ADHD: Social Cognition is almost as bad as in ASD

‘Look me in the eye’ is a brilliant book by John Robison, where he describes his life with Asperger’s Syndrome. A key point of conflict for him, is learning and applying social skills, or rather trying to get to grips with building up his own version of Social Cognition. Having lived for 40 years with undiagnosed ADHD and Atypical Autism, I can relate to his struggles.

This article is a short description of the measurable difference between people with ADHD and ASD, compared to Neuro-typicals. I have previously written an article where I proposed combining ADHD and ASD into a single continuum which I’ve coined ‘ADHtism’, since between 30-50% of people with ASD also have ADHD, and 2/3 of all with ADHD also have ASD.

So I went into the Rabbit Hole and tried to see if we had any scientific evidence that supports this hypothesis, and surprisingly I’ve found quite a few, and I can see that the literature is increasingly taking a view, similar to mine.

One of the more data heavy studies on the topic, is from Miranda et al., 2017, where they compare children with High Functioning Autism (HFASD), Attention Deficit Hyperactivity Disorder (ADHD) and Typical Development (TD) on various cognitive parameters, focusing in Theory of Mind (ToM), Affect Recogntion and Social Cognition.

Definitions: TD = Typical Development, also called Neuro-typical, ASD = Autism Spectrum Disorder, ADHD = Attention Deficit Hyperactivity Disorder.

SUMMARY

The following paragraphs are cited from the Miranda et al., 2017 study where they discuss the findings and their importance in understanding where TD, ASD and ADHD differs from each other.

[…]Research on poor social functioning in children with ASD and ADHD has increased exponentially, suggesting a significant clinical overlap between these two disorders in terms of impairments in social skills.

Although, the consequences of social impairment in the trajectory of both disorders is no longer disputed, only a small body of research has examined social cognition deficits comparing groups of children with ASD, ADHD, and TD.

The literature review on this area of study reveals two important issues:

• First, there is a lack of consistency in the findings related to the profile of ToM skills in individuals with ASD and ADHD.
• Second, another question that remains unresolved is related to the possible functional link between ToM and EF in ASD and ADHD.

Therefore, the first objective of this study was to analyze two fundamental social cognition abilities, affect recognition and ToM, in children with HFASD, ADHD, and typical development, matched on age, IQ, and semantic knowledge.

Children with HFASD were expected to have worse performance on all the social cognition measures than children with TD and children with ADHD.

The analysis revealed that children with HFASD and children with ADHD, compared to a group of typically developing peers, showed impairments on all the social cognition measures.

In addition, consistency is observed in the results, regardless of the ToM assessment methodology employed, that is, performance tasks or parent estimates of daily life behavior.

This finding, which is consistent with the initial hypothesis, supports the idea that children with these two disorders experience deficits in Affect Recognition (Downs and Smith, 2004; Sinzig et al., 2008; Demurie et al., 2011; Demopoulos et al., 2013; Baribeau et al., 2015) and attribution of mental states, such as feelings, beliefs, intentions, and desires (Buitelaar et al., 1999; Adachi et al., 2004; Demurie et al., 2011; Demopoulos et al., 2013; Hutchins et al., 2016).

The use of ToM measures with different levels of complexity, i.e., laboratory tasks of explicit knowledge and applied abilities in everyday life contexts, adds specific nuances to the findings.

First, when comparing the ability to recognize basic emotions such as happiness, sadness, fear, anger, and disgust, the performance of children with HFASD and children with ADHD is not significantly different.

The ease of distinguishing between different faces is based on holistic processing, that is, the perception of faces as more than the sum of their parts.

It is likely that failures of individuals with ASD and ADHD in understanding and interpreting facial emotions are due to the use of predominantly non-holistic, chaotic, and disorganized strategies.

They focus attention on some minor facial feature that keeps them from fully understanding someone else’s emotional expression[…](Miranda et al., 2017)

CONCLUSION

I’ve tried to make a comparison of the tests results myself, in order to see if there was some measurements that could give us some kind of insight into the overlapping areas and the areas where there are significant differences.

If we compare Affect Recognition (spotting and correctly perceiving other people’s emotions) between ASD and ADHD, the difference is not very significant (ASD: 1.08 and ADHD: 0.92), but if you compare both to TD, there is a more than 4 point difference (less), showing that people with ASD and ADHD both have major problems with AR, but at least they suck just as bad at it, as each other.

ToM Verbal is far worse if you have ASD, than if you have ADHD. This means that understanding what other people mean with the words they speak, is less clear for people with ASD, than it is for those with ADHD. Still ASD and ADHD are scoring 2-3 point lower than TD.

ToM Conceptual also shows that people with ASD are far more impaired than those with ADHD, (ASD: 1.57, ADHD: 0.59) which means that people with ASD are really bad at understanding, that other people have their own version of reality, which is different from them self. Being one of the one’s with a big impairment on ToM Conceptual myself, but in the cognitive sense, not the ‘Where’s Sally’ (Uta Frith) sense, cause I consistenly forget that others do not share my obsessions, and sometimes do not even notice when they’ve left ‘our’ conversation …

The rest of the results show how they score on ToM Early (approx. 0-1 yrs.), ToM Basic (approx. 1-3 yrs.) and ToM Advanced (approx. 5-8 yrs.), and the trend goes on over all of the measurement, and throughout the developmental period.

What is noticeable though, is that when we test adults with ASD vs. Adults with ADHD, we see that Social Cognition Skills have almost normalized in people with ADHD (0.04 vs. TD), whereas the people with ASD shows a pervasive impairment, throughout their life.

So I must conclude that ASD and ADHD have many of the same symptoms, in childhood, but where people with ADHD will improve their functioning as their 30% developmental delay in maturity in brain growth ebbs out around the age of 30, people with ASD will always be impaired on Social Cognitive Skills, providing the proof that ADHD symptoms are based on lack of neural network connections (what medication and neuroplasticity overcomes).

ASD symptoms are based on fundamental brain development anomalies in the Brainstem and the PNS, causing the higher order functions to be ‘given crappy data to work with’, from their somatosensory system, which makes them less able to interpret interoceptive and exteroceptive stimuli (senses, feelings, sensations, gut-feeling etc.) making them unable to correctly relate to social reciprocity, social norms and social skills in general, making them feel ‘as if they are from a different planet’, hence not going back to embarass themselves, over and over again.

References

Miranda et al., (2017), Social Cognition in Children with High-Functioning Autism Spectrum Disorder and Attention-Deficit/Hyperactivity Disorder. Associations with Executive Functions., Front Psychol. 2017 Jun 23;8:1035., PMID: 28690570 PMCID: PMC5481358 DOI: 10.3389/fpsyg.2017.01035

For more on Theory of Mind Inventory (ToMI) (2016)