Children's ADHD & Autism

ADHD and autism are two of the most common neurodevelopmental conditions of childhood, and the commonness is the thing that makes them familiar, and the familiar is the thing that makes them seem simple, and the simple is the thing that makes them seem separate, and the separate is the thing that makes the overlap invisible, and the invisible overlap is the thing that this book is about. This is a book about the overlapping challenges of children's ADHD and autism, and the sequencing of evidence-based care, and the understanding of both is the thing that makes the helping possible, and the helping is the thing the book is for.

The overlap matters because the overlap is common, and the common is the thing that makes the overlap the rule rather than the exception, and the rule is the thing that makes the overlap the thing the clinician and the parent must understand. The child with ADHD is not uncommonly a child with autism traits, and the child with autism is not uncommonly a child with ADHD traits, and the not-uncommonly is the thing that makes the overlap the thing that the assessment must look for, and the looking is the thing that the care depends on, and the depending is the thing that makes the overlap matter.

This book is written from fifteen years of clinical practice, much of it with children and families who came in with one diagnosis and who, in the work, turned out to have both, and the having-both was the thing that made the one-diagnosis care not enough, and the not-enough was the thing that brought them back into the room. The overlap is the work, and the work is what this book is for.

Who This Book Is For

It is for the parent who has a child with ADHD and who wonders whether there is more, and the wondering is the thing that the overlap explains. It is for the parent who has a child with autism and who sees the attention and the activity and the impulsivity and wonders whether the autism is the whole story, and the wondering is the thing that the overlap addresses. It is for the clinician who works with children and who needs a framework for the overlap that is clear enough to use and practical enough to apply. It is for the teacher who has the child in the classroom and who needs to understand what they are seeing. It is for anyone who loves a child who is both and who wants to help.

What This Book Is Not

This book is not a diagnostic manual. It is not a substitute for a comprehensive evaluation by a qualified clinician. The conditions this book describes are clinical conditions, and the clinical conditions require the clinical assessment, and the assessment is the thing that the diagnosis is built on, and the diagnosis is the thing that the care is built on, and the building is the thing that the professional does. This book is a guide to the understanding — the understanding of the overlap and the sequencing — and the understanding is the thing that makes the working-with-the-professional better, and the better is the thing the book is for.

The book is also not a promise. The conditions it describes are real, and the care it describes is evidence-based, but the evidence is the thing that guides, not the thing that guarantees, and the guiding is the thing that makes the care good, and the good is the thing that the evidence provides, and the providing is the thing that the book is about. Every child is different, and the different is the thing that makes the care personal, and the personal is the thing that the sequencing is for.

The Two — Overlap and Sequencing

The book is built around two things — the overlapping challenges and the sequencing of evidence-based care — and the two, together, are the understanding, and the understanding is the thing that makes the helping possible.

The overlapping challenges are the things that the ADHD and the autism share, and the sharing is the thing that makes the two hard to separate, and the hard-to-separate is the thing that makes the overlap the thing that must be understood. The symptoms that look like ADHD may be autism, and the symptoms that look like autism may be ADHD, and the may-be is the thing that makes the overlap the thing that the assessment must address, and the addressing is the thing that the care depends on.

The sequencing of evidence-based care is the ordering of the interventions, and the ordering is the thing that makes the care effective, and the effective is the thing that makes the care worth doing. The sequencing is not arbitrary. It is the thing that the evidence and the clinical wisdom produce, and the producing is the thing that makes the sequencing the thing that the clinician and the parent follow, and the following is the thing that makes the care work.

The Six Chapters, Named

The book is built around six chapters, and the six, together, are the work.

The first chapter — this one — is the why. It is about why the overlap matters and why the sequencing is the thing that follows from the understanding of the overlap.

The second chapter is the recognition. It is about knowing what you are seeing — the signs of ADHD, the signs of autism, and the signs that are both — and the knowing is the thing that makes the overlap visible.

The third chapter is the overlap. It is about where ADHD and autism meet — the shared symptoms, the shared challenges, the shared needs — and the meeting is the thing that makes the overlap the thing that must be addressed.

The fourth chapter is the assessment. It is about sequencing the evaluation — the order of the looking, the order of the testing, the order of the diagnosing — and the sequencing is the thing that makes the assessment accurate.

The fifth chapter is the evidence-based care. It is about what works — the interventions, the therapies, the supports — and the evidence is the thing that makes the care trustworthy, and the trustworthy is the thing that makes the care worth doing.

The sixth chapter is the sequencing. It is about putting it together for the child — the ordering of the care, the integrating of the interventions, the building of the plan — and the putting-together is the thing that makes the care personal, and the personal is the thing that makes the care effective.

