Rates of comorbid symptoms in children with ASD,ADHD, and comorbid ASD and ADHD

The current diagnostic criteria do not allow co-diagnosis of autism spectrum disorder (ASD) and attention deficit/hyperactivity disorder (ADHD). As a result, there has been little research on how these two disorders co-occur in the ASD population. The current study aimed to extend the literature in this area by examining comorbid rates in three different diagnostic groups (ASD, ADHD, and comorbid ASD + ADHD) using the Autism Spectrum Disorders-Comorbidity for Children (ASD-CC). Children with comorbid ASD and ADHD evinced higher rates of comorbid symptoms than children with ASD or ADHD alone. Additionally, children with comorbid ASD and ADHD endorsed more severe comorbid symptoms. Implications regarding these findings are discussed.     

Comparing the rates of tantrum behavior in children with ASD and ADHD as well as children with comorbid ASD and ADHD diagnoses

The current study investigated the presentation of tantrum behaviors in individuals with an autism spectrum disorder (ASD) diagnosis with and without a comorbid diagnosis of attention deficit hyperactivity disorder (ADHD). Participants included 347 children ranging in age from 2 to 18 years old. Diagnostic categories in the current study were based upon clinical diagnosis. The severity of ASD symptomology was measured by the Autism Spectrum Disorder-Diagnostic Child Version (ASD-DC). The presence and severity of tantrum behaviors were measured by the Tantrum behavior subscale of the Autism Spectrum Disorders-Comorbidity for Children (ASD-CC). The influence of diagnosis and ASD symptomology had upon the expression of tantrum behaviors were examined, controlling for participant age. Initial analysis revealed significant differences in the expression of tantrum behavior between the ASD, ADHD and ASD/ADHD groups. However, age did not have a significant influence on the exhibition of tantrum behaviors. Follow-up analyses demonstrated that those individuals diagnosed with an ASD and a comorbid ADHD diagnosis exhibited significantly greater tantrum behavior. Post hoc analyses identified a significant positive correlation between increases in ASD symptomology and elevations of the severity of tantrum behaviors for each group. The observed correlation for the ADHD group was found to be significantly greater than the ASD group. Correlations for individual item responses of the ASD-CC were also computed and discussed for each diagnostic group.     

Externalizing and tantrum behaviours in children with ASD and ADHD compared to children with ADHD

Objective: Compare rates of externalizing in children with autism spectrum disorder (ASD) and attention deficit/hyperactivity disorder (ADHD) symptoms to children with ADHD.

Method: Parents/caregivers of 85 children with ASD and/or ADHD were surveyed about their children's behaviours using the Autism Spectrum Disorders-Comorbidity for Children and the Autism Spectrum Disorders-Behaviour Problem for Children.

Results: Specific main effects analyses were then conducted. Children with ASD exhibited a higher number of externalizing (F(1,?83)?=?83.34, p?<?0.001) and tantrum behaviours (F(1,83)?=?781.86, p?<?0.001) than children without ASD.

Conclusions: ASD exacerbates the externalizing symptoms of ADHD during childhood. This study adds to the literature on the importance of assessing for a wide-range of possible behaviour problems in children presenting with ADHD symptomatology. The implications of these findings are discussed in the context of other research.     

