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 and which cause difficulties with fitting in and connecting to other people.

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.

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

Dyslexia comes under the heading of a sensory issue in the diagram 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

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 as representative of the experiences of all non speaking autistic people.

ADHD

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

Attention

Hyperactivity

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. Spectrumnews.org has a discussion on this topic that concludes that ADHD might be a form of autism. See Decoding the overlap between autism and 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 as 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.