A Word on the Word "Sequencing"

The book uses the word "sequencing" often, and the word matters. The sequencing is not the listing. The listing is the thing that puts the interventions in a row, and the row is the thing that makes the listing look like a plan, but the listing without the ordering is the listing that does not guide, and the not-guiding is the thing that makes the listing not the sequencing. The sequencing is the ordering — the deliberate, evidence-based, child-specific ordering of the interventions — and the ordering is the thing that makes the care effective, and the effective is the thing that the sequencing provides. The sequencing is the heart of the book, and the heart is the thing that the six chapters build toward, and the building-toward is the thing that makes the book worth reading, and the reading is the thing that makes the helping possible. Begin.

The recognition is the first work, and the first is the thing that everything else depends on, and the depending is the thing that makes the recognition the thing that must be done well. This chapter is about the recognition — knowing what you are seeing — and the knowing is the thing that makes the overlap visible, and the visible is the thing that makes the overlap addressable, and the addressable is the thing that makes the care possible.

Recognizing ADHD

ADHD is the attention-deficit/hyperactivity disorder, and the disorder is the thing that shows up as the inattention and the hyperactivity and the impulsivity, and the showing-up is the thing that makes the ADHD recognizable, and the recognizable is the thing that makes the ADHD nameable, and the nameable is the thing that makes the ADHD addressable.

The inattention is the first sign. The child with ADHD is the child who has trouble sustaining the attention, and the trouble is the thing that shows up as the not-finishing, the not-listening, the not-organizing, the not-remembering, the not-following-through. The inattention is not the not-caring, and the not-caring is the thing that the inattention is often mistaken for, and the mistaken-for is the thing that makes the inattention misjudged, and the misjudged is the thing that makes the child blamed for what is not their choice, and the blamed is the thing that the recognition addresses.

The hyperactivity is the second sign. The child with ADHD is the child who is always moving, and the always-moving is the thing that shows up as the fidgeting, the climbing, the running, the not-staying-seated, the not-being-quiet, the not-being-still. The hyperactivity is not the bad behavior, and the bad-behavior is the thing that the hyperactivity is often mistaken for, and the mistaken-for is the thing that makes the hyperactivity punished, and the punished is the thing that makes the child feel wrong for what is not their fault, and the wrong is the thing that the recognition addresses.

The impulsivity is the third sign. The child with ADHD is the child who acts before thinking, and the acting-before-thinking is the thing that shows up as the blurting, the interrupting, the not-waiting, the not-taking-turns, the grabbing, the hitting, the running-into-the-street. The impulsivity is not the rudeness, and the rudeness is the thing that the impulsivity is often mistaken for, and the mistaken-for is the thing that makes the impulsivity corrected, and the corrected is the thing that does not address the cause, and the not-addressing-the-cause is the thing that the recognition addresses.

Recognizing Autism

Autism is the autism spectrum disorder, and the disorder is the thing that shows up as the social-communication differences and the restricted and repetitive behaviors, and the showing-up is the thing that makes the autism recognizable, and the recognizable is the thing that makes the autism nameable, and the nameable is the thing that makes the autism addressable.

The social-communication differences are the first sign. The child with autism is the child who experiences the social and the communication differently, and the differently is the thing that shows up as the not-making-eye-contact, the not-reading-the-social-cues, the not-sharing-the-interest, the not-using-the-gestures, the not-understanding-the-jokes, the not-knowing-when-the-conversation-is-over. The differences are not the not-caring, and the not-caring is the thing that the differences are often mistaken for, and the mistaken-for is the thing that makes the child seem cold, and the cold is the thing that the child is not, and the not is the thing that the recognition addresses.

The restricted and repetitive behaviors are the second sign. The child with autism is the child who has the intense interests and the repetitive behaviors and the need for the routine and the sensitivity to the sensory, and the having is the thing that shows up as the lining-up, the sorting, the repeating, the scripting, the flapping, the rocking, the not-able-to-transition, the not-able-to-tolerate-the-loud, the not-able-to-eat-the-texture. The behaviors are not the oddness, and the oddness is the thing that the behaviors are often mistaken for, and the mistaken-for is the thing that makes the child seem strange, and the strange is the thing that the child is not, and the not is the thing that the recognition addresses.

Recognizing the Overlap

The overlap is the thing that makes the recognition hard, and the hard is the thing that makes the overlap the thing that must be looked for. The overlap is the thing that happens when the signs of the ADHD and the signs of the autism are present in the same child, and the same-child is the thing that makes the overlap common, and the common is the thing that makes the overlap the rule rather than the exception.