Autism spectrum disorder symptoms in children with ADHD: A community-based study

This study examined the prevalence of autism spectrum disorder (ASD) symptoms in a community-based sample of children with attention-deficit/hyperactivity disorder (ADHD) and non-ADHD controls. We also examined the relationship between ASD symptoms and ADHD subtype, ADHD symptom severity and child gender. Participants were 6–10-year-old children (164 ADHD; 198 non-ADHD control) attending 43 schools in Melbourne, Australia, who were participating in the Children's Attention Project. ADHD was assessed in two stages using the parent and teacher Conners’ 3 ADHD index and the Diagnostic Interview Schedule for Children IV (DISC-IV). ASD symptoms were identified using the Social Communication Questionnaire (SCQ). Unadjusted and adjusted linear and logistic regression examined continuous and categorical outcomes, respectively. Children with ADHD had more ASD symptoms than non-ADHD controls (adjusted mean difference = 4.0, 95% confidence interval (CI) 2.8; 5.3, p < 0.001, effect size = 0.7). Boys with ADHD had greater ASD symptom severity than girls with ADHD (adjusted mean difference = 2.9, 95% CI 0.8; 5.2, p = 0.01, effect size = 0.4). Greater ADHD symptom severity was associated with greater ASD symptom severity (regression co-efficient = 1.6, 95% CI 1.2; 2.0, p < 0.001). No differences were observed by ADHD subtype. Greater hyperactive/impulsive symptoms were associated with greater ASD symptoms (regression coefficient = 1.0; 95% CI 0.0; 2.0, p = 0.04) however, this finding attenuated in adjusted analyses (p = 0.45). ASD symptoms are common in children with ADHD. It is important for clinicians to assess for ASD symptoms to ensure appropriate intervention.     

Parent-reported problematic sleep behaviors in children with comorbid autism spectrum disorder and attention-deficit/hyperactivity disorder

BackgroundSleep problems are frequent and well documented in children with Autism Spectrum Disorders (ASD), children with Attention Deficit/Hyperactivity Disorder (ADHD) and children with internalizing problems, however limited work has examined sleep problems in children presenting with comorbid ASD/ADHD. In healthy children, sleep problems negatively impact social, emotional, and academic functioning. The current study sought to examine diagnostic severity as predictors of sleep problems in children with comorbid ASD/ADHD. Additionally, the association between sleep and “real-life” functional domains (i.e., intellectual functioning, academic achievement, and executive functioning) were assessed.MethodSleep, internalizing difficulties, intellectual functioning, academic achievement and executive functioning were assessed in 85 children with who carried the dual diagnoses of ASD and ADHD.ResultsInternalizing difficulties, rather than ASD or ADHD symptom severity, was the most consistent predictor of problematic sleep behaviors (i.e., nightmares overtiredness, sleeping less than other children, trouble sleeping, and Total Problematic Sleep Behaviors) in this sample. Further, parent report of problematic sleep behaviors was significantly associated with functional domains after controlling for ASD, ADHD, and internalizing symptoms.ConclusionsResults suggest that internalizing symptoms are associated with problematic sleep behaviors in children with comorbid ASD/ADHD and may have implications for the “real-life” functioning among children with comorbid ASD/ADHD.     

Anxiety relates to classroom executive function problems in students with ASD,but not ADHD

BackgroundAnxiety occurs at elevated rates in developmental disorders and has been linked to executive functioning (EF) deficits. EF is strongly related to academic outcomes, but the relationship between anxiety and EF in the classroom has not been examined.MethodWe explored this relationship in two neurodevelopmental disorders, autism spectrum disorders (ASD) and attention-deficit/hyperactivity disorder (ADHD), in order to evaluate the specificity of associations between parent-reported anxiety and teacher-reported EF deficits in the classroom setting.ResultsGreater anxiety was associated with more classroom EF-related problems in the ASD group, but not in the ADHD group. Item-level analysis of classroom EF problems in the ASD group revealed associations between anxiety and difficulties with task initiation, attention, and completion. Anxiety was not related to total or item-level teacher-reported EF problems in the ADHD group.ConclusionFurther investigation into disorder-specific mechanisms that lead to the manifestation of anxiety symptoms may pave the way for more effective treatment and favorable academic outcome. Anxiety is related to poor EF in the classroom for students with ASD, which has implications for treating anxiety to promote positive academic outcomes and incorporating EF supports and training into treatment models for anxiety. The lack of association between anxiety and EF for students with ADHD was unexpected and warrants further exploration.     

