Attention and basic literacy and numeracy in children with Autism Spectrum Disorder: A one-year follow-up study

Little is known about the link between Executive Functioning (EF) and academic performance in children with Autism Spectrum Disorder (ASD) and how such links develop over time. This study examined word reading, basic mathematics, attention switching, sustained attention and their development. Two age, gender and perceptual IQ matched groups of cognitively able 7–12 year olds (ASD N = 40; typical developing [TYP] N = 40) were assessed at baseline and one year later, completing Word Reading and Numerical Operations tests and computerized tasks tapping attention switching and sustained attention. Children with ASD had similar word reading and numerical operations performance and similar development of these skills relative to TYP children. A delay in attention switching but similar development was found in children with ASD relative to TYP children. The EF tasks were correlated with reading and mathematics in ASD children only, however, in regression analyses these factors were not significant predictors of Time 2 reading and mathematics after accounting for Time 1 reading and mathematics scores. These findings indicate similar word reading and mathematics development but atypical attention profiles in cognitively able children with ASD. Implications for educators are discussed.     

Autism and other psychiatric comorbidity in neurofibromatosis type 1: evidence from a population‐based study

Aim To investigate psychopathology in children with neurofibromatosis type 1 (NF1), particularly the prevalence of autism spectrum disorder (ASD) and attention‐deficit–hyperactivity disorder (ADHD) symptomatology, using a population‐based sampling approach. Method Standard questionnaire screen reports were analysed for ASD (Social Responsiveness Scale, SRS), ADHD (Conners’ Parent Rating Scale‐ Revised, CPRS‐R), and other psychiatric morbidity (Strengths and Difficulties Questionnaire, SDQ) from parents and teachers of children aged from 4 to 16 years (112 females, 95 males) on the UK North West Regional Genetic Service register for NF1. Results Parental response rate was 52.7% (109/207 children; 59 females, 50 males, mean age 9y 11mo, SD 3y 3mo). The SRS showed that in 29.4% (32/109) of children, autism was in the severe, clinical range (T‐score>75) and in 26.6% (29/109) in the mild to moderate range (T‐score 60–75). CPRS‐R scores showed that in 53.8% (57/106) of children autism was in the clinical ADHD range (ADHD index T‐score>65). Based on their scores on the SDQ total difficulties scale, 41.5% (44/106) of children were in the abnormal range and 14.2% (15/106) were in the borderline range. Twenty‐five per cent (26/104) of children met criteria for both clinical autism and ADHD. Interpretation This representative population‐based sample of children with NF1 indicates a high prevalence of ASD symptoms associated with NF1 as well as substantial co‐occurrence with ADHD symptoms. The findings clarify the psychopathology of NF1 and show the disorder as a potentially important single‐gene cause for autism symptoms.     

Prevalence and Incidence of Autism Spectrum Disorder in an Israeli Population

The prevalence of autism spectrum disorders has been steadily rising. In most parts of the world, rates as high as 1 % are reported, including in the United States. In Israel, previously reported prevalence rates have been in the 0.2 % range, and were based on parental reporting of diagnosis. In this study, records from one of the largest Israeli Health Maintenance organizations were used to calculate both incidence and prevalence of autism spectrum disorder (ASD) in Israel. Israeli prevalence of ASD was calculated at 0.48 % for 1–12 years olds and 0.65 % for 8 year old children in 2010, higher than previous Israeli reports, but still lower than prevalence estimates for the US. Incidence calculations ranged from 0.65 to 0.84 per 1,000 children for children 1–12 year olds. Reasons for these differences are suggested and 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.     