The overlap is recognizable in the shared signs — the inattention that is also the not-engaging, the hyperactivity that is also the sensory-seeking, the impulsivity that is also the not-reading-the-social-cues, the repetitive behavior that is also the not-able-to-shift-attention, the social difference that is also the not-listening, the routine need that is also the not-able-to-transition. The shared signs are the things that make the overlap the thing that the recognition must address, and the addressing is the thing that makes the overlap visible, and the visible is the thing that makes the overlap nameable, and the nameable is the thing that makes the overlap addressable.

The recognition of the overlap is the thing that the parent and the clinician must do together, and the together is the thing that makes the recognition accurate, and the accurate is the thing that makes the care right. The parent sees the child in all the settings, and the all-the-settings is the thing that makes the parent's seeing comprehensive, and the comprehensive is the thing that the clinician needs. The clinician sees the child through the training, and the training is the thing that makes the clinician's seeing expert, and the expert is the thing that the parent needs. The together is the thing that makes the recognition complete, and the complete is the thing that makes the care possible.

The Recognition as the Foundation

The recognition is the foundation the care stands on, and the foundation, laid, is the thing that makes the care possible, and the possible is the thing that makes the care effective, and the effective is the thing that makes the care worth doing. The recognition is not the diagnosis, but the recognition is the thing that makes the diagnosis possible, and the diagnosis is the thing that makes the care right, and the right is the thing that the recognition provides. The next chapter is the overlap — where ADHD and autism meet — and the meeting is the thing that makes the overlap the thing that must be understood, and the understanding is the thing that makes the care address both.

The overlap is the thing that makes the two conditions hard to separate, and the hard-to-separate is the thing that makes the overlap the thing that must be understood, and the understanding is the thing that makes the care address both. This chapter is about the overlap — where ADHD and autism meet — and the meeting is the thing that makes the overlap the rule rather than the exception, and the rule is the thing that makes the overlap the thing the care must address.

The Shared Symptoms

The first thing that makes the overlap is the shared symptoms, and the shared is the thing that makes the two conditions look alike, and the look-alike is the thing that makes the two hard to tell apart. The inattention is the shared symptom, and the sharing is the thing that makes the inattention present in both the ADHD and the autism, and the present-in-both is the thing that makes the inattention the thing that the assessment must sort, and the sorting is the thing that the next chapter is about.

The inattention of ADHD is the inattention that is the not-sustaining, and the not-sustaining is the thing that is across all the settings and all the tasks, and the across-all is the thing that makes the inattention of ADHD the inattention that is the not-able-to-attend. The inattention of autism is the inattention that is the not-engaging, and the not-engaging is the thing that is specific to the not-interesting, and the specific-to-the-not-interesting is the thing that makes the inattention of autism the inattention that is the not-able-to-attend-to-what-is-not-the-interest. The two are different, and the different is the thing that the assessment must sort, and the sorting is the thing that makes the care right.

The hyperactivity is the shared symptom, and the sharing is the thing that makes the hyperactivity present in both, and the present-in-both is the thing that makes the hyperactivity the thing that the assessment must sort. The hyperactivity of ADHD is the hyperactivity that is the always-moving, and the always-moving is the thing that is across all the settings, and the across-all is the thing that makes the hyperactivity of ADHD the hyperactivity that is the not-able-to-be-still. The hyperactivity of autism is the hyperactivity that is the sensory-seeking, and the sensory-seeking is the thing that is specific to the under-stimulated, and the specific-to-the-under-stimulated is the thing that makes the hyperactivity of autism the hyperactivity that is the not-able-to-be-still-without-the-right-input. The two are different, and the different is the thing that the assessment must sort.

The impulsivity is the shared symptom, and the sharing is the thing that makes the impulsivity present in both, and the present-in-both is the thing that makes the impulsivity the thing that the assessment must sort. The impulsivity of ADHD is the impulsivity that is the acting-before-thinking, and the acting-before-thinking is the thing that is across all the settings, and the across-all is the thing that makes the impulsivity of ADHD the impulsivity that is the not-able-to-wait. The impulsivity of autism is the impulsivity that is the not-reading-the-social-cues, and the not-reading-the-social-cues is the thing that is specific to the social, and the specific-to-the-social is the thing that makes the impulsivity of autism the impulsivity that is the not-knowing-the-when. The two are different, and the different is the thing that the assessment must sort.

The Shared Challenges

The second thing that makes the overlap is the shared challenges, and the shared is the thing that makes the two conditions create the same difficulties, and the same-difficulties is the thing that makes the two hard to tell apart by the impact. The executive functioning is the shared challenge, and the sharing is the thing that makes the executive functioning difficult in both the ADHD and the autism, and the difficult-in-both is the thing that makes the executive functioning the thing that the care must address.

