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Co-occurrence of attention deficit hyperactivity disorder (ADHD) and autism spectrum disorders (ASD)

Author/s
Paramala J. Santosh, M. Chiara Colonneli
Citation
Issue 2 Spring 2012
CEPiP.2012.1.118-126
Abstract

The current diagnostic manuals, DSM-IV-TR and ICD-10, do not allow the diagnosis of ADHD to be made separately in the presence of autism (pervasive developmental disorder). However, the characteristics of ADHD are very common in autism, occurring in around 30 to 70%. Surveys of children with ADHD also reveal a high proportion of features of Autism Spectrum Disorder (ASD). Furthermore, treatment of ADHD in the presence of autism is of benefit in a large proportion. The inconsistency in the diagnostic manuals should be resolved in the forthcoming DSM-5 and ICD-11. The results of twin studies have been consistent with the sharing of genetic influences between autism and ADHD symptoms. Genome-wide studies have also shown shared chromosomal regions of interest for susceptibility sites for both conditions. There is an overlap between the executive function deficits in both conditions, although the details of the dysfunction may be different. There is evidence that all the standard treatments for ADHD can be effective in the presence of autism (though to a lesser extent than in pure ADHD): methylphenidate, amphetamines, atomoxetine, clonidine and guanfacine. Atypical antipsychotics such as risperidone and aripiprazole may be of specific importance in managing ASD with irritability, aggression and hyperactivity. The idea that ADHD cannot be diagnosed or treated successfully in those with ASD is a myth that should be dispelled; many of those who have both autism spectrum disorder and ADHD can benefit greatly from the treatment of the ADHD.

Cite as: Cutting Edge Psychiatry in Practice 2012, 2(1):118-126; https://doi.org/10.65031/ijhu1555

References

  1. McDougle CJ, Posey DJ. (2003). Autistic and other pervasive developmental disorder in: Pediatric Psychopharmacology. Martin A. et al. New York: Oxford University Press; 563-579 https://doi.org/10.1093/oso/9780195141733.003.0042
  2. Gillberg, C., P. J. Santosh, et al. (2009). ADHD with Autism Spectrum Disorders in ADHD Comorbidities: Handbook of ADHD Complications in Children and Adults, (Ed) Brown T.E. Washington, DC American Psychiatric Publishing. https://doi.org/10.1176/appi.books.9781615377367.lg14
  3. Feinstein AR. (1970). Taxonorics. I. Formulation of criteria. Arch Intern Med. 126(4):679-93. https://doi.org/10.1001/archinte.1970.00310100125018
  4. Taurines R, Schmitt J, Renner T et al. (2010). Developmental comorbidity in attention-deficit/ hyperactivity disorder. Atten Defic Hyperact Disord. Dec: 2(4): 267-89 https://doi.org/10.1007/s12402-010-0040-0
  5. APA (2000). Diagnostic and Statistical Manual of Mental Disorders, 4th Edn (text revision). Washington DC, American Psychiatric Association (APA). https://doi.org/10.1017/s0033291700035765
  6. WHO (1992). International Classification of Diseases - 10th Revision (ICD-10). Multiaxial Classification of Child and Adolescents Psychiatric Disorders, Cambridge University Press, World Health Organization. https://doi.org/10.1192/s0007125000149360
  7. Clark T, Feehan C, Tinline C, Vostanis P (1999). Autistic symptoms in children with attention deficit-hyperactivity disorder. Eur Child Adolesc Psychiatry. 8(1): 50-5. https://doi.org/10.1007/s007870050083
  8. Santosh, P. J. and A. Mijovic (2004). Social impairment in Hyperkinetic Disorder - relationship to psychopathology and environmental stressors. Eur Child Adolesc Psychiatry 13(3): 141-50. https://doi.org/10.1007/s00787-004-0372-4
  9. Santosh, P. J. and A. Mijovic (2006). Does pervasive developmental disorder protect children and adolescents against drug and alcohol use?. Eur Child Adolesc Psychiatry 15(4): 183-8. https://doi.org/10.1007/s00787-005-0517-0
