Abstract
High rates of attention deficit/hyperactivity disorder (ADHD) and anxiety symptoms have been documented in autism spectrum disorder (ASD), and have been associated with social and adaptive impairments. The study examined the frequency of clinically elevated ADHD and anxiety symptoms in an ASD group in comparison to a non-clinical group, compared the clinical presentation in the ASD group with and without ADHD and anxiety, assessed which child and familial variables add to the severity of Inattention, Hyperactivity/Impulsivity (HI), and anxiety symptoms, and evaluated whether having clinically elevated ADHD and/or anxiety symptoms adds to the prediction of adaptive functioning in ASD. The study included 260 participants diagnosed with ASD (mean age: 7.5 ± 1.1), using standardized tests. The rate of clinically elevated ADHD and anxiety symptoms in ASD was 62.7 and 44.6%, respectively, and symptom severity was significantly greater than the non-clinical sample. The entire population was divided into four subgroups: ASD alone, ASD+ADHD, ASD+anxiety, ASD+ADHD+anxiety, based on the parental behavioral questionnaire. The ASD alone group showed less severe autism symptoms in comparison to the other groups. Having ASD+ADHD symptoms was associated with greater impairments in socialization adaptive skills. Only the group with ASD+ADHD+anxiety was associated with poorer daily living adaptive skills. Regression analyses for prediction of ADHD and anxiety symptoms revealed that being a female and having lower adaptive skills scores predicted higher Inattention severity; being older, having better cognition, and more severe Restrictive Repetitive Behavior symptoms predicted more severe HI symptoms; being older and having more severe social impairments predicted higher anxiety scores. A regression analysis for the prediction of adaptive skills revealed that in addition to cognition and autism severity, the severity of Inattention symptoms added to the prediction of overall adaptive skills. In light of these findings, clinicians should diagnose these comorbidities in ASD early on, and provide effective interventions to reduce their negative impact on functioning, thereby improving outcome.
Highlights
Autism spectrum disorder (ASD) is a neurobehavioral disorder defined by social- communication deficits and restricted and repetitive behaviors that are typically detectable in early childhood and continue into adulthood [1]
Autism Diagnostic Interview-Revised (ADI–R) A semi-structured interview administered to parents, designed to make a diagnosis of autism according to DSM-IV criteria
We examined the correlations of all three CPRS subdomains– Inattention (IA) Hyperactivity/Impulsivity (HI) and Anxiety, with Vineland Adaptive Behavior Scales (VABS), Autism Diagnosis Interview-Revised (ADI-R), and Autism Diagnosis Observation Schedule (ADOS) calibrated severity scale (CSS) subdomain scores (Table 5)
Summary
Autism spectrum disorder (ASD) is a neurobehavioral disorder defined by social- communication deficits and restricted and repetitive behaviors that are typically detectable in early childhood and continue into adulthood [1]. Previous studies have examined the co-morbidity of ADHD in ASD and described more severe autism symptoms [14], higher rates of cognitive impairment [10], more deficits in adaptive skills [2, 15] and lower quality of life [10] in individuals with ASD and ADHD in comparison to ASD alone. These studies were all cross-sectional and groups were not based on having an ADHD diagnosis but rather on ADHD symptom severity. Ashwood et al [15] found significant associations between reduced adaptive functioning and autism symptoms, but not with ADHD symptoms
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