The executive functioning is the brain's management system, and the management is the thing that does the planning, the organizing, the starting, the sustaining, the shifting, the regulating, the remembering. The executive functioning is the thing that is difficult in the ADHD, and the difficult is the thing that is the core of the ADHD, and the core is the thing that makes the ADHD the executive-functioning condition. The executive functioning is the thing that is also difficult in the autism, and the also-difficult is the thing that is the common co-occurrence, and the common is the thing that makes the autism often an executive-functioning condition too, and the too is the thing that makes the overlap the thing that the care must address.

The social challenges are the shared challenge, and the sharing is the thing that makes the social difficult in both, and the difficult-in-both is the thing that makes the social the thing that the care must address. The social challenges of ADHD are the social challenges of the impulsivity and the inattention — the interrupting, the not-listening, the not-waiting, the not-reading-the-room — and the social challenges are the things that make the social hard for the child with ADHD. The social challenges of autism are the social challenges of the social-communication differences — the not-making-eye-contact, the not-reading-the-cues, the not-understanding-the-jokes — and the social challenges are the things that make the social hard for the child with autism. The two are different, but the impact is the same, and the same-impact is the thing that makes the social the shared challenge.

The emotional regulation is the shared challenge, and the sharing is the thing that makes the emotional regulation difficult in both, and the difficult-in-both is the thing that makes the emotional regulation the thing that the care must address. The emotional regulation of ADHD is the emotional regulation of the impulsivity and the frustration — the quick-to-anger, the quick-to-tears, the quick-to-quit — and the emotional regulation is the thing that makes the emotions hard for the child with ADHD. The emotional regulation of autism is the emotional regulation of the overwhelm and the meltdown — the not-able-to-tolerate, the not-able-to-recover, the not-able-to-regulate — and the emotional regulation is the thing that makes the emotions hard for the child with autism. The two are different, but the impact is the same, and the same-impact is the thing that makes the emotional regulation the shared challenge.

The Shared Needs

The third thing that makes the overlap is the shared needs, and the shared is the thing that makes the two conditions require the same supports, and the same-supports is the thing that makes the two conditions the thing that the care can address together. The structure is the shared need, and the sharing is the thing that makes the structure helpful for both the ADHD and the autism, and the helpful-for-both is the thing that makes the structure the thing that the care can provide.

The structure is the thing that makes the world predictable, and the predictable is the thing that makes the world manageable, and the manageable is the thing that the child with ADHD and the child with autism both need. The structure is the routine, the schedule, the visual-support, the clear-expectation, the consistent-consequence, and the structure is the thing that makes the child able to function, and the able-to-function is the thing that the structure provides, and the providing is the thing that makes the structure the shared need.

The patience is the shared need, and the sharing is the thing that makes the patience helpful for both, and the helpful-for-both is the thing that makes the patience the thing that the care can provide. The patience is the thing that makes the adult able to stay calm, and the calm is the thing that makes the child able to calm, and the able-to-calm is the thing that the child with ADHD and the child with autism both need. The patience is the not-reacting, the not-escalating, the not-taking-it-personally, and the patience is the thing that makes the adult able to help, and the able-to-help is the thing that the patience provides.

The understanding is the shared need, and the sharing is the thing that makes the understanding helpful for both, and the helpful-for-both is the thing that makes the understanding the thing that the care can provide. The understanding is the thing that makes the adult see the child as the child, and the seeing-as-the-child is the thing that makes the adult able to respond to the need rather than the behavior, and the responding-to-the-need is the thing that the child with ADHD and the child with autism both need. The understanding is the not-judging, the not-blaming, the not-shaming, and the understanding is the thing that makes the adult able to connect, and the able-to-connect is the thing that the understanding provides.

The Overlap as the Rule

The overlap is the rule, and the rule is the thing that makes the overlap the thing that the care must address, and the addressing is the thing that makes the care right. The child with both is the child who needs the care that addresses both, and the both is the thing that makes the care more than the care for one, and the more-than-the-care-for-one is the thing that makes the sequencing necessary, and the necessary is the thing that the next chapters are about. The overlap is not the problem. The overlap is the thing that makes the child the child they are, and the child they are is the child the care is for, and the for is the thing that the understanding of the overlap makes possible.

The assessment is the thing that makes the diagnosis accurate, and the accurate is the thing that makes the care right, and the right is the thing that the assessment provides. This chapter is about the assessment — sequencing the evaluation — and the sequencing is the thing that makes the assessment accurate, and the accurate is the thing that makes the care address both the ADHD and the autism, and the both is the thing that the overlap requires.

