ABA Therapy: Demystifying the Approach and Addressing Concerns

If you have been reading about autism and ADHD lately, you may have noticed something frustrating. The symptom lists start to blur together, and both of them seem to describe your child. A child who doesn't answer when called, who can't stay seated at dinner, or who has a hard time when plans change could fit either page you have open. That confusion is common, and there is a reason for it. Autism and ADHD can share several behaviors that are easy to see, while the patterns that help tell them apart are often quieter. Below, we walk through what the two can share, what specialists look at during an evaluation, how the two can occur together, and what you can do at home to prepare. This article can't replace an evaluation, but it can help you walk into one with clearer questions. Why autism and ADHD can look so similar Autism (ASD) and attention-deficit/hyperactivity disorder (ADHD) are both neurodevelopmental conditions. CHADD (Children and Adults with Attention-Deficit/Hyperactivity Disorder), notes that children in both groups can show high levels of inattention, impulsivity, and hyperactivity. In daily life, that may look like: ● Trouble paying attention, especially to things that don't hold the child's interest ● Acting quickly without stopping to think ● Moving a lot, fidgeting, or having a hard time staying seated Because these behaviors are visible and frequent, they are often the first things parents and teachers notice. They are also the least helpful for telling the two conditions apart. Developmental-behavioral pediatrician Dr. Adiaha Spinks-Franklin summed it up for CHADD this way: “All that bounces is not ADHD; all that flaps is not autism.” What specialists look at to tell them apart During an evaluation, professionals look beyond attention and activity level. When autism is being considered, CHADD points to two areas that carry a lot of weight: social communication, and restricted or repetitive behaviors and interest s. How your child communicates and connects This area covers how a child shares attention, feelings, and interests with other people. The CDC lists examples such as not responding to their name by 9 months, not showing you an object they like by 15 months, not pointing to show you something interesting by 18 months, and not noticing when others are hurt or upset by 24 months. At home, you might quietly notice: Does my child turn when I call their name? Do they bring me things just to show me? Do they point to share something they find interesting? Do they notice when someone is upset? Repetitive behaviors and very focused interests The CDC also describes patterns such as: ● Lining up toys or objects and getting upset when the order changes ● Repeating words or phrases over and over (echolalia) ● Playing with toys the same way every time ● Getting upset by minor changes or needing to follow certain routines ● Flapping hands, rocking, or spinning in circles ● Unusual reactions to how things sound, smell, taste, look, or feel What specialists look at for ADHD For ADHD, the focus is on patterns of inattention, hyperactivity, and impulsivity. The CDC's summary of the DSM-5 criteria explains that symptoms need to be present for at least six months, show up in more than one setting (for example, at home and at school), and begin by age 12. Clinicians also consider whether the behaviors go beyond what is expected for the child's age and whether they get in the way of daily life. One behavior on its own rarely tells the whole story. Specialists look for patterns across places, people, and time, and they also check for other explanations. For ADHD, the CDC notes that a medical exam, including hearing and vision tests, can help rule out other problems with similar symptoms. When a child has both Autism and ADHD can occur together. A 2019 review of 96 studies published in The Lancet Psychiatry estimated that about 28% of autistic people also have ADHD. Looking at it from the other direction, an analysis of a 2014 U.S. national survey found that about 1 in 8 children currently diagnosed with ADHD had also been diagnosed with autism. Timing can matter too. In one U.S. study based on parent reports, children who had both conditions and received the ADHD diagnosis first were diagnosed with autism at about age 8.6 on average, compared with about age 4.7 when autism was identified first or at the same time. The researchers described these findings as preliminary. For parents, the takeaway is practical: if something still doesn't fit after one diagnosis, it is reasonable to ask whether the other has been considered. What you can do at home before an evaluation Only a qualified professional can diagnose autism or ADHD, and you don't need to figure it out on your own. What you can do is collect clear