Autism and attachment disorder

Autism and attachment disorders may look similar, but there are definite differences in the way they are expressed in daily functioning. When a child has experienced a very difficult early life and/or abuse or trauma, it can be hard to tell whether the child has attachment problems, is autistic, or both.

The difficulties they show may appear very similar on the surface. Children and young people with autism and their parents are, however, known to be at high risk of developing insecure attachment patterns. It is important to note that while attachment disorder is focused in childhood, autism is lifelong and occurs in adults as well as children and young people.

Note the similarities between attachment disorder (AD) and autism (sometimes known as ASD). Children and young people and young people with either diagnosis may experience:

Difficulty with social skills (including use of language)
Struggles with emotional regulation
Stimming
Need for routine
Unusual eye contact
May seem calmer when alone
Avoiding affection
Listless or sad appearance
Self-esteem issues

However, there may be differences to note and discuss with the other professionals involved such as:

Look for the presence of traumatic events or dysfunctional relationships in the family. AD is caused by childhood distress, such as separation from parents or changing caregivers. While autistic people can experience trauma, autism itself is not caused by trauma.
Consider why the child has issues with food, if this is a concern. Both autistic children and young people and those with AD may experience difficulties with food. The difference is in why: autistic children and young people may have trouble with the food itself, while children and young people with AD have issues with the social relationships involved in eating.
Consider repetitive language. Autistic children and young people may use repetition for reassurance, enjoyment, or scripting, while children and young people with AD mostly use it for reassurance.
Consider how they treat their favourite things. Autistic children and young people tend to be more careful with treasured items in general, while children and young people with AD may be more likely to lose or break them.
Watch how the child plays with toys. Autistic children and young people are usually more solitary and organize their toys rather than creating storylines. Children and young people with AD will seek out others and play out a story. They may not play alone for very long. Consider if the child role-plays. Autistic children and young people tend to struggle with taking on various roles. Some cannot, and others can take a reactive role if a loved one initiates the storyline. Children and young people with AD often prefer a certain type of role (e.g. playing the baby), often repetitively play out their past experiences with their preferred endings, and have trouble ending the role-play.
Consider how the child distinguishes between fact and fiction. Autistic children and young people tend to be inexperienced and literal in this area. Children and young people with AD often show exaggerated ideas.
Consider how much the child pays attention to the other person’s emotions and thoughts. Autistic children and young people tend not to understand, while children and young people with AD tend to be hypervigilant and overly reactive.

Look at other conversation skills. Autistic children and young people and children and young people with AD are both unusual in conversation skills, usually in different ways including:

Eye contact: Autistic children and young people often offer little to no eye contact or will stare. Children and young people with AD give varying eye contact based on their emotions.
Physical closeness: Autistic children and young people do not know how close to stand to someone, and their physical distance does not mean anything. Children and young people with AD use physical distance as a tool to express emotions.
Vocabulary: Autistic children and young people tend to have word-finding problems and may have a strong vocabulary. Children and young people with AD tend to have a poor vocabulary. Children and young people with AD often use more emotional language than autistic children and young people do.
Factual commentary: Autistic children and young people recite information, often offering too much, because they do not know how much to say. Children and young people with AD do much less of this.
Emotional self-control: Children and young people with both disabilities have trouble regulating their own emotions, and experience very strong feelings.
Learning skills: Autistic children and young people tend to learn coping tips better if they get an explanation of how to do it. Children and young people with AD learn better from modelling.
Confusion: Autistic children and young people tend to have trouble understanding their own and others’ emotions (alexithymia).
Outbursts: Autistic “meltdowns” tend to have clearer causes, and are shorter than tantrums in children and young people with AD.
Panic: Autistic children and young people are more likely to panic over unexpected things such as changes in routine, whereas children and young people with AD are more likely to panic over worries about having their needs met (physical or emotional).
Memory and sense of time. Both autism and AD involve dysfunction, and the child may have difficulties with their memory and sense of time. Autistic children and young people often have poor working memory, and excellent long-term memory. Children and young people with AD tend to fixate on certain events and have selective memory. They may be confused about what they remember. Autistic children and young people have trouble keeping track of time, needing clocks and disliking waiting because of the uncertainty it brings.

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