Sleep problems in children with autism, attention-deficit hyperactivity disorder, and epilepsy

This study aimed to examine sleep problems in children with autism spectrum disorders (ASD), attention-deficit/hyperactivity disorder (ADHD), and epilepsy in clinical settings. We assessed 64 children with ASD, 64 with ADHD, 64 with epilepsy, and 64 typically developing children without any neuropsychiatric disorders by using a sex-and age-matched case-control study design. The parents reported their children's sleep problems. Parents of children with ASD and ADHD reported more current and lifetime sleep problems of their children than parents of children with epilepsy, especially in snoring and restless legs syndrome. Current or lifetime sleep problems did not differ between children with ASD and children with ADHD, or between children with epilepsy and typically developing children. Demographic characteristics and medication status could not fully explain the increased risk of sleep problems in children with ASD and ADHD. Our findings lend evidence to support more sleep problems in children with ASD and ADHD than typically developing children. Our study adds that children with epilepsy do not. These findings emphasize the importance to assess sleep problems in children with neurodevelopmental disorders highly comorbid with ASD or ADHD in clinical practice.     

Exploration of the correlation between autism spectrum disorder symptomology and tantrum behaviors

The purpose of the current study was to investigate the relationship between the presence of Autism Spectrum Disorder (ASD) symptoms and tantrum behaviors in 598 children ranging in age from two to sixteen years old who meet cutoffs for ASD. Diagnostic categories created in the current study were provided by the Autism Spectrum Disorder – Diagnostic Child Version (ASD-DC). Initial analysis replicated previous research revealing significant differences in the expression of tantrum behavior between the ASD, Atypical, and Normal groups. Pearson Bivariate correlations were then computed for each individual's ASD symptom score and their total score on the Tantrum behavior subscale. Follow-up correlations found significant positive correlations between individual's in the Atypical, Normal, and ASD categories and their scores for the Tantrum behavior subscale of the Autism Spectrum Disorders – Comorbidity for Children (ASD-CC). Post hoc analyses revealed that the correlation between ASD symptomology and tantrum behaviors in the Normal group was significantly different when compared to children in the ASD group.     

ADHD and autistic traits,family function,parenting style,and social adjustment for Internet addiction among children and adolescents in Taiwan: A longitudinal study

This longitudinal study investigated the prevalence, predictors, and related factors for Internet addiction among elementary and junior high school students in Taiwan. A convenient sample of grades 3, 5, and 8 students (n = 1153) was recruited from six elementary and one junior high schools. They were assessed during the beginning and the end of the spring semester of 2013. Internet addiction was examined by the Chen Internet Addiction Scale (CIAS). Other factors were screened using the Chinese version of the Autism Spectrum Quotient (AQ) for autistic trait, the Parental Bonding Instrument (PBI) for parenting, the Family APGAR for family support, the Social Adjustment Inventory for Children and Adolescents for social function, and the Swanson, Nolan, and Pelham, version IV scale (SNAP-IV) for ADHD symptoms. The prevalence of Internet addiction decreased from 11.4% to 10.6%. Male, low family support, poor social adjustment, and high ADHD-related symptoms were related to Internet addiction. However, there was an inverse relationship between autistic traits and Internet addiction. Further, its predictivity could be accounted by poor academic performance, male, and protective parenting style. Internet addiction is not uncommon among youths in Taiwan. The predictors identified in this study could be the specific measures for the development of a prevention program for Internet addiction in the youth population.     

Catechol-O-methyltransferase Val158Met polymorphism and hyperactivity symptoms in Egyptian children with autism spectrum disorder