  10. Yoshida Y, Uchiyama T. (2004). The clinical necessity for assessing Attention Deficit/Hyperactivity Disorder (AD/HD) symptoms in children with high-functioning Pervasive Developmental Disorder (PDD). Eur Child Adolesc Psychiatry. 13(5):307-14. https://doi.org/10.1007/s00787-004-0391-1
  11. Goldstein S, Schwebach AJ (2004). The comorbidity of Pervasive Developmental Disorder and Attention Deficit Hyperactvity Disorder: results of a retrospective chart review. J Autism Dev Disord. 34(3): 329-39. https://doi.org/10.1023/b:jadd.0000029554.46570.68
  12. Sturm H, Fernell E, Gillberg C. (2004). Autism spectrum disorders in children with normal intellectual levels: associated impairments and subgroups. Dev Med Child Neurol. 46(7): 444-7. https://doi.org/10.1017/s0012162204000738
  13. Reiersen AM, Constantino JN, Volk HE et al. (2007). Autistic traits in a population-based ADHD twin sample. J Child Psychol Psychiatry 48(5): 464-72. https://doi.org/10.1111/j.1469-7610.2006.01720.x
  14. Ronald A, Simonoff E, Kuntsi J et al. (2008). Evidence for overlapping genetic influences on autistic and ADHD behaviours in a community twin sample. J Child Psychol Psychiatry 49(5): 535-42. https://doi.org/10.1111/j.1469-7610.2007.01857.x
  15. Reiersen AM, Constantino JN, Todd RD (2008). Co-occurrence of motor problems and autistic symptoms in attention- deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry 47(6): 662-72. https://doi.org/10.1097/chi.0b013e31816bff88
  16. Reiersen AM, Constantino JN, Grimmer M, (2008). Evidence for shared genetic influences on self-reported ADHD and autistic symptoms in young adult Australian twins. Twin Res Hum Genet 11(6): 579-85. https://doi.org/10.1375/twin.11.6.579
  17. Gillberg C. (1991). Outcome in autism and autistic-like conditions. J Am Acad Child Adolesc Psychiatry. May; 30(3): 375-82. https://doi.org/10.1097/00004583-199105000-00004
  18. Gillberg CL. The Emanuel Miller Memorial Lecture 1991 (1992). Autism and autistic-like conditions: subclasses among disorders of empathy. J Child Psychol Psychiatry. Jul; 33(5):813-42. https://doi.org/10.1111/j.1469-7610.1992.tb01959.x
  19. Murphy DL, Lerner A, Rudnick G, Lesch KP (2004). Serotonin transporter: gene, genetic disorders, and pharmacogenetics. Mol Interv. Apr; 4(2):109-23. https://doi.org/10.1124/mi.4.2.8
  20. Smalley SL, Kustanovich V, Minassian SL, et al. (2002). Genetic linkage of attention-deficit/hyperactivity disorder on chromosome 16p13, in a region implicated in autism. Am J Hum Genet 71(4): 959-63. https://doi.org/10.1086/342732
  21. Bakker SC, van der Meulen EM, Buitelaar JK et al. (2003). A whole-genome scan in 164 Dutch sib pairs with attention- deficit/hyperactivity disorder: suggestive evidence for linkage on chromosomes 7p and 15q. Am J Hum Genet. May; 72(5):1251-60. https://doi.org/10.1086/375143
  22. Gillberg C, de Souza L (2002). Head circumference in autism, Asperger syndrome, and ADHD: a comparative study. Dev Med Child Neurol. May; 44(5):296-300. https://doi.org/10.1017/s0012162201002110
  23. Castellanos FX, Lee PP, Sharp W, et al. (2002). Developmental trajectories of brain volume abnormalities in children and adolescents with attention-deficit/hyperactivity disorder. JAMA. Oct 9; 288(14): 1740-8. https://doi.org/10.1001/jama.288.14.1740
  24. Ozonoff S, Jensen J. (1999). Brief report: specific executive function profiles in three neurodevelopmental disorders. J Autism Dev Disord. Apr; 29(2):171-7. https://doi.org/10.1023/a:1023052913110
  25. Ozonoff S, Strayer DL, McMahon WM, Filloux F. (1994). Executive function abilities in autism and Tourette syndrome: an information processing approach. J Child Psychol Psychiatry. Sep; 35(6):1015-32. https://doi.org/10.1111/j.1469-7610.1994.tb01807.x
