ADHD and Autism in Young Children: Overlapping Symptoms and Key Differences in Communication, Play, and Social Thinking 

When young children show developmental or behavioral challenges, Autism Spectrum Disorder (ASD) and Attention-Deficit/Hyperactivity Disorder (ADHD) are often considered as potential diagnoses. While these conditions share some overlapping traits, they have distinct differences in their causes, presentations, and the types of interventions required. From a speech-language pathology (SLP) perspective, the role of an SLP varies significantly, as communication deficits are a hallmark of ASD but not of ADHD. 

The Role of Speech-Language Pathologists in Autism and ADHD Autism Spectrum Disorder (ASD): A Communication-Based Diagnosis 

One of the defining characteristics of Autism Spectrum Disorder (ASD) is difficulty with communication, which is why SLPs play a central role in intervention. Communication challenges in ASD may involve: 

  • Expressive Language: Difficulty using words, sentences, and gestures to communicate wants, needs, and ideas. 
  • Expressive-Receptive Language: Challenges with both understanding spoken language and expressing themselves effectively. 
  • Social Pragmatics/Social Cognition: Difficulty using language in social contexts, interpreting nonverbal cues, engaging in conversations, and understanding social norms. 

Exclusion of Articulation and Speech Production: These areas are generally not part of the core diagnosis for ASD, though some children may have co-occurring articulation difficulties. 

ADHD: Communication Challenges Are Secondary 

ADHD does not inherently involve a core communication deficit. While children with ADHD may exhibit challenges related to communication, these are usually secondary to attention and regulation difficulties rather than true language processing issues. For example: 

  • Receptive Challenges in ADHD: Apparent difficulties with understanding directions or conversations are often due to inattention rather than a true language processing disorder. If a child appears to have only receptive language difficulties, it is more likely a result of inattention than a language issue. 
  • Expressive Challenges in ADHD: These may arise due to impulsivity or lack of organization in expressing ideas, rather than a fundamental difficulty with expressive language itself. 

SLPs generally work with children with ADHD only if there is a comorbid language disorder (e.g., expressive, expressive-receptive, or pragmatic language impairments) or if the SLP is offering social skills interventions to address social-pragmatic difficulties. 

Overlapping Symptoms Between ADHD and Autism 

Both ADHD and autism can present challenges in communication, play, and social functioning. These overlaps include: 

1. Social Communication Challenges 

  • ADHD: Impulsivity and inattention may lead to interrupting, difficulty maintaining a topic, or missing social cues. 
  • ASD: Social communication challenges are a defining feature and involve difficulty initiating, maintaining, and understanding the nuances of conversations. 

2. Attention and Focus 

  • ADHD: Sustaining attention is a primary challenge, often linked to executive functioning difficulties, affecting task completion and conversational engagement.
  • ASD: Attention difficulties are often related to sensory processing or restricted interests, with executive functioning challenges influencing the ability to shift focus or prioritize tasks effectively. 

3. Apparent Language Delays 

  • ADHD: Language delays can be unrelated to ADHD and can be signs of a co-morbid language disorder. 
  • ASD: True language delays, particularly in expressive or expressive-receptive language, are common and are a hallmark of the diagnosis. 

Key Differences in Communication, Play, and Social Thinking

1. Communication Deficits 

  • ADHD: Communication difficulties stem from impulsivity, distractibility, or difficulty organizing thoughts. Receptive language issues are often misinterpreted as language delays but are typically due to inattention, unless they have a co-morbid language disorder. 

Example: A child may not follow multi-step directions, not because they don’t understand, but because they were distracted. 

  • ASD: Communication deficits are core to the diagnosis and involve genuine expressive or expressive-receptive language delays, as well as difficulties in pragmatic language. 

Example: A child may not respond to their name, struggle to form sentences, or have difficulty using language for social purposes. 

2. Joint/Shared Attention 

  • ADHD: Joint attention is usually intact but inconsistent due to distractibility. ○ Example: A child may briefly engage with a caregiver pointing at a bird but then become distracted by something else. 
  • ASD: Joint attention is often significantly impaired, with challenges sharing focus on objects or events with others. 

Example: A child may not follow a caregiver’s point to a toy or show interest in sharing that experience. 

3. Symbolic Play Development 

  • ADHD: Symbolic play skills are typically age-appropriate but may lack organization or sustained engagement. 

Example: A child might start playing house but abandon the activity before completing it. 

  • ASD: Symbolic play is often delayed or absent, with a preference for repetitive or sensory-driven play. 

Example: A child might spin wheels on a toy car instead of pretending it is driving. 

4. Social Thinking 

  • ADHD: Social issues stem from impulsivity and inattentiveness rather than an inability to interpret social cues. 

Example: A child might interrupt or talk over a peer but can understand and engage in social norms when reminded. 

  • ASD: Social thinking deficits are foundational, including difficulties with perspective-taking and understanding emotions or social nuances. 

Example: A child may not understand why a peer is upset when their toy is taken. 

SLP Intervention for ADHD and Autism

For Autism Spectrum Disorder 

SLPs work extensively with children with ASD to address: 

  • Expressive and receptive language delays. 
  • Pragmatic language and social communication challenges. 
  • Joint attention, symbolic play, and perspective-taking skills. 

For ADHD 

SLPs typically do not work with children with ADHD unless there is a comorbid condition. Intervention may include: 

  • Addressing expressive-receptive language difficulties if present. 
  • Offering social skills groups to support pragmatic language and self-regulation in social interactions. 

Conclusion 

Speech-language pathologists play a critical role in supporting children with autism due to the inherent communication challenges in ASD, including expressive, expressive-receptive, and social-pragmatic difficulties. In contrast, ADHD does not involve core communication deficits, and any language challenges are typically secondary to inattention or impulsivity. 

By understanding the overlapping symptoms and distinct differences between ADHD and autism, SLPs can ensure children receive tailored interventions that meet their unique developmental needs. If you’re concerned about your child’s communication, reach out to a licensed SLP and psychologist for an evaluation. Early identification and intervention are significant predictors of lifelong success and improved outcomes.

About The Author

Craig Selinger 

Owner at Brooklyn Letters and Themba Tutors

Craig Selinger is the dedicated owner of Brooklyn Letters and Themba Tutors, reputable private practices renowned for exceptional services. Together with his team of skilled professionals, they extend their expertise across a wide range of locations, including Manhattan, Brooklyn, Queens, Staten Island, Bronx, Westchester, Long Island, New Jersey, and Connecticut. With a New York State license as a speech-language therapist (pathologist) and a learning specialist, Craig boasts an impressive track record spanning over two decades, during which he and his team have helped more than a thousand families, establishing Brooklyn Letters as a respected practice in the field. Craig’s proficiency encompasses a diverse array of domains, including addressing early childhood speech-language delays, skillfully managing expressive and receptive language disorders, and adeptly tackling language learning obstacles such as reading, writing, executive functioning, social and pragmatic communication. He also demonstrates mastery in speech production concerns, i.e., articulation and enunciation. What sets Craig and his team apart is their dedication to providing comprehensive care. They actively collaborate with the best professionals,, including neuropsychologists, mental health therapists, and allied health professionals. This network of expertise ensures a holistic approach to each client’s unique needs.

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