Catechol-O-methyltransferase (COMT) plays an important role in the catabolism of brain dopamine and norepinephrine, which have been implicated in the pathogenesis of Autism spectrum disorder (ASD) as well as in other neuropsychatric disorders. We aimed to investigate the association of COMT Val158Met gene polymorphism with ASD and to examine the influence of such genotypes on hyperactivity symptoms in ASD patients. Eighty ASD patients (mean age 9 ± 1.9 years) and 100 control children (mean age 8.9 ± 1.9 years) were examined. COMT Val58Met polymorphism was genotyped using Tetra-primer ARMS-PCR method. The clinical diagnosis of ASD and ADHD were confirmed according to the DSM-IV criteria for research. We found no significant difference in genotypes or alleles’ frequencies of COMT Val158Met polymorphism between ASD patients and control group. There was a significant association between COMT (Val/Val) genotype and both increasing CARS (p = 0.001) and hyperactivity scores (p = 0.006). Regarding Conner's Score, the DSM-IV hyperactive impulsive were significantly higher in Val/Val genotype than both Met/Val and Met/Met genotypes (p = 0.03). Our data suggested an association between COMT Val58Met polymorphism and hyperactivity symptoms in Egyptian children with ASD.     

Treating children with attention-deficit/hyperactivity disorder and comorbid epilepsy

Attention-deficit/hyperactivity disorder (ADHD) is one of common neurodevelopmental disorder often comorbid with epilepsy. There are no existing guidelines on how to manage these two conditions when they are comorbid. To identify relationship between epilepsy and ADHD and to know role of antiepileptics and safety of stimulant like methylphenidate in such conditions from existing literature, we searched articles published in clinical journals available online between 1990-2010, with these key words in medline:children, epilepsy, seizure, comorbid, ADHD, treatment. Relevant abstracts were further selected for their focus on current topic. Cross references were extracted. Finally relevant articles that included original research articles, reviews and abstracts of non-english literature were used. Children with epilepsy may manifest with symptoms of ADHD. Children with ADHD may develop epilepsy. Some antiepileptics like phenobarbitone, gabapentin, topiramate may not be helpful in controlling behavioral symptoms of ADHD. Stimulants are the main stay of pharmacotherapy for ADHD but there is risk of decreasing seizure threshold in children with comorbid epilepsy especially when their epilepsy is not well controlled. Existing evidence is not in favor of screening children with ADHD for EEG abnormality before starting stimulant therapy.     

Do You Really Lose When You Snooze? Sleep Correlates of Externalizing and Attention Problems Among Pediatric Patients with ADHD,ASD, and Comorbid Diagnosis

ABSTRACT

Introduction

The primary aim of this retrospective study was to assess differential associations between sleep disturbances with externalizing/internalizing problems, ADHD profiles (inattention, hyperactivity/impulsivity), and social impairment among children with ADHD, autism spectrum disorder (ASD), and comorbid diagnoses (ASD+ADHD).     

Rates of psychotropic medication use in children with ASD compared to presence and severity of problem behaviors

There is a scarcity of research on the relationship between presence of problem behaviors and psychotropic medication use in children with autism spectrum disorder (ASD). Participants in the current study were children and adolescents ages 3–17 years who were sorted into four groups: ASD on psychotropic medication (N = 100), ASD not on psychotropic medication (N = 147), typically developing on medication (N = 48), and typically developing not on medication (N = 168). A one-way multivariate analysis of covariance (MANCOVA) was conducted to determine the relationship between medication use and rates of internalizing and externalizing behaviors. Post hoc analyses revealed that children with ASD on psychotropic medication evinced significantly more externalizing behaviors than children with ASD not on medication. However, the two groups did not significantly differ on rates of internalizing behaviors. These results suggest that psychotropic medications may often be prescribed to manage externalizing behaviors. Implications of these findings are discussed in relation to the existing literature.     

Neurodevelopmental correlates of behavioural and emotional problems in a neuropaediatric sample

Most research does not address the overlap between neurodevelopmental disorders when investigating concomitant mental health problems. The purpose of the present study was to examine the association of intellectual disability (ID), autism spectrum disorder (ASD), and attention-deficit/hyperactivity disorder (ADHD) with the presence of behavioural and emotional problems after controlling for other well-known correlates and risk factors. The sample included 4- to 18-year-old children who attended neuropaediatric clinics (N = 331). After controlling for adversity, age, gender, other developmental/neurological disorders, parental emotional problems, and parenting strategies, the presence of ADHD but not ASD or ID was uniquely associated with behaviour problems. Neither ADHD nor ASD nor ID was significantly associated with emotional problems after controlling for other risk factors. However, ADHD, ASD and behavioural/emotional disorders but not ID were significantly associated with functional impairment in everyday activities after controlling for other risk factors. Because children with neurodevelopmental disorders have complex needs, a holistic approach to diagnosis and interventions is highly warranted, including the assessment and treatment of behavioural and emotional disorders.     

