAL INFORMATION

My personal understanding of self-control is primarily based on the book “ADHD and The Nature of Self-control” by Dr. Russell A. Barkley, Ph.D. (1997), where Dr. Barkley explains in detail how self-control is related to the symptoms of ADHD. Dr. Barkley have used his vast knowledge from evolutionary biology (e.g. Bronowski, Dawkins, B.F. Skinner and Darwin) combined with his 40 years+ experience in research and treatment of ADHD.

DIAGNOSTIC CRITERIAS

According to the newest diagnostic manual from WHO, ICD-11, ADHD, ASD and ODD are defined as;

ADHD

Attention deficit hyperactivity disorder is characterized by a persistent pattern (at least 6 months) of inattention and/or hyperactivity-impulsivity, with onset during the developmental period, typically early to mid-childhood. The degree of inattention and hyperactivity-impulsivity is outside the limits of normal variation expected for age and level of intellectual functioning and significantly interferes with academic, occupational, or social functioning. Inattention refers to significant difficulty in sustaining attention to tasks that do not provide a high level of stimulation or frequent rewards, distractibility and problems with organization. Hyperactivity refers to excessive motor activity and difficulties with remaining still, most evident in structured situations that require behavioural self-control. Impulsivity is a tendency to act in response to immediate stimuli, without deliberation or consideration of the risks and consequences. The relative balance and the specific manifestations of inattentive and hyperactive-impulsive characteristics varies across individuals, and may change over the course of development. In order for a diagnosis of disorder the behaviour pattern must be clearly observable in more than one setting.

ASD

Autism spectrum disorder is characterized by persistent deficits in the ability to initiate and to sustain reciprocal social interaction and social communication, and by a range of restricted, repetitive, and inflexible patterns of behaviour and interests. The onset of the disorder occurs during the developmental period, typically in early childhood, but symptoms may not become fully manifest until later, when social demands exceed limited capacities. Deficits are sufficiently severe to cause impairment in personal, family, social, educational, occupational or other important areas of functioning and are usually a pervasive feature of the individual’s functioning observable in all settings, although they may vary according to social, educational, or other context. Individuals along the spectrum exhibit a full range of intellectual functioning and language abilities.

ODD

Oppositional defiant disorder is a persistent pattern (e.g., 6 months or more) of markedly defiant, disobedient, provocative or spiteful behaviour that occurs more frequently than is typically observed in individuals of comparable age and developmental level and that is not restricted to interaction with siblings. Oppositional defiant disorder may be manifest in prevailing, persistent angry or irritable mood, often accompanied by severe temper outbursts or in headstrong, argumentative and defiant behaviour. The behavior pattern is of sufficient severity to result in significant impairment in personal, family, social, educational, occupational or other important areas of functioning.

FURTHER READING ON RELATED ISSUES

The common root cause of ADHD, ASD and ODD is the inability to self-regulate emotions and behavior. Self-regulation is a part of the core functions of human nature, causing us to “postpone immediate needs to receive a greater reward, in the future“.

This ability to postpone our immediate needs are also a key feature of social reciprocity, the social interaction between people that makes us “do someone a favor now, to receive their help, later“.

When a person have ADHD, ASD or ODD, this function is severely impaired, as social reciprocity is not an inherently natural behavioral feature of human nature, but a learned behavior.

Since ADHD, ASD and ODD causes disruption in understanding the value of social reciprocity, this results in a lack of understanding why you would postpone your needs, impulsivity, now, and think of other’s needs, before your own.

Understanding that the lack of social reciprocal behavior is not a deliberate choice, but a symptom of these disorders, hopefully can change societal understanding of persons with ADHD, ASD and ODD, and their behavior, causing empathy instead of judgement.

SELF-REGULATION

Self-control separates us from our ancient ancestors and the rest of the animal kingdom, thanks to our large prefrontal cortex. It is the ability to subdue our impulses in order to achieve longer-term goals. Rather than responding to immediate impulses, we can plan, evaluate alternative actions, and, often enough, avoid doing things we’ll later regret. The ability to exert self-control is typically called willpower. It is what allows us to direct our attention, and it underlies all kinds of achievement.

According to Dr. Russell A. Barkley, Ph.D., who is the world’s leading authority on ADHD, self-regulation can be defined as;

[…] The term “self-regulation” in psychology has a relatively specific definition. While it is often considered the means by which an individual manages themselves in order to attain their goals, it can be thought of as having at least three components.