What the Assessment Is

The assessment is the comprehensive, systematic, evidence-based evaluation of the child, and the evaluation is the thing that makes the child's profile clear, and the clear is the thing that makes the diagnosis accurate, and the accurate is the thing that makes the care right. The assessment is not a test. It is a process, and the process is the thing that gathers the information from the multiple sources, and the multiple-sources is the thing that makes the information comprehensive, and the comprehensive is the thing that makes the assessment accurate.

The assessment is done by the qualified clinician — the psychologist, the psychiatrist, the neurodevelopmental pediatrician — and the qualified is the thing that makes the assessment trustworthy, and the trustworthy is the thing that makes the assessment the thing the care is built on. The assessment is not the thing the parent does alone, but the parent is the thing the assessment depends on, and the depending is the thing that makes the parent's role essential, and the essential is the thing that makes the parent the partner in the assessment, and the partner is the thing that makes the assessment complete.

The Sequencing of the Evaluation

The sequencing is the ordering of the evaluation, and the ordering is the thing that makes the evaluation accurate, and the accurate is the thing that makes the diagnosis right. The sequencing is not arbitrary. It is the thing that the evidence and the clinical wisdom produce, and the producing is the thing that makes the sequencing the thing that the clinician follows, and the following is the thing that makes the evaluation work.

The first step is the history. The history is the gathering of the child's story — the development, the family, the medical, the educational, the social — and the gathering is the thing that makes the child's context clear, and the clear is the thing that makes the child's presentation understandable, and the understandable is the thing that makes the assessment accurate. The history is the thing the parent provides, and the providing is the thing that makes the parent essential, and the essential is the thing that makes the history the first step, and the first is the thing that makes the history the foundation the rest of the assessment stands on.

The second step is the observation. The observation is the seeing of the child in the multiple settings — the clinic, the home, the school — and the seeing is the thing that makes the child's behavior visible, and the visible is the thing that makes the child's presentation real, and the real is the thing that makes the assessment grounded. The observation is the thing the clinician does and the thing the parent does and the thing the teacher does, and the multiple-observers is the thing that makes the observation comprehensive, and the comprehensive is the thing that makes the assessment accurate.

The third step is the rating scales. The rating scales are the standardized, evidence-based questionnaires that the parent and the teacher complete, and the completing is the thing that makes the child's behavior quantified, and the quantified is the thing that makes the child's presentation measurable, and the measurable is the thing that makes the assessment objective. The rating scales are the things that measure the ADHD and the autism and the overlap, and the measuring is the thing that makes the overlap visible, and the visible is the thing that makes the overlap addressable.

The fourth step is the direct assessment. The direct assessment is the testing of the child by the clinician — the cognitive, the academic, the language, the social, the adaptive — and the testing is the thing that makes the child's strengths and challenges clear, and the clear is the thing that makes the child's profile complete, and the complete is the thing that makes the assessment comprehensive. The direct assessment is the thing that the clinician does, and the doing is the thing that makes the direct assessment the thing that the clinician's training provides, and the providing is the thing that makes the direct assessment the thing that the parent cannot do alone.

The fifth step is the differential. The differential is the sorting of the ADHD from the autism from the overlap from the other conditions — the anxiety, the depression, the learning, the sleep, the trauma — and the sorting is the thing that makes the diagnosis accurate, and the accurate is the thing that makes the care right. The differential is the thing that the clinician does, and the doing is the thing that makes the differential the thing that the training provides, and the providing is the thing that makes the differential the thing that the assessment depends on.

The Sequencing of the Diagnosis

The diagnosis is the thing that the assessment produces, and the producing is the thing that makes the diagnosis the thing the care is built on. The diagnosis is not the label. The diagnosis is the understanding, and the understanding is the thing that makes the care right, and the right is the thing that the diagnosis provides. The diagnosis is the thing that names the condition, and the naming is the thing that makes the condition addressable, and the addressable is the thing that makes the care possible.

The sequencing of the diagnosis is the ordering of the conditions, and the ordering is the thing that makes the care prioritized, and the prioritized is the thing that makes the care effective. The child with both ADHD and autism is the child who needs the care that addresses both, and the both is the thing that makes the care more than the care for one, and the more-than-the-care-for-one is the thing that makes the sequencing necessary. The sequencing of the diagnosis is the thing that determines which condition is addressed first, and the which-first is the thing that the evidence and the clinical wisdom produce, and the producing is the thing that makes the sequencing the thing that the care follows.