Constipation prevalence and perceptions: Comparison of children and adolescents with ASD and other developmental-behavioral disorders

BackgroundFew studies have compared youth constipation in autism spectrum disorder (ASD) to constipation in other developmental-behavioral (DB) disorders.MethodsChildren and caregivers presenting to a DB pediatrics and psychology clinic completed written questionnaires on constipation. Comparison groups were ASD vs without ASD and caregiver vs child responses. Binary logistic regression were conducted to compare categorical variables.ResultsCaregivers of 169 toilet trained children and 26 non-toilet trained children completed the survey; 30 % of the toilet trained and 62 % of the non-toilet trained children had ASD. 88 toilet trained children completed the survey. Based on caregiver response, toilet trained youth with ASD were more likely to have been constipated in the past and to currently or previously taken medication to manage constipation. In both the total toilet trained and non-toilet trained sample, more caregivers endorsed their child meeting Rome IV criteria for functional constipation than endorsed current constipation. 37 % of parent/child pairs disagreed on whether the child met the Rome IV criteria. Caregivers of toilet trained youth with ASD were more likely to endorse specific barriers and impairment due to managing constipation in comparison to caregivers of youth without ASD.ConclusionsChildren with ASD may be at a higher lifetime risk of constipation and of needing medication compared to children with other DB disorders. Providers should use thorough questions to identify constipation and gather information from both caregiver and child when possible. Clinicians should consider targeting behavioral treatment recommendations to perceived caregiver concerns.     

Attention-deficit/hyperactivity disorder (AD/HD) in autism spectrum disorder

The purpose of this review is to provide an overview of the research on attention-deficit/hyperactivity disorder (AD/HD) in individuals with autism spectrum disorder (ASD). Topics explored are the prevalence of AD/HD, the importance of studying AD/HD, as well as the questionnaire measures used to measure AD/HD in individuals with ASD. Research on the relationship between AD/HD in ASD and parental stress and psychological distress, developmental regression, language and communication, adaptive behavior, social skills, autism severity, challenging behavior, comorbid psychopathology, gastrointestinal symptoms, sleep problems, epilepsy, sensory issues, motor difficulties, and quality of life are also discussed. Research on cardiac reactivity and executive functioning are also explored. Finally, recommendations for treatment are given as well as areas where future research is needed.     

Prevalence of attention-deficit/hyperactivity disorder in individuals with autism spectrum disorder: A meta-analysis

BackgroundComorbidity with attention-deficit/hyperactivity disorder (ADHD) is very common in autism spectrum disorder (ASD), worsening the developmental trajectory of ASD. The reported rates of ADHD in ASD vary widely. However, no meta-analysis has been conducted specifically to assess both the current and lifetime prevalence of ADHD in ASD. This study aims to fill in this gap.MethodWe searched the Web of Science, PubMed, PsycINFO, CINAHL, and Embase databases for eligible articles published between January 1, 2000, and September 5, 2020. The risk of bias tool was used to assess the studies’ quality. Overall pooled estimates of the current and lifetime prevalence of ADHD in ASD were obtained using random-effects models. Study heterogeneity was examined by Q and I² statistics.FindingsA total of 63 articles were eventually included, of which 56 studies reported the current prevalence, and 13 studies reported the lifetime prevalence. The results revealed that the pooled current and lifetime prevalence rates of ADHD among ASD were 38.5 % (95 % CI 34.0–43.2) and 40.2 % (95 % CI 34.9–45.7), respectively. Our study also confirmed that age, intellectual disability, recruitment settings, and diagnostic criteria significantly influenced the current prevalence of ADHD in ASD.ConclusionASD has considerable high current or lifetime prevalence rates of co-occurring ADHD. The findings demonstrate that clinicians should consider the high prevalence of ADHD in ASD and especially stay alert to possible ADHD diagnoses in school-age children and adolescents with ASD. Medical institutions should improve the assessment and tracking system of ADHD comorbidity in ASD and maximize the diagnostic accuracy for better treatment.     