Self-regulation involves (1) any action an individual directs at themselves so as to (2) result in a change in their behavior (from what they might otherwise have done) in order to (3) change the likelihood of a future consequence or attainment of a goal.

When you walk into a coffee shop and see a display counter filled with pastries or confections you face a situation that may tempt you to buy these things that are likely to ruin your plans for losing weight this month. To deal with this temptation while you wait for your coffee to be prepared, you may avert your eyes from the counter, walk to a different section of the shop away from the tempting goodies, engage yourself in mental conversation about why you need to not buy those products, and even visualize an image of the new slenderer version of yourself you expect to achieve in the near future.

All of these are self-directed actions you are using to try and alter the likelihood of giving into temptation and therefore increase your chances of meeting your goal of weight loss this month. This situation calls upon a number of distinct yet interacting mental abilities to successfully negotiate the situation.

You have to be aware that a dilemma has arisen when you walked into the shop (self-awareness), you have to restrain your urge to order the pastry to go with the coffee you have ordered (inhibition), you re-directed your attention away from the tempting objects (executive attention or attentional management), you spoke to yourself using your mind’s voice (verbal self-instruction or working memory), and you visualized an image of your goal and what you would look like when you successfully attain it (nonverbal working memory, or visual imagery). You may also have found yourself thinking about various other ways you could have coped effectively with these temptations (problem-solving), and may have even used words of encouragement toward yourself to enhance the likelihood that you would follow your plan (self-motivation). These and other mental activities are usually included in the modern understanding of human self-regulation. […]

SELF-CONTROL AS A FINITE RESSOURCE

There is significant debate in science as to whether or not willpower is a finite resource. Studies demonstrate that exercising willpower makes heavy demands on mental energy, notably on reserves of glucose, the brain’s preferred fuel, creating ego depletion. It’s one reason we’re more apt to reach for that chocolate chip cookie when we’re feeling stressed than when we’re feeling on top of the world. Recently, scientists have failed to replicate some of the studies underlying the concept of ego depletion, and more research is underway.

EMOTIONAL DYSREGULATION

The common denominator of these three disorders are that they all cause emotional dysregulation (ED). ED is characterized by impairment of emotional self-regulation (ESR) and emotional self-control (ESC).

EMOTIONAL SELF-REGULATION

Research consistently shows that self-regulation skill is necessary for reliable emotional well being. Behaviorally, self-regulation is the ability to act in your long-term best interest, consistent with your deepest values. (Violation of one’s deepest values causes guilt, shame, and anxiety, which undermine well being.) Emotionally, self-regulation is the ability to calm yourself down when you’re upset and cheer yourself up when you’re down.

THE SELF-CONTROL SYSTEM

I can highly recommend further reading on the topic of self-control in this article from PubMed:

In Search of a Human Self-Regulation System

William M. Kelley et al. (2015)

[…]

So what should a self-regulation system look like? A self-regulation system should satisfy the following criteria:

■ It must be conscious. Unlike automatic and implicit influences of subcortical reward activity, effective self-regulation relies on conscious, ongoing attempts to regulate behavior (Baumeister & Masicampo 2010, Hofmann et al. 2009, Posner & Rothbart 1998). As a consequence, self-regulation is effortful and slow by comparison. Event-related neuroimaging studies hoping to glimpse momentary instances of self-regulation may fail to do so because a self- regulation system designed in this way would perpetually lose to the faster, automatic subcortical systems. To compensate, a conscious, effortful self- regulation system must be tonically engaged to be ready in advance of incoming reward cues.

■ It must understand time. An effective self-regulation system must be capable of understanding what the ventral striatum cannot—that short-term, immediate rewards can have negative long-term consequences. As such, a self-regulation system must be capable of long-term goal planning and goal maintenance to effectively regulate against impulses with long-term negative consequences and to promote behaviors with no short-term immediate reward (e.g., exercising) that are intended to improve long-term well-being (Baumeister & Heatherton 1996).

■ It must be configurable. Long-term goals change, and different situations necessitate regulation of different impulses. As cortical real estate is limited, we are not likely to have an independent self-regulation system for each of our vices. An effective self-regulation system must therefore be domain general and capable of swapping and updating goal parameters as situations dictate.

■ It must be anatomically positioned to interact with both processing and output systems. If self-regulation systems are domain general and configurable, then they must be interconnected with multiple processing systems to exert control over impulses or motor plans that conflict with long-term goals. In addition, their localization within the cortex should overlap with lesion studies demonstrating the myriad impairments of self-regulation following traumatic brain imaging.

[…]

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