observations that help the evaluation team see what you see at home. Keep a three-line note Behavior analysts often use a simple structure called ABC: what happened before a behavior (antecedent), what the child did (behavior), and what happened after (consequence). You can use the same idea at home: ● Before: I called his name while he played with his trucks. ● What he did: He kept playing and didn't look up. ● After: I touched his shoulder, and he looked at me. Try to write what happened rather than what you think it means. A week of short notes can show patterns that are hard to remember in the middle of an appointment. Use the CDC Milestone Tracker The CDC's free Milestone Tracker app includes milestone checklists from 2 months to 5 years and creates a summary you can share with your child's doctor. It can be a simple way to keep your observations in one place. Bring your questions A few questions you may want to ask at the appointment: ● Have both autism and ADHD been considered? ● What other explanations are you looking at? ● What should we watch for at home while we wait for results? ● If an evaluation is needed, who can complete it and how long is the wait? Where ABA therapy fits Applied behavior analysis (ABA) is one of the services often recommended after an autism diagnosis. It focuses on teaching skills that matter in daily life, such as communication, following routines, waiting, and handling transitions, and it involves parents along the way. ABA providers do not diagnose autism or ADHD, so an evaluation comes first. At Stepping Stones Behavioral Services, we provide ABA therapy at home and in school for children and teens from 18 months to 21 years old across South Florida, from Broward to St. Lucie County. We work with several insurance plans, including: Aetna, Cigna, Humana Military, ChampVa, Curative, Anthem, and all Blue Cross and Blue Shield plans. If your child already has a diagnosis, or you are waiting for one and want to understand what ABA could look like, our team can talk you through the next steps.  Frequently asked questions Can a child have both autism and ADHD? Yes. A 2019 review of 96 studies estimated that about 28% of autistic people also have ADHD. A diagnosis of one condition doesn't rule out the other. Can a parent tell autism and ADHD apart at home? Not reliably. Many visible behaviors overlap, and a diagnosis requires a professional evaluation. What parents can do is write down specific observations and share them with the evaluation team. Who can diagnose autism or ADHD? ADHD can be diagnosed by a pediatrician or other primary care provider, or by a mental health professional such as a psychologist or psychiatrist. According to the CDC, an autism evaluation is done by trained specialists, such as a developmental pediatrician or a child psychologist. Your child's doctor can help you find the right next step. My child has an ADHD diagnosis, but something still doesn't fit. What should I do? Bring your notes to your child's doctor and ask whether autism has been considered. It is a reasonable question, especially if you notice differences in communication, social connection, or repetitive behaviors. This article is for general education and does not replace an evaluation by a qualified professional. About the author Reina Valdez, MS, BCBA, is the CEO and founder of Stepping Stones Behavioral Services. She holds a bachelor's degree in Neuroscience and Behavior from Florida Atlantic University and a master's degree in Psychology with a concentration in Applied Behavior Analysis from Purdue University Global. Sources ● CHADD. Is It ADHD or Autism? https://chadd.org/adhd-news/adhd-news-caregivers/is-it-adhd-or-autism/ ● CDC. Signs and Symptoms of Autism Spectrum Disorder. https://www.cdc.gov/autism/signs-symptoms/index.html ● CDC. Symptoms and Diagnosis of ADHD (summary of DSM-5 criteria). https://www.cdc.gov/ncbddd/adhd/diagnosis.html ● CDC. Diagnosing ADHD. https://www.cdc.gov/adhd/diagnosis/index.html ● CDC. Clinical Screening and Diagnosis for Autism. https://www.cdc.gov/autism/diagnosis/index.html ● Lai, M.-C., et al. (2019). Prevalence of co-occurring mental health diagnoses in the autism population: a systematic review and meta-analysis. The Lancet Psychiatry, 6, 819-829. https://pubmed.ncbi.nlm.nih.gov/31447415/ ● Zablotsky, B., Bramlett, M. D., & Blumberg, S. J. (2017). The co-occurrence of autism spectrum disorder in children with ADHD. Journal of Attention Disorders. https://stacks.cdc.gov/view/cdc/50445 ● Miodovnik, A., et al. (2015). Timing of the diagnosis of attention-deficit/hyperactivity disorder and autism spectrum disorder. Pediatrics, 136(4), e830-e837. https://thetransmitter.org/spectrum/attention-deficit-may-mask-autism-delay-diagnosis ● CDC. Milestone Tracker app. https://www.cdc.gov/act-early/milestones-app/index.html