A comparison of children and adolescents with ASD,atypical development,and typical development on the Behavioral Assessment System for Children,Second Edition (BASC-2)

The present study examined the use of the Behavioral Assessment System for Children, Second Edition (BASC-2) in discerning 151 children and adolescents 12–16 years of age with autism spectrum disorder (ASD) from atypically and typically developing children and adolescents. Scores on the BASC-2 composites (i.e., externalizing behaviors, internalizing behaviors, behavior symptom index [BSI], adaptive behaviors) and subscales (i.e., hyperactivity, aggression, conduct problems, anxiety, depression, somatization, atypicality, withdrawal, attention, adaptability, social skills, leadership, activities of daily living, functional communication) were compared between children and adolescents with ASD, atypical development, and typical development. With the exception of aggression, somatization, and internalizing behaviors, participants with ASD were significantly more impaired than typically developing participants in all other composites and subscales. In comparison to atypically developing participants, the scores of participants with ASD evinced more impairment for BSI and its subscales, with the exception of attention, and the adaptive behavior composite and its subscales, with the exception of adaptability. Scores on the externalizing behaviors and internalizing behaviors composites and their subscales, with the exception of anxiety, were not significantly different. Research and clinical implications are discussed.     

A comparison of patterns of sensory processing in children with and without developmental disabilities

This study compared the patterns of sensory processing among children with autism spectrum disorder (ASD), attention deficit and hyperactivity disorder (ADHD), and children without disabilities. Parents reported on the frequency of sensory processing issues by completing the Chinese Sensory Profile (CSP). Children with disabilities (ASD or ADHD) exhibited significantly more sensory processing issues than children without disabilities. The results of GLM and discriminant analyses showed that the CSP effectively differentiated between children with and without developmental disabilities. But it failed to identify major differences in sensory processing issues between children with either ASD or ADHD. Sensory processing issues could be one of many criteria that characterize and differentiate the features of children with different developmental disabilities. Although no significant gender differences in sensory processing issues appeared, age was a significant cofounding factor in evaluating sensory processing. Children without disabilities showed some small decreases in sensory processing issues as they aged from 6 to 12 years old. Children with ASD showed some decrease in sensory processing issues over the span of their childhood, while children with ADHD showed a significant increase in auditory processing issues as well as small increases in many aspects of sensory processing.     

Callous-unemotional traits moderate executive function in children with ASD and ADHD: A pilot event-related potential study

Attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) are associated with varied executive function (EF) difficulties. Callous-unemotional (CU) traits, a proposed antecedent of adult psychopathy, are often associated with intact or enhanced EF. Here we test whether CU traits may therefore modulate EF in ASD and ADHD, in which EF is typically impaired. We collected CU traits and measured event-related potentials (ERPs) that index EF during a cued-continuous performance test (CPT-OX) in boys with ASD, ADHD, comorbid ASD + ADHD and typical controls. We examined attentional orienting at cues (Cue-P3), inhibitory processing at non-targets (NoGo-P3) and conflict monitoring between target and non-target trials (Go-N2 vs. NoGo-N2). In children with ASD, higher CU traits were associated with an enhanced increase in N2 amplitude in NoGo trials compared to Go trials, which suggests relatively superior conflict monitoring and a potential cognitive strength associated with CU traits. The results emphasise the importance of considering the effects of co-occurring traits in the assessment of heterogeneity of EF profiles in neurodevelopmental disorders.