Abstract
According to the scientific literature, 50 to 70% of individuals with autism spectrum disorder (ASD) also present with comorbid attention deficit hyperactivity disorder (ADHD). From a clinical perspective, this high rate of comorbidity is intriguing. What is the real significance of this dual diagnosis? Is ADHD in fact always present in such cases? Might the attentional impairment reported among our ASD patients actually be a distinct trait of their ASD—namely, impaired joint attention—rather than an ADHD attention deficit? Could their agitation be the consequence of this joint attention impairment or related to a physical restlessness etiologically very different from the agitation typical of ADHD? The neurobiological reality of ASD-ADHD comorbidity is a subject of debate, and amphetamine-based treatment can have paradoxical or undesirable effects in the ASD population. Consequently, does a dual diagnosis, notwithstanding its currency in the literature, prevent us from shedding sufficient light on major physiopathologic questions raised by the clinical picture of ASD?
Highlights
The semiology of autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD) presented in current nosography, which helps clinicians to identify these disorders, makes it clear that they are different entities, affecting children and their developmental histories in ways that are clearly distinct
We maintain that the definition of autism must take into account those symptoms that mirror or overlap with symptoms of ADHD, thereby better representing both the clinical reality of ASD, whose symptoms vary in intensity along a spectrum, and its neurobiological reality, i.e., the cortical dysfunction of which the clinical symptoms are an expression
The mixed findings of etiologic ASD-ADHD comorbidity studies do not permit a clinical description of the physiopathologic comorbidity of these disorders
Summary
The semiology of autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD) presented in current nosography, which helps clinicians to identify these disorders, makes it clear that they are different entities, affecting children and their developmental histories in ways that are clearly distinct. Children with ADHD tend to be relatively boisterous and talkative, and eager rather than apprehensive of interactions with peers or adults, autistic children may be distinguished by their repetitive and less coordinated motor function, difficulty communicating, emotions in sync with their sensory reality more than with their social setting, and uniform behaviors that keep the unpredictable at bay. These two disorders differ in their incidence. Both fall into the wider category of neurodevelopmental disorders, within which “comorbidities” are considered relatively frequent
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