Comparing social skill profiles of children with autism spectrum disorders versus children with attention deficit hyperactivity disorder: Where the deficits lie

Marked socialization impairment is evident in both individuals with autism spectrum disorders (ASD) and individuals with attention deficit/hyperactivity disorder (ADHD). The current study utilizes the Matson Evaluation of Social Skills for Youngsters-II (MESSY-II) to explore similarities and discrepancies in the social skill profiles of children with ASD and children with ADHD ages 6–9 years old and 10–16 years old. Children with ASD and children with ADHD were both found to be significantly deficient in social skills compared to atypically developing peers without an Axis I or Axis II diagnosis; however, specific skill deficits vary between the groups. In particular, children with ASD exhibited a lack of adaptive social skills whereas children with ADHD demonstrated social skill knowledge but an increased level of maladaptive social behavior. The trends of socialization impairment over time were also found to differ in children with ASD versus children with ADHD. While children with ASD remained at similar levels of adaptive social skill impairment over age groups, children with ADHD were found to become more socially impaired in more areas over time. The distinct patterns and trends of social skill deficit found in children with ASD and children with ADHD can inform treatments targeted toward the specific deficits observed within each disorder.     

Naturalistic exploration of the effect of osmotic release oral system-methylphenidate on remission rate and functional improvement in Taiwanese children with attention-deficit-hyperactivity disorder

Aim: To determine the differences in the remission rate, recovery rate, functional improvement, and treatment adherence related to treatment with short‐acting immediate‐release methylphenidate (IR‐MPH) and long‐acting osmotic‐release oral system‐methylphenidate (OROS‐MPH) in a naturalistic setting among Taiwanese children with attention‐deficit–hyperactivity disorder (ADHD). Methods: A total of 757 children with ADHD, aged 6–18 years, was evaluated using the following in order determine functional improvement and treatment adherence: the Chinese version of the Swanson, Nolan, and Pelham, version IV scale (SNAP‐IV‐C), Clinical Global Impression‐ADHD‐Severity (CGI‐S) to measure remission and recovery rates, the Chinese version of the Social Adjustment Inventory for Children and Adolescents (CSAICA), and caregiver's satisfaction rate, treatment adherence, and frequency of adverse effects. Results: According to the SNAP‐IV‐C scores, the remission rate was 30.72%, and the recovery rate was 16.38%. Compared to short‐acting IR‐MPH, OROS‐MPH was associated with greater functional improvement and treatment adherence among children with ADHD. Conclusion: OROS‐MPH treatment at the adequate dosage can achieve higher remission and recovery rates, produce greater functional improvement, and result in better treatment adherence than IR‐MPH treatment.     

Dose-Response Effects of Long-Acting Liquid Methylphenidate in Children with Attention Deficit/Hyperactivity Disorder (ADHD) and Autism Spectrum Disorder (ASD): A Pilot Study

Attention deficit/hyperactivity disorder (ADHD) symptoms are common in youth with autism spectrum disorders (ASD) and are frequently treated with stimulant medications. Twenty-seven children were randomized to different dose titration schedules, and ADHD symptoms, tolerability, and aberrant behaviors were assessed weekly during a 6-week trial with long-acting liquid methylphenidate (MPH). MPH at low to moderate doses was effective in reducing ADHD symptoms and was well tolerated in young children with ASD and ADHD. Future studies are needed to assess generalization and maintenance of efficacy.     

Evaluation of the ADHD Rating Scale in Youth with Autism

Scientists and clinicians regularly use clinical screening tools for attention deficit/hyperactivity disorder (ADHD) to assess comorbidity without empirical evidence that these measures are valid in youth with autism spectrum disorder (ASD). We examined the prevalence of youth meeting ADHD criteria on the ADHD rating scale fourth edition (ADHD-RS-IV), the relationship of ADHD-RS-IV ratings with participant characteristics and behaviors, and its underlying factor structure in 386, 7–17 year olds with ASD without intellectual disability. Expected parent prevalence rates, relationships with age and externalizing behaviors were observed, but confirmatory factor analyses revealed unsatisfactory fits for one-, two-, three-factor models. Exploratory analyses revealed several items cross-loading on multiple factors. Implications of screening ADHD in youth with ASD using current diagnostic criteria are discussed.     

