Objective
Autism spectrum disorders (ASD) and attention-deficit/hyperactivity disorder (ADHD)
frequently co-occur. Given the heterogeneity of both disorders, several more homogeneous
ASD–ADHD comorbidity subgroups may exist. The current study examined whether such
subgroups exist, and whether their overlap or distinctiveness in associated comorbid
symptoms and cognitive profiles gives support for a gradient overarching disorder
hypothesis or a separate disorders hypothesis.
Method
Latent class analysis was performed on Social Communication Questionnaire (SCQ) and
Conners' Parent Rating Scale (CPRS-R:L) data for 644 children and adolescents (5 through
17 years of age). Classes were compared for comorbid symptoms and cognitive profiles
of motor speed and variability, executive functioning, attention, emotion recognition,
and detail-focused processing style.
Results
Latent class analysis revealed five classes: two without behavioral problems, one
with only ADHD behavior, and two with both clinical symptom levels of ASD and ADHD
but with one domain more prominent than the other (ADHD[+ASD] and ASD[+ADHD]). In
accordance with the gradient overarching disorder hypothesis were the presence of
an ADHD class without ASD symptoms and the absence of an ASD class without ADHD symptoms,
as well as cognitive functioning of the simple ADHD class being less impaired than
that of both comorbid classes. In conflict with this hypothesis was that there was
some specificity of cognitive deficits across classes.
Conclusions
The overlapping cognitive deficits may be used to further unravel the shared etiological
underpinnings of ASD and ADHD, and the nonoverlapping deficits may indicate why some
children develop ADHD despite their enhanced risk for ASD. The two subtypes of children
with both ASD and ADHD behavior will most likely benefit from different clinical approaches.
Key Words
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References
- Diagnostic and Statistical Manual of Mental Disorders.Text Revision, 4th Edition. American Psychiatric Association, Washington, DC2000
- Evidence for overlapping genetic influences on autistic and ADHD behaviours in a community twin sample.J Child Psychol Psychiatry Allied Disc. 2008; 49: 535-542
- Are ADHD traits dissociable from the autistic profile?.J Autism Dev Disord. 2011; 41: 357-363
- Comorbid psychiatric disorders in children with autism: interview development and rates of disorders.J Autism Dev Disord. 2006; 36: 849-861
- Comparative study of children with ADHD only, autism spectrum disorder + ADHD, and chronic multiple tic disorder + ADHD.J Attention Disord. 2009; 12: 474-485
- Autism symptoms in attention-deficit/hyperactivity disorder: a familial trait which correlates with conduct, oppositional defiant, language and motor disorders.J Autism Dev Disord. 2009; 39: 197-209
- A review on cognitive and brain endophenotypes that may be common in autism spectrum disorder and attention-deficit/hyperactivity disorder and facilitate the search for pleiotropic genes.Neurosci Biobehav Rev. 2011; 35: 1363-1396
- Links between co-occurring social-communication and hyperactive-inattentive trait trajectories.J Am Acad Child Adolesc Psychiatry. 2011; 50: 892-902
- Examining executive functioning in children with autism spectrum disorder, attention deficit hyperactivity disorder and typical development.Psychiatry Res. 2009; 166: 210-222
- Brief report: attention effect on a measure of social perception.J Autism Dev Disord. 2008; 38: 1797-1802
- “Hunting with a knife and … fork”: examining central coherence in autism, attention deficit/hyperactivity disorder, and typical development with a linguistic task.J Exp Child Psychol. 2010; 107: 377-393
- The relationship of working memory, inhibition, and response variability in child psychopathology.J Neurosci Methods. 2006; 151: 5-14
- Shared heritability of attention-deficit/hyperactivity disorder and autism spectrum disorder.Eur Child Adolesc Psychiatry. 2010; 19: 281-295
- Latent Class Analysis.Sage, Beverly Hills, CA1987
- Prevalence of autism spectrum disorders in a total population sample.Am J Psychiatry. 2011; 168: 904-912
- Attention-deficit hyperactivity disorder: a category or a continuum?.J Am Acad Child Adolesc Psychiatry. 1997; 36: 737-744
- Latent class subtyping of attention-deficit/hyperactivity disorder and comorbid conditions.Am Acad Child Adolesc Psychiatry. 2008; 47: 797-807
- The quantitative nature of autistic social impairment.Pediatr Res. 2011; 69: 55-62
- Simple identification of complex ADHD subtypes using current symptom counts.Am Acad Child Adolesc Psychiatry. 2009; 48: 441-450
- Autistic traits in a population-based ADHD twin sample.J Child Psychol Psychiatry Allied Disc. 2007; 48: 464-472
- How specific are executive functioning deficits in attention deficit hyperactivity disorder and autism?.J Child Psychol Psychiatry Allied Disc. 2004; 45: 836-854
- ADHD symptom subtypes in children with pervasive developmental disorder.J Autism Dev Disord. 2006; 36: 271-283
- Attention deficit hyperactivity disorder symptoms in pervasive developmental disorders: association with autistic behavior domains and coexisting psychopathology.Psychopathology. 2007; 40: 172-177
- Adults with autism spectrum disorders and ADHD neuropsychological aspects.Res Dev Disabil. 2010; 31: 1659-1668
- Inhibition, flexibility, working memory and planning in autism spectrum disorders with and without comorbid ADHD-symptoms.Child Adolesc Psychiatry Ment Health. 2008; 2: 4
- Disentangling weak coherence and executive dysfunction: planning drawing in autism and attention-deficit/hyperactivity disorder.Philos Trans R Soc Lond B Biol Sci. 2003; 358: 387-392
- Differential diagnosis of autism spectrum disorder and attention deficit hyperactivity disorder by means of inhibitory control and 'theory of mind'.J Autism Dev Disord. 2011; 41: 1718-1726
Van Steijn DJ, Richards JS, Oerlemans AM, De Ruiter SW, Van Aken MAG, Franke B, Buitelaar JK, Rommelse NNJ. The co-occurrence of Attention-Deficit/Hyperactivity Disorder - and Autism Spectrum Disorder symptoms in parents of children with ASD or ASD with ADHD [published online ahead of print April 27, 2012]. J Child Psychol Psychiatry Allied Discipl. DOI: 10.1111/j.1469-7610.2012.02556.x.
- Wechsler Preschool and Primary Scale of Intelligence—Revised.Psychological Corporation, San Antonio, TX1989
- WAIS-III Nederlandstalige Bewerking.Psychological Corporation, London2000
- WISC-III Handleiding.Psychological Corporation, London2002
- The revised Conners' Parent Rating Scale (CPRS