Autism and AD(H)D: Why Social Integration Can Be So Difficult

“Hey, Mom! Could you look over this email before I send it? I want to make sure I am saying this right.”

This concern for proper phrasing and understanding of a specific social interaction is something I hear quite often from my youngest son. As many of you already are aware, my ‘baby’ (I know he is eighteen years old now, but he will always be my baby) struggled with severe dyslexia. With the help of a Davis® Dyslexia Program, he has mastered reading. But, what has become evident as he gets older is that he still struggles with some of the social nuances that many of us take for granted.

He has only been formally diagnosed with dyslexia, having escaped the barrage of other possible labels that may have easily been applied to him – ADD and Asperger’s to name a few.

So, the question is: “What is it about ADD/ADHD and autism, that results in difficulties with social interaction?”

The vast array of social struggles these individuals endure has been well-documented. But, I was curious as to WHY they struggle. WHY can’t my son understand that there are ‘nicer’ ways to say some things as opposed to just stating the obvious?

As a pediatrician, a Davis® Facilitator and, most importantly, a mom, I have some theories…

Lorna Wing is credited for describing the Triad of Impairment that is seen in Autism Spectrum Disorder (ASD). This triad – social communication, social interaction, and social imagination – refers to the difficulties seen in individuals with Autism Spectrum Disorder and their ability for social integration. When I look at AD(H)D, there are some similarities in the struggles that are experienced socially.

First, let’s lay a foundation of understanding.


If we look at what is generally considered neurotypical childhood development, as described by Jean Piaget, we see that, in autism, development appears to be either stuck in a stage, or incomplete.

The important thing to understand is that although we ascribe chronological ages to specific stages of development, they are not age-specific. Development is sequence-specific. Therefore, to move on to the next stage, you must complete the previous stage, regardless of your age.

Consequently, the inability to take turns, share, read facial expressions, and so on may seem unusual for a twelve-year-old, but is perfectly appropriate for a two-year-old.

The ability to socially integrate requires the individual to be able to reference their past experiences, consider other people’s feelings, and read body language and verbal tones. These are all characteristics that are found in Piaget’s third and higher stages of development. Many individuals with ASD are stuck in the earlier stages of development and therefore cannot be expected to master social integration past rote memorization of responses without some intervention.


It is my feeling that individuals with ADD/ADHD do not have problems paying attention. They have difficulty paying attention to what others want them to pay attention to. When they appear inattentive, they have often ventured into their own thought world and are no longer perceiving what is happening in the ‘real’ world. This disoriented perception is an amazing place from which to create, but it is not a good place to perceive what is happening in their real environment at any given moment.

If we spend much of our time disoriented into our thought world, beginning at a young age, then we do not perceive experiences the way they are really happening. We perceive those experiences as what we ‘think’ is happening. The problem with this is that we don’t learn ‘real’ world cause and effect.

If we don’t learn that things happen (effect) because of something else (cause), then we don’t understand consequence.

If we don’t understand consequence, then we don’t understand sharing, taking turns, not interrupting, turning in our homework, why we don’t hit, why we get in trouble or why we must consider someone else’s feelings. I am sure you can see how this could affect social integration.

We could spend hours talking about this (and I do in my workshops), but for now, let’s sum up what struggles with social integration can look like for individuals with ASD and/or AD(H)D. Here are just a few of the many possibilities.

Social Communication:

Autism: Decreased verbal ability, difficulty interpreting facial expressions/body language/tone of voice, difficulty expressing feelings, speaking in references specific to them, difficulty understanding figures of speech and metaphors, difficulty following long or complicated sentences, difficulty with multiple step commands.

ADD/ADHD: Distracted by own thoughts, misinterpreting body language and expressions, losing thread of conversations, difficulty with multiple step commands, losing train of thought, difficulty expressing thoughts in words, seeming random and unassociated in speech content.


Social Interaction:

Autism: Personal space issues, self-stimulating behaviors, socially inappropriate laughing/yelling/speaking, seeming uninterested.

ADD/ADHD: Difficulty taking turns, impulsivity, not understanding how they are causing any negative effects, hyperactivity.


Social Imagination:

Autism: Inability to see someone else’s perspective, difficulty with change, no concept of ‘real’ world cause and effect, no interpersonal or imaginative play, not understanding that others have their own thoughts and feelings, difficulty predicting what could happen next.

ADD/ADHD: Inability to accurately predict what will happen, inaccurate perception of cause and effect resulting in inferring non-causal relationships.


There is good news.

If we know there are missing pieces of information or knowledge within their development, then we can help them by providing the missing pieces.

Then the question is – HOW?

We are answering these questions and filling in the blanks in our upcoming Unlock the Genius workshop.

Keep it simple,

Dr. Angie


  1. Jeanette Grant on December 1, 2017 at 6:26 am

    Hi Dr. Angie,

    I am a MFT Intern working for Marla Maynard. She suggested I talk with you. I have an 11 year old grandson who lives with me who has been diagnosed with ADHD, PTSD, ODD and some say IED. He is a very loving and kind hearted young man but he is also very aggressive, angry, and difficult to deal with once something sets him off. He has a tendency to catastrophize even the slightest situation. He is currently medicated on Concerta ER 72 mg, Risperdal 1mg, and Intuniv ER 3mg qd. Without meds or even an hour late, life for him and us is hell. Since I am only an intern, funds are limited but I thought I would give it a shot to see if there is any way to help him. Any advice or help you could offer would be greatly GREATLY appreciated.

    • drangie on December 5, 2017 at 11:09 pm

      Jeanette, thank you for your post. In short, YES, there is hope and we can help. I have sent you an email with a link for a Complimentary Phone Consultation with me so we can work out your next course of action. We are here to help you and your grandson find joy and balance while helping him to participate fully in life. I look forward to speaking with you. – Dr. Angie

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