Autistic Traits and Empathy in Children With Attention Deficit Hyperactivity Disorder, Autism Spectrum Disorder and Co-occurring Attention Deficit Hyperactivity Disorder/Autism Spectrum Disorder.

Stefania Aiello,Antonio Cerasa,Agrippina Campisi,Flavia Marino,Francesco Mainiero,Eva Germano,Gennaro Tartarisco,David Vagni,Francesca Famà,Liliana Ruta,Cristina Carrozza,Elisa Leonardi,Antonella Gagliano,Maria Ausilia Alquino,Giovanni Pioggia,Rosamaria Siracusano

doi:10.3389/fnins.2021.734177

Abstract

Attention Deficit Hyperactivity Disorder (ADHD) and Autism Spectrum Disorders (ASD) are two of the most represented neurodevelopmental conditions in childhood. The diagnostic shift introduced by the DSM-5, allowing a combined diagnosis of ADHD and ASD, poses different clinical challenges related to diagnostic overshadowing, accuracy of clinical judgment and potential delay in an ASD diagnosis in children presenting with ADHD. Here we tried to disentangle the clinical phenotype and specificity of the two co-occurring conditions in relation to autism traits and empathy, by comparing children with ASD with and without comorbid ADHD with children presenting ADHD only and children with typical development. The child versions of the Autism Quotient (C-AQ) and Empathy Quotient (C-EQ) were administered to a total sample of 198 male children between 6 and 14 years old with age appropriate language skills and normal intelligence. Univariate analysis demonstrated no significant differences in the C-AQ total and subscale scores as well as the C-EQ between children with ASD and children with ASD + ADHD, while children with ADHD alone presented an intermediate phenotype between ASD and TD. Furthermore, a receiver operating characteristic (ROC) analysis was applied to discriminate among the different phenotypes. We found that the C-AQ and C-EQ were accurate at distinguishing with satisfactory reliability between: (a) ASD vs. non- ASD (N-ASD) groups comprising both ADHD and TD children (Area Under the Curve AUC 88% for C-AQ and 81% for C-EQ); (b) ASD and TD (AUC 92% for C-AQ and 95% for C-EQ); (c) ASD and ADHD (AUC 80% for C-AQ and 68% for C-EQ). Our data confirm the reliability of the C-AQ and C-EQ as behavioral markers to differentiate ASD (regardless of comorbid ADHD) from an ADHD condition and TD. Interestingly, in our sample an ADHD condition does not increase the severity of the clinical phenotype in terms of autism traits distribution and empathy, suggesting that the psychological measures detected by the two quantitative instruments are independent of ADHD traits. This evidence will contribute to the translational efforts in developing better tailored treatments and preventive strategies.

Highlights

The Diagnostic and Statistical Manual of Mental Disorders fifth edition (DSM-5) (American Psychiatric Association [APA], 2013) introduced a new conceptualization of Neurodevelopmental Disorders, providing a fundamental shift from a categorical to a dimensional system of diagnosis (Hudziak et al, 2007; Jones, 2012)
N = 77 children presented a diagnosis of Autism Spectrum Disorder (ASD) only (ASD−); n = 24 children received a diagnosis of ASD and ADHD (ASD+); n = 33 children had ADHD only and n = 64 children had typical development (TD)
We decided to use a stratified Bias-corrected accelerated (BCa) for both outcome measures to have more robust error ranges

Summary

Introduction

The Diagnostic and Statistical Manual of Mental Disorders fifth edition (DSM-5) (American Psychiatric Association [APA], 2013) introduced a new conceptualization of Neurodevelopmental Disorders, providing a fundamental shift from a categorical to a dimensional system of diagnosis (Hudziak et al, 2007; Jones, 2012). The major changes in the ASD diagnostic category were: (i) the rearrangement of the three core domains down to two core domains (social communication and restricted and repetitive behaviors); (ii) the removal of sub-diagnoses (Autistic Disorder, Asperger Syndrome, Pervasive Developmental Disorder Not Otherwise Specified, Disintegrative Disorder) in favor of a dimensional approach of symptoms’ severity; and (iii) the possibility of a comorbid diagnosis of ADHD. EF is known to self-regulate emotional and empathic abilities, referred to as “Hot Executive functions” (Yang et al, 2011), which result impaired in children with autism (Harmsen, 2019), with significantly higher deficits in emotional regulation (ER) than other neurodevelopmental and psychiatric disorders (Samson et al, 2012; Joshi et al, 2018). Difficulties in controlling emotions often result in internalizing problems such as anxiety and depression (Gadow et al, 2012; Operto et al, 2021)

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