Autistic spectrum disorder,attention deficit hyperactivity disorder,and allergy: Is there a link? A nationwide study

Previous studies showed that both attention deficit hyperactivity disorder (ADHD) and autistic spectrum disorder (ASD) were associated separately with a higher risk of allergic diseases. However, the comorbid effect of ADHD and ASD on the risk of allergic diseases is still unknown. Using the Taiwan National Health Insurance Research Database, 5386 children aged less than 18 years with ADHD alone, 578 with ASD alone, 458 with ADHD + ASD, and 25,688 non-ADHD/ASD age- and sex-matched (1:4) controls were enrolled in our study. The prevalence of allergic diseases, including asthma, allergic rhinitis, atopic dermatitis, and allergic conjunctivitis, was evaluated among the four groups. Logistic regression analysis showed that the ADHD + ASD group (odds ratio [OR]: 2.26, 95% confidence interval [CI]: 1.83–2.79), ADHD-alone group (OR: 1.81, 95% CI: 1.70–1.93), and ASD-alone group (OR: 1.24, 95% CI: 1.04–1.48) had an increased risk of allergic comorbidities compared to the control after adjusting age, sex, and level of urbanization. ASD children with more allergic comorbidities (≧3: OR: 2.57, 95% CI: 1.74–3.79; 2: OR: 2.00, 95% CI: 1.41–2.84; 1: OR: 1.60, 95% CI: 1.16–2.22) were associated with a greater likelihood of ADHD. Children with ADHD or ASD had an increased risk of allergic comorbidities, and those with both ADHD and ASD had the highest. These results may inspire more research to clarify the underlying mechanisms among ASD, ADHD, and allergic diseases.     

Association between autism symptoms and family functioning in children with attention-deficit/hyperactivity disorder: a community-based study

Autism spectrum disorder (ASD) symptoms are elevated in populations of children with attention-deficit/hyperactivity disorder (ADHD). This study examined cross-sectional associations between ASD symptoms and family functioning in children with and without ADHD. Participants were recruited to a longitudinal cohort study, aged 6–10 years (164 ADHD; 198 controls). ADHD cases were ascertained using community-based screening and diagnostic confirmation from a diagnostic interview. ASD symptoms were measured using the Social Communication Questionnaire. Outcome variables were parent mental health, family quality of life (FQoL), couple conflict and support, and parenting behaviours. After adjustment for a range of child and family factors (including other mental health comorbidities), higher ASD symptoms were associated with poorer FQoL across all three domains; emotional impact (p = 0.008), family impact (p = 0.001) and time impact (p = 0.003). In adjusted analyses by subgroup, parents of children with ADHD+ASD had poorer parent self-efficacy (p = 0.01), poorer FQoL (p ≤ 0.05), with weak evidence of an association for less couple support (p = 0.06), compared to parents of children with ADHD only. Inspection of covariates in the adjusted analyses indicated that the association between ASD symptoms and most family functioning measures was accounted forby child internalising and externalising disorders, ADHD severity, and socioeconomic status; however, ASD symptoms appear to be independently associated with poorer FQoL in children with ADHD. The presence of ASD symptoms in children with ADHD may signal the need for enhanced family support.     

Effect of osmotic-release oral system methylphenidate on different domains of attention and executive functioning in children with attention-deficit-hyperactivity disorder

Aim This study investigated whether components of attention and executive functioning improve when children with attention‐deficit–hyperactivity disorder (ADHD) are treated with osmotic‐release oral system (OROS) methylphenidate. Method Thirty children (24 males, six females; mean age 8y 6mo, SD 1y 11mo; range 6y 5mo –12y 6mo) with ADHD combined type participated in a double‐blind, placebo‐controlled crossover trial with the child’s clinically most effective dose as identified with a systematic open‐label titration procedure. After 1 week on each treatment (placebo and OROS methylphenidate), a neuropsychological battery that assessed sustained attention, selective attention, attentional control, response inhibition, and working memory was administered. This battery included the Gordon Diagnostic System, seven subtests of the Test of Everyday Attention for Children, and two tests of working memory. Results Performance on two of three tests of response inhibition improved on OROS methylphenidate compared with placebo (p<0.01). Performance on one of two tasks assessing attentional control and one of five measures assessing sustained attention demonstrated clear improvement. There was no improvement on the two tasks assessing selective attention or the two tasks assessing working memory. Interpretation When OROS methylphenidate was used to treat children with ADHD at the clinically most effective dose, general improvement was noted on tasks requiring response inhibition; response to treatment in other domains was either variable or not demonstrated.     

