Getting an autism diagnosis for your child can be a difficult process. There are no clearly identified physical / biological markers for autism and it presents very differently in each person. As well as these factors making diagnosis less than straightforward, autism also shares symptoms with other conditions, like attachment difficulties.
Sometimes when children are not diagnosed with autism they are diagnosed with an attachment disorder instead. This can be even more common if your child exhibits traits of PDA (Pathological Demand Avoidance) because your child may have different traits to other autistic children, which may closely resemble traits of attachment disorder.
If your child is currently being diagnosed and has traits that could either be caused by attachment difficulties or autism the professionals will need to rule out attachment disorders before giving an autism diagnosis. It’s also possible for a child to have both. Whatever the case it is important if you are going through the diagnosis process with your child to have an understanding of what attachment disorder is, how it is caused, how it can be similar to autism and how it is different.
What is an attachment disorder?
Attachment disorders are psychiatric illnesses that can develop in young children who have problems with emotional attachments to others. Children who have attachment issues can develop two possible types of disorders: Reactive Attachment Disorder (RAD) and Disinhibited Social Engagement Disorder (DSED).
Children with RAD have problems seeking out adults for company and comfort when they are upset, and may appear to have little or no emotions when interacting with others. Children with DSED struggle to tell the difference between safe adults and strangers, and may be over familiar with people they don’t know, or allow strangers to care for them.
What causes attachment disorder?
Children usually develop an attachment disorder because of severe difficulties in their early interpersonal relationships. This may be because they have been physically or emotionally neglected or abused, or spent their early years with inadequate care or frequent changes in their primary caregiver, for example, having multiple foster families or living in an institutional setting like an orphanage or care home.
Although the above situations are the most common causes of attachment disorders there can be other reasons. It is not always the case that attachment disorder is caused by parents not spending enough time with their child on purpose, or abusing their child or the child being in care. For example if the child was ill as a baby they may have been separated from their parents when in hospital, mum may have suffered from postnatal depression, or the child may have experienced multiple traumatic events early in life.
It is also possible a child may have both autism and attachment disorder. The social and communication difficulties experienced by those with autism can sometimes create attachment problems.
What traits of attachment disorder are the same as autism traits?
There are striking similarities between how autism and attachment disorder can affect a child’s behaviour and character. Here are some common traits of both autism and attachment disorder in children:
- Difficulty with social skills and communication
- Emotional dysregulation
- Unusual eye contact
- Preferring to be alone
- Avoiding affection from others / seeking affection from strangers
- Sensory issues
- Problems with Theory of Mind
- Problems with food and social eating situations
In what ways are attachment disorders and autism different?
With proper treatment and secure love attachment disorder can be cured. Whilst autistic people can get support and learn skills, autism itself is a lifelong neurological condition.
Here are some other common differences:
- Food Children with attachment disorders may have problems with the social aspect of eating, who they accept food from and hiding or throwing away food, whilst autistic children usually have more of a problem with the food itself and how it is presented to them.
- Affection and trust Some autistic children don’t have a problem with affection per se and trust their primary caregivers, but have more of a problem with sensory issues such as kisses and hugging.
- Playing with other children Autistic children are usually more concerned with rules and fairness, struggle with role play or may prefer playing alone. Children with attachment disorders are more concerned with winning, are more able to engage in role play, are less likely to be able to play alone for long due to poor concentration and are more likely to bend or break rules.
- Lying and manipulation Children with attachment disorders can be very adept at telling elaborate lies to impress people or shift blame away from themselves, whilst autistic children are often very bad at lying or deceiving others.
- Perspectives of others’ thoughts and feelings Autistic children may be oblivious to others’ feelings and thoughts, whilst children with attachment disorder tend to be hypervigilant and overresponsive to other people’s thoughts and actions.
How do professionals decide whether a child has autism or an attachment disorder?
An autism diagnosis relies on input from a multi-disciplinary team of professionals and caregivers, who will usually take all the evidence, such as parental questionnaires, observation of the child, ADOS assessment and reports from professionals like teachers and doctors and come to a decision between them.
Heather Moran, a clinical and educational psychologist, developed The Coventry Grid in 2010 to help professionals differentiate between autism and attachment disorder. This has since been converted into an interview Q&A format for professionals to use to help them come to a decision easier. You can read about it and see the interview questions here.
What can I do if I don’t agree with the outcome of my child’s attachment disorder diagnosis?
If you are getting a diagnosis through the NHS you can ask your child’s GP or paediatrician for a second opinion. If you believe your child is a complex case, you can ask for your child to be referred to a specialist team, or you can seek a private diagnosis instead.
You can also make a complaint to the NHS. The complaints procedure will differ depending on where you live in the UK, but if you are in England the complaints procedure is here.