The Assessment as the Map

The assessment is the map of the child, and the map, made, is the thing that makes the child's profile clear, and the clear is the thing that makes the care right, and the right is the thing that makes the care effective. The assessment is not the end. It is the beginning, and the beginning is the thing that makes the rest of the work possible, and the possible is the thing that the next chapter — the evidence-based care — is about, and the about is the thing that makes the care the thing that the assessment makes possible, and the possible is the thing that the sequencing provides.

The evidence-based care is the thing that makes the helping trustworthy, and the trustworthy is the thing that makes the helping worth doing, and the worth-doing is the thing that the evidence provides. This chapter is about the evidence-based care — what works — and the what-works is the thing that makes the care effective, and the effective is the thing that makes the care worth providing.

What Evidence-Based Means

Evidence-based is the thing that means the care has been studied and shown to work, and the studied-and-shown is the thing that makes the care trustworthy, and the trustworthy is the thing that makes the care the thing the clinician and the parent can rely on. The evidence-based is not the only kind of care, but the evidence-based is the kind of care that the science supports, and the supporting is the thing that makes the evidence-based the kind of care that the book is about.

The evidence-based care is the care that has been tested in the studies, and the testing is the thing that has shown the care works, and the showing is the thing that makes the care evidence-based. The studies are the things that compare the care to the not-care, and the comparing is the thing that shows whether the care makes the difference, and the difference is the thing that makes the care effective, and the effective is the thing that makes the care evidence-based.

The Evidence-Based Care for ADHD

The evidence-based care for ADHD is the care that the studies have shown works for the ADHD, and the works-for-the-ADHD is the thing that makes the care the thing the clinician and the parent provide. The evidence-based care for ADHD includes the medication and the behavior therapy and the parent training and the school support, and the including is the thing that makes the care comprehensive, and the comprehensive is the thing that makes the care effective.

The medication is the first evidence-based care for ADHD, and the first is the thing that the studies have shown works, and the works is the thing that makes the medication the thing that the doctor considers. The medication is the stimulant and the non-stimulant, and the both are the things that the studies have shown work, and the work is the thing that makes the medication the thing that the doctor may prescribe. The medication is not the only care, and the not-only is the thing that makes the medication the thing that is part of the care, not the whole of the care, and the part is the thing that makes the medication the thing that works with the other care, and the with is the thing that makes the care comprehensive.

The behavior therapy is the second evidence-based care for ADHD, and the second is the thing that the studies have shown works, and the works is the thing that makes the behavior therapy the thing the clinician provides. The behavior therapy is the thing that teaches the child the skills and the strategies, and the teaching is the thing that makes the child able to manage the attention and the activity and the impulsivity, and the able-to-manage is the thing that the behavior therapy provides. The behavior therapy is the thing that the clinician does with the child and with the parent and with the teacher, and the with-all is the thing that makes the behavior therapy comprehensive, and the comprehensive is the thing that makes the behavior therapy effective.

The parent training is the third evidence-based care for ADHD, and the third is the thing that the studies have shown works, and the works is the thing that makes the parent training the thing the clinician provides. The parent training is the thing that teaches the parent the skills and the strategies, and the teaching is the thing that makes the parent able to manage the child's behavior, and the able-to-manage is the thing that the parent training provides. The parent training is the thing that makes the parent the thing the child needs, and the needs is the thing that makes the parent training the thing that works.

The school support is the fourth evidence-based care for ADHD, and the fourth is the thing that the studies have shown works, and the works is the thing that makes the school support the thing the school provides. The school support is the thing that includes the accommodation and the modification and the intervention, and the including is the thing that makes the school the thing that supports the child, and the supporting is the thing that makes the school support effective. The school support is the thing that makes the child able to succeed in the school, and the able-to-succeed is the thing that the school support provides.

The Evidence-Based Care for Autism

The evidence-based care for autism is the care that the studies have shown works for the autism, and the works-for-the-autism is the thing that makes the care the thing the clinician and the parent provide. The evidence-based care for autism includes the behavioral intervention and the developmental intervention and the social-communication intervention and the sensory support and the parent training, and the including is the thing that makes the care comprehensive, and the comprehensive is the thing that makes the care effective.

The behavioral intervention is the first evidence-based care for autism, and the first is the thing that the studies have shown works, and the works is the thing that makes the behavioral intervention the thing the clinician provides. The behavioral intervention is the thing that teaches the child the skills and the behaviors, and the teaching is the thing that makes the child able to function, and the able-to-function is the thing that the behavioral intervention provides. The behavioral intervention is the thing that is structured and systematic and individualized, and the structured is the thing that makes the behavioral intervention effective, and the effective is the thing that makes the behavioral intervention evidence-based.