Real‐time fMRI neurofeedback in adolescents with attention deficit hyperactivity disorder

Attention Deficit Hyperactivity Disorder (ADHD) is associated with poor self‐control, underpinned by inferior fronto‐striatal deficits. Real‐time functional magnetic resonance neurofeedback (rtfMRI‐NF) allows participants to gain self‐control over dysregulated brain regions. Despite evidence for beneficial effects of electrophysiological‐NF on ADHD symptoms, no study has applied the spatially superior rtfMRI‐NF neurotherapy to ADHD. A randomized controlled trial tested the efficacy of rtfMRI‐NF of right inferior prefrontal cortex (rIFG), a key region that is compromised in ADHD and upregulated with psychostimulants, on improvement of ADHD symptoms, cognition, and inhibitory fMRI activation. To control for region‐specificity, an active control group received rtfMRI‐NF of the left parahippocampal gyrus (lPHG). Thirty‐one ADHD boys were randomly allocated and had to learn to upregulate their target brain region in an average of 11 rtfMRI‐NF runs over 2 weeks. Feedback was provided through a video‐clip of a rocket that had to be moved up into space. A transfer session without feedback tested learning retention as a proximal measure of transfer to everyday life. Both NF groups showed significant linear activation increases with increasing number of runs in their respective target regions and significant reduction in ADHD symptoms after neurotherapy and at 11‐month follow‐up. Only the group targeting rIFG, however, showed a transfer effect, which correlated with ADHD symptom reductions, improved at trend level in sustained attention, and showed increased IFG activation during an inhibitory fMRI task. This proof‐of‐concept study demonstrates for the first time feasibility, safety, and shorter‐ and longer‐term efficacy of rtfMRI‐NF of rIFG in adolescents with ADHD. Hum Brain Mapp 38:3190–3209, 2017. © 2017 The Authors Human Brain Mapping Published by Wiley Periodicals, Inc.     

Inhibition, flexibility, working memory and planning in autism spectrum disorders with and without comorbid ADHD-symptoms

Background

Recent studies have not paid a great deal of attention to comorbid attention-deficit/hyperactivity disorder (ADHD) symptoms in autistic children even though it is well known that almost half of children with autism spectrum disorder (ASD) suffer from hyperactivity, inattention and impulsivity. The goal of this study was to evaluate and compare executive functioning (EF) profiles in children with ADHD and in children with ASD with and without comorbid ADHD.

Methods

Children aged 6 to 18 years old with ADHD (n = 20) or ASD (High-Functioning autism or Asperger syndrome) with (n = 20) and without (n = 20) comorbid ADHD and a typically developing group (n = 20) were compared on a battery of EF tasks comprising inhibition, flexibility, working memory and planning tasks. A MANOVA, effect sizes as well as correlations between ADHD-symptomatology and EF performance were calculated. Age- and IQ-corrected z scores were used.

Results

There was a significant effect for the factor group (F = 1.55; dF = 42; p = .02). Post-hoc analysis revealed significant differences between the ADHD and the TD group on the inhibition task for false alarms (p = .01) and between the ADHD group, the ASD+ group (p = .03), the ASD- group (p = .02) and the TD group (p = .01) for omissions. Effect sizes showed clear deficits of ADHD children in inhibition and working memory tasks. Participants with ASD were impaired in planning and flexibility abilities. The ASD+ group showed compared to the ASD- group more problems in inhibitory performance but not in the working memory task.

Conclusion

Our findings replicate previous results reporting impairment of ADHD children in inhibition and working memory tasks and of ASD children in planning and flexibility abilities. The ASD + group showed similarities to the ADHD group with regard to inhibitory but not to working memory deficits. Nevertheless the heterogeneity of these and previous results shows that EF assessment is not useful for differential diagnosis between ADHD and ASD. It might be useful for evaluating strengths and weaknesses in individual children.     

Maturation in auditory event‐related potentials explains variation in language ability in children

Processing of auditory information in the cortex continues to develop into later childhood and adolescence. Recent research has indicated that intraclass correlation (ICC) is the best method for capturing maturation in auditory event‐related potentials (AEPs) of school‐age children. However, the sensitivity of the ICC approach in discerning AEP changes in children has not been consistently demonstrated and positive results have not been replicated. We attempted this replication and further explored whether AEP maturation estimated using the ICC approach predicts cognitive and linguistic abilities in addition to chronological age. We measured AEPs in response to simple tones in groups of 7‐, 8‐, 9‐ and 10‐year olds with typical development (N = 67) and used ICC to estimate the age equivalent of each child's AEP (AEP‐age). Results indicated that ICC differentiated 7‐ to 8‐year‐old children from 9‐ to 10‐year‐old children and that AEP‐age predicted both chronological age and significant, unique variance in language ability, but not in nonverbal IQ. Our findings support the view that auditory organization in children reflects both general developmental maturation and more specific development of language skills, and support the future use of AEP‐age to identify and understand individual differences in brain maturation in typically developing and clinical populations.     

Differential stimulant response on attention in children with comorbid anxiety and oppositional defiant disorder

Attention-deficit hyperactivity disorder (ADHD) affects 3% to 7% of school-age children. Approximately 30% of the children with ADHD also have comorbid anxiety or oppositional defiant disorder. Methylphenidate is the drug of choice for the medical treatment of such cases. When compared with children with ADHD alone, children with comorbid anxiety or oppositional defiant disorder may show worsening of the global attention score in response to methylphenidate and not only a "reduced response," as reported in previous studies. This study included 1122 children diagnosed as ADHD, of which 174 were diagnosed with comorbid anxiety and 141 with comorbid oppositional defiant disorder. All patients performed the Test of Variables of Attention before and after methylphenidate administration. A normal distribution (Gaussian distribution) of reaction to methylphenidate, as measured by the global ADHD score in children diagnosed as pure ADHD, was found. These findings were in contrast to children with ADHD and comorbid anxiety or oppositional defiant disorder who showed a bimodal distribution and hence represent a distinct population. In both groups with comorbid disorders, there was a larger subgroup in which significant worsening of global ADHD score occurred after methylphenidate administration (P < .05). Children with ADHD and comorbid anxiety or oppositional defiant disorder might represent clinically distinct populations in which inattention is secondary to those disorders; therefore, methylphenidate may be an inappropriate treatment for such children.     

Attention-deficit/Hyperactivity Disorder in the Context of Autism Spectrum Disorders

Autism spectrum disorders (ASD) are frequently marked by symptoms consistent with attention-deficit/hyperactivity disorder (ADHD), namely inattention, hyperactivity, and impulsivity. Recent work has established that about half of the ASD population also meets diagnostic criteria for ADHD, although the comorbid diagnoses are precluded by the DSM-IV-TR. Individuals with co-occurring ASD and ADHD symptoms are more severely impaired, with significant deficits seen in social processing, adaptive functioning, and executive control. Children with ASD and ADHD symptoms are also prone to motor problems, which lead to especially poor outcomes. Recent work has also demonstrated high rates of ASD symptoms in a subset of children with ADHD. Medication studies have demonstrated the efficacy of methylphenidate, atomoxetine, and guanfacine, among others, in treating ADHD symptoms co-occurring with ASD. However, these effects were not as great as those seen when treating primary ADHD, and they are less well-tolerated in the ASD population.     

Perception of the prosody and content of sentences in an unfamiliar language in children with autism spectrum disorders

Prior research suggests that children with autism spectrum disorders (ASD) show atypical patterns of attention to the prosody (intonation and emotional tone of voice) and content (words) of spoken sentences. Using a discrimination-choice procedure embedded in a custom-made videogame, we examined attention to these features of sentences in 15 children with ASD (ages 5 years, 5 months–18 years) and 15 age-matched typical controls (TYP). Using an unfamiliar language (German) to remove semantics, we assessed the role of meaning in promoting attention to content over prosody. As in a previous study with English sentences, TYP children attended to content to a greater extent than children with ASD while maintaining equivalent levels of discrimination based on prosody. However, in contrast to previous results, TYP children did not show a preference for enthusiastic over grouchy tone of voice, which suggests that the unfamiliar language rendered affective valence less salient. The results confirm intact perception of prosody in children with ASD, and a more selective pattern of attention to content in TYP children.