  26. Geurts HM, Verté S, Oosterlaan J, Roeyers H, Sergeant JA (2004). How specific are executive functioning deficits in attention deficit hyperactivity disorder and autism? J Child Psychol Psychiatry. 45 (4): 836-54. https://doi.org/10.1111/j.1469-7610.2004.00276.x
  27. Goldberg E, Bougakov D (2005). Neuropsychologic assessment of frontal lobe dysfunction. Psychiatr Clin North Am. 28(3):567-80, 578-9. https://doi.org/10.1016/j.psc.2005.05.005
  28. Happé F, Booth R, Charlton R, Hughes C. (2006). Executive function deficits in autism spectrum disorders and attention- deficit/hyperactivity disorder: examining profiles across domains and ages. Brain Cogn. Jun;61(1):25-39. https://doi.org/10.1016/j.bandc.2006.03.004
  29. Mayes SD, Calhoun SL. (2007) Learning, attention, writing, and processing speed in typical children and children with ADHD, autism, anxiety, depression, and oppositional-defiant disorder. Child Neuropsychol. Nov; 13(6):469-93. https://doi.org/10.1080/09297040601112773
  30. Miniscalco C, Hagberg B, Kadesjö B, Westerlund M, Gillberg C. (2007). Narrative skills, cognitive profiles and neuropsychiatric disorders in 7-8-year-old children with late developing language. Int J Lang Commun Disord. Nov-Dec; 42(6):665-81. https://doi.org/10.1080/13682820601084428
  31. Wheeler J., Carlson C, L. (1994). The Social Functioning Of Children With ADD With Hyperactivity And ADD Without Hyperactivity: A Comparison Of Their Peer Relations And Social Deficits. Journal of Emotional and Behavioral Disorders January 2: 2-12. https://doi.org/10.1177/106342669400200101
  32. Barkley RA (1997): Behavioral inhibition, sustained attention, and executive functions: constructing a unifying theory of ADHD. Psychol Bull 121(1):65-94. https://doi.org/10.1037//0033-2909.121.1.65
  33. Greene RW, Biederman J, Faraone SV et al. (1996). Toward a new psychometric definition of social disability in children with attention-deficit hyperactivity disorder. J Am Acad Child Adolesc Psychiatry. 35(5): 571-8. https://doi.org/10.1097/00004583-199605000-00011
  34. Gillberg C. (1999). Nordic unity on DAMP/ADHD. A current document summarizes the current knowledge. Lakartidningen. 28;96(30-31):3330-1.
  35. Landau, S. and A. L. Moore (1991). Social skills deficits in children with attention-deficit hyperactivity disorder. School Psychology Review 20 (235-251). https://doi.org/10.1080/02796015.1991.12085548
  36. Whalen CK, Henker B, Hinshaw SP (1985). Cognitive-behavioral therapies for hyperactive children: premises, problems, and prospects. J Abnorm Child Psychol. Sep; 13(3):391-409. https://doi.org/10.1007/bf00912724
  37. Santosh PJ, Baird G, Pityaratstian N, Tavare E, Gringras P. (2006). Impact of comorbid autism spectrum disorders on stimulant response in children with attention deficit hyperactivity disorder: a retrospective and prospective effectiveness study. Child Care Health Dev 32(5): 575-83. https://doi.org/10.1111/j.1365-2214.2006.00631.x
  38. RUPP (2005). Randomized, controlled, crossover trial of methylphenidate in pervasive developmental disorders with hyperactivity. Arch Gen Psychiatry 62(11): 1266-74. https://doi.org/10.1001/archpsyc.62.11.1266
  39. Ghuman JK, Aman MG, Lecavalier L et al. (2009). Randomized, placebo-controlled, crossover study of methylphenidate for attention-deficit/hyperactivity disorder symptoms in preschoolers with developmental disorders. J Child Adolesc Psychopharmacol. Aug; 19(4):329-39. https://doi.org/10.1089/cap.2008.0137
  40. Campbell M, Fish B, David R, et al. (1972). Response to triiodothyronine and dextroamphetamine: a study of preschool schizophrenic children. J Autism Child Schizophr. Oct-Dec; 2(4):343-58. https://doi.org/10.1007/bf01538168
  41. Campbell M, Small AM, Collins PJ, et al. (1976). Levodopa and levoamphetamine: a crossover study in young schizophrenic children. Curr Ther Res Clin Exp. Jan; 19(1):70-86.       