The developmental intervention is the second evidence-based care for autism, and the second is the thing that the studies have shown works, and the works is the thing that makes the developmental intervention the thing the clinician provides. The developmental intervention is the thing that supports the child's development through the play and the relationship and the interaction, and the supporting is the thing that makes the child able to develop, and the able-to-develop is the thing that the developmental intervention provides. The developmental intervention is the thing that is natural and relational and individualized, and the natural is the thing that makes the developmental intervention effective.

The social-communication intervention is the third evidence-based care for autism, and the third is the thing that the studies have shown works, and the works is the thing that makes the social-communication intervention the thing the clinician provides. The social-communication intervention is the thing that teaches the child the social and the communication skills, and the teaching is the thing that makes the child able to connect, and the able-to-connect is the thing that the social-communication intervention provides.

The sensory support is the fourth evidence-based care for autism, and the fourth is the thing that the studies have shown works, and the works is the thing that makes the sensory support the thing the clinician provides. The sensory support is the thing that addresses the child's sensory needs, and the addressing is the thing that makes the child able to tolerate, and the able-to-tolerate is the thing that the sensory support provides. The sensory support is the thing that includes the sensory diet and the environmental modification and the sensory tool, and the including is the thing that makes the sensory support comprehensive.

The Evidence-Based Care for the Overlap

The evidence-based care for the overlap is the care that addresses both the ADHD and the autism, and the both is the thing that makes the care the thing the child with the overlap needs. The evidence-based care for the overlap is the thing that integrates the care for the ADHD and the care for the autism, and the integrating is the thing that makes the care comprehensive, and the comprehensive is the thing that makes the care effective for the child with both.

The integrating is the thing that the sequencing produces, and the sequencing is the thing that the next chapter is about, and the about is the thing that makes the integrating the thing that the care depends on, and the depending is the thing that makes the sequencing the heart of the book, and the heart is the thing that the next chapter is for, and the for is the thing that makes the care the thing the child needs, and the needs is the thing that the evidence-based care provides.

The sequencing is the heart of the book, and the heart is the thing that makes the care the thing the child needs, and the needs is the thing that the sequencing addresses. This chapter is about the sequencing — putting it together for the child — and the putting-together is the thing that makes the care personal, and the personal is the thing that makes the care effective, and the effective is the thing that makes the care worth providing.

What the Sequencing Is

The sequencing is the deliberate, evidence-based, child-specific ordering of the interventions, and the ordering is the thing that makes the care effective, and the effective is the thing that the sequencing provides. The sequencing is not the listing. The listing is the thing that puts the interventions in a row, and the row is the thing that makes the listing look like a plan, but the listing without the ordering is the listing that does not guide, and the not-guiding is the thing that makes the listing not the sequencing. The sequencing is the ordering — the deliberate, evidence-based, child-specific ordering — and the ordering is the thing that makes the care the thing the child needs.

The sequencing is done by the clinician with the parent and with the school, and the with-all is the thing that makes the sequencing comprehensive, and the comprehensive is the thing that makes the sequencing effective. The sequencing is not the thing the clinician does alone, but the sequencing is the thing the clinician leads, and the leading is the thing that makes the clinician essential, and the essential is the thing that makes the sequencing the thing that the team follows, and the following is the thing that makes the sequencing work.

The Principles of the Sequencing

The sequencing is guided by the principles, and the principles are the things that make the sequencing the thing that the evidence and the clinical wisdom produce. The principles are these:

The first principle is the safety. The safety is the thing that comes first, and the first is the thing that makes the safety the thing that the sequencing prioritizes. The child who is not safe is the child who cannot benefit from the care, and the not-able-to-benefit is the thing that makes the safety the thing that must come first. The safety is the thing that includes the physical safety and the emotional safety, and the including is the thing that makes the safety comprehensive, and the comprehensive is the thing that makes the safety the thing that the sequencing addresses before anything else.

The second principle is the function. The function is the thing that comes second, and the second is the thing that makes the function the thing that the sequencing prioritizes after the safety. The child who is not functioning is the child who cannot benefit from the higher care, and the not-able-to-benefit is the thing that makes the function the thing that must come second. The function is the thing that includes the sleep and the nutrition and the routine and the regulation, and the including is the thing that makes the function comprehensive, and the comprehensive is the thing that makes the function the thing that the sequencing addresses before the skills.

The third principle is the skills. The skills are the thing that comes third, and the third is the thing that makes the skills the thing that the sequencing prioritizes after the function. The child who is functioning is the child who can benefit from the skills, and the able-to-benefit is the thing that makes the skills the thing that comes third. The skills are the thing that includes the attention and the behavior and the social and the communication, and the including is the thing that makes the skills comprehensive, and the comprehensive is the thing that makes the skills the thing that the sequencing addresses after the function.

The fourth principle is the integration. The integration is the thing that comes fourth, and the fourth is the thing that makes the integration the thing that the sequencing prioritizes after the skills. The child who has the skills is the child who can benefit from the integration, and the able-to-benefit is the thing that makes the integration the thing that comes fourth. The integration is the thing that includes the generalization and the maintenance and the independence, and the including is the thing that makes the integration comprehensive, and the comprehensive is the thing that makes the integration the thing that the sequencing addresses after the skills.

The Sequencing for the Child with Both

The child with both ADHD and autism is the child who needs the sequencing that addresses both, and the both is the thing that makes the sequencing the thing that the overlap requires. The sequencing for the child with both is the thing that integrates the care for the ADHD and the care for the autism, and the integrating is the thing that makes the care comprehensive, and the comprehensive is the thing that makes the care effective for the child with both.

The first step is the safety and the function. The safety and the function are the things that come first, and the first is the thing that makes the safety and the function the things that the sequencing prioritizes. The sleep and the nutrition and the routine and the regulation are the things that the child with both needs, and the needs are the things that the sequencing addresses first, and the first is the thing that makes the safety and the function the foundation the rest of the care stands on.

The second step is the ADHD care. The ADHD care is the thing that comes second, and the second is the thing that makes the ADHD care the thing that the sequencing prioritizes after the safety and the function. The ADHD care is the thing that includes the medication and the behavior therapy and the parent training and the school support, and the including is the thing that makes the ADHD care comprehensive, and the comprehensive is the thing that makes the ADHD care effective. The ADHD care is the thing that comes second because the ADHD is the thing that is often the most disruptive, and the most-disruptive is the thing that makes the ADHD the thing that must be addressed before the autism, and the before is the thing that makes the ADHD care the thing that comes second.

The third step is the autism care. The autism care is the thing that comes third, and the third is the thing that makes the autism care the thing that the sequencing prioritizes after the ADHD care. The autism care is the thing that includes the behavioral intervention and the developmental intervention and the social-communication intervention and the sensory support, and the including is the thing that makes the autism care comprehensive, and the comprehensive is the thing that makes the autism care effective. The autism care is the thing that comes third because the autism is the thing that is often the most complex, and the most-complex is the thing that makes the autism the thing that must be addressed after the ADHD, and the after is the thing that makes the autism care the thing that comes third.

The fourth step is the integration. The integration is the thing that comes fourth, and the fourth is the thing that makes the integration the thing that the sequencing prioritizes after the autism care. The integration is the thing that includes the generalization and the maintenance and the independence, and the including is the thing that makes the integration comprehensive, and the comprehensive is the thing that makes the integration effective. The integration is the thing that comes fourth because the integration is the thing that makes the care last, and the lasting is the thing that makes the care worth doing, and the worth-doing is the thing that makes the integration the thing that the sequencing addresses last, and the last is the thing that makes the integration the thing that makes the care the thing the child keeps.

The Sequencing as the Ongoing Work

The sequencing is not the one-time work. It is the ongoing work, and the ongoing is the thing that makes the sequencing the thing that the team revisits, and the revisiting is the thing that makes the sequencing the thing that adapts, and the adapting is the thing that makes the sequencing the thing that stays right for the child, and the right is the thing that the sequencing provides. The child grows and changes, and the growing and the changing are the things that make the sequencing the thing that must be revisited, and the revisiting is the thing that makes the sequencing the thing that stays current, and the current is the thing that makes the care the thing the child needs at each stage, and the each-stage is the thing that the sequencing addresses.

A Final Word

The overlapping challenges of children's ADHD and autism are real, and the real is the thing that makes the challenges the thing that the care must address, and the addressing is the thing that the sequencing provides. The recognition makes the overlap visible. The understanding of the overlap makes the care address both. The assessment makes the diagnosis accurate. The evidence-based care makes the helping trustworthy. The sequencing makes the care personal and effective. The five, together, are the work, and the work, done, is the thing that gives the child the care they need, and the need, met, is the thing that makes the child's life better, and the better is the thing the whole book is for.

You did not choose the conditions that make the child the child they are. You can choose, in the moment you begin the work, to do the sequencing the care requires. The recognition is here. The understanding is here. The assessment is here. The evidence-based care is here. The sequencing is here. The work is clear. The child, helped, is the child who is able to be the child they are, and the able-to-be is the thing that makes the life the life the child deserves, and the deserving, honored, is the thing the whole book is for, and the book is now yours, and the sequencing, done, is the thing that makes it so.

— Dr. David K. Lubega, LICSW, LCSW-C