Abstract
Although childhood-onset psychiatric disorders are often considered as distinct and separate from each other, they frequently co-occur, with partial overlapping symptomatology. Autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) commonly co-occur with each other and with other mental disorders, particularly disruptive behavior disorders, oppositional defiant disorder/conduct disorder (ODD/CD). Whether these associated comorbidities represent a spectrum of distinct clinical phenotypes is matter of research. The aim of our study was to describe the clinical phenotypes of youths with ADHD with and without ASD and/or ODD/CD, based on neuropsychological and psychopathological variables. One-hundred fifty-one participants with ADHD were prospectively recruited and assigned to four clinical groups, and assessed by means of parent-reported questionnaires, the child behavior checklist and the behavior rating inventory of executive functions. The ADHD alone group presented a greater impairment in metacognitive executive functions, ADHD+ASD patients presented higher internalizing problems and deficits in Shifting tasks, and ADHD+ODD/CD subjects presented emotional-behavioral dysregulation. Moreover, ADHD+ASD+ODD/CD individuals exhibited greater internalizing and externalizing problems, and specific neuropsychological impairments in the domains of emotional regulation. Our study supports the need to implement the evaluation of the psychopathological and neuropsychological functioning profiles, and to characterize specific endophenotypes for a finely customized establishment of treatment strategies.
Highlights
Attention deficit and hyperactivity disorder (ADHD) is one of the most frequent reasons for consultation in the context of mental health services for minors, causing significant impairment in various life contexts from childhood to adolescence and adulthood [1,2,3]
One of the aspects of this heterogeneity is the comorbidity between ADHD and other psychiatric disorders in at least 60% of patients, mostly other neurodevelopmental conditions— autism spectrum disorders (ASD), intellectual disabilities, Tourette syndrome, and motor coordination disorders [1,4,5,6,7,8]; and disruptive behavior disorders—such as oppositional defiant disorder (ODD) and conduct disorder (CD); and internalizing disorders—especially anxiety and mood disorders
The main aim of our preliminary study is to describe the clinical phenotypes of minors with ADHD in its “pure” presentation and with psychiatric comorbidities (ASD and/or oppositional defiant disorder/conduct disorder (ODD/CD)), with respect to psychopathological and neuropsychological variables, to highlight similarities and differences among the groups
Summary
Attention deficit and hyperactivity disorder (ADHD) is one of the most frequent reasons for consultation in the context of mental health services for minors, causing significant impairment in various life contexts from childhood to adolescence and adulthood [1,2,3]. ADHD children with comorbid ODD and/or CD are characterized by higher rates of learning difficulties and school problems, including neglect, expulsion, and dropouts from school [16,17], and lower performances in visual–motor integration and visuo-spatial tasks [18]. They are more prone, in adulthood, to develop drug abuse, and to be engaged in criminal behaviors and antisocial conduct [19,20]
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