  42. Jou RJ, Handen BL, Hardan AY. (2005). Retrospective assessment of atomoxetine in children and adolescents with pervasive developmental disorders. J Child Adolesc Psychopharmacol. Apr; 15(2):325-30. https://doi.org/10.1089/cap.2005.15.325
  43. Posey DJ, Wiegand RE, Wilkerson J, et al. (2006) Open-label atomoxetine for attention-deficit/ hyperactivity disorder symptoms associated with high-functioning pervasive developmental disorders. J Child Adolesc Psychopharmacol. Oct; 16(5):599-610. https://doi.org/10.1089/cap.2006.16.599
  44. Troost PW, Steenhuis MP, Tuynman-Qua HG, et al. (2006). Atomoxetine for attention-deficit/hyperactivity disorder symptoms in children with pervasive developmental disorders: a pilot study. J Child Adolesc Psychopharmacol. Oct; 16(5):611-9. https://doi.org/10.1089/cap.2006.16.611
  45. Arnold LE, Aman MG, Cook AM, et al. (2006). Atomoxetine for hyperactivity in autism spectrum disorders: placebo- controlled crossover pilot trial. J Am Acad Child Adolesc Psychiatry. 45(10): 1196-205. https://doi.org/10.1097/01.chi.0000231976.28719.2a
  46. Zeiner P, Gjevik E, Weidle B (2011). Response to atomoxetine in boys with high-functioning autism spectrum disorders and attention deficit/hyperactivity disorder. Acta Paediatr. 100(9): 1258-61. https://doi.org/10.1111/j.1651-2227.2011.02263.x
  47. McCracken JT, McGough J, Shah B, et all. Research Units on Pediatric Psychopharmacology Autism Network (2002). Risperidone in children with autism and serious behavioral problems. N Engl J Med. Aug 1;347(5):314-21.          
  48. Shea S, Turgay A, Carroll A et al. (2004). Risperidone in the treatment of disruptive behavioral symptoms in children with autistic and other pervasive developmental disorders. Pediatrics. Nov; 114(5): 634-41. https://doi.org/10.1542/peds.2003-0264-f
  49. Owen R, Sikich L, Marcus RN et al. (2009). Aripiprazole in the treatment of irritability in children and adolescents with autistic disorder. Pediatrics. Dec; 124(6): 1533-40. https://doi.org/10.1542/peds.2008-3782
  50. Marcus RN, Owen R, Kamen L et al. (2009). A placebo-controlled, fixed-dose study of aripiprazole in children and adolescents with irritability associated with autistic disorder. J Am Acad Child Adolesc Psychiatry. Nov; 48(11): 1110-9. https://doi.org/10.1097/chi.0b013e3181b76658
  51. Fankhauser MP, Karumanchi VC, German ML, Yates A, Karumanchi SD. (1992). A double-blind, placebo-controlled study of the efficacy of transdermal clonidine in autism. J Clin Psychiatry. Mar;53(3):77-82.         
  52. Jaselskis CA, Cook EH Jr, Fletcher KE, Leventhal BL. (1992). Clonidine treatment of hyperactive and impulsive children with autistic disorder. J Clin Psychopharmacol. Oct;12(5):322-7. https://doi.org/10.1097/00004714-199210000-00005
  53. Leskovec TJ, Rowles BM, Findling RL. (2008). Pharmacological treatment options for autism spectrum disorders in children and adolescents. Harv Rev Psychiatry. 16(2):97-112. https://doi.org/10.1080/10673220802075852
  54. Ming X, Gordon E, Kang N, Wagner GC (2008). Use of clonidine in children with autism spectrum disorders. Brain Dev. 30(7): 454-60. https://doi.org/10.1016/j.braindev.2007.12.007
  55. Posey DJ, Puntney JI, Sasher TM, Kem DL, McDougle CJ. (2004). Guanfacine treatment of hyperactivity and inattention in pervasive developmental disorders: a retrospective analysis of 80 cases. J Child Adolesc Psychopharmacol. Summer;14 (2):233-41. https://doi.org/10.1089/1044546041649084
  56. Scahill L, Aman MG, McDougle CJ, et al (2006). A prospective open trial of guanfacine in children with pervasive developmental disorders. J Child Adolesc Psychopharmacol. Oct; 16(5): 589-98. https://doi.org/10.1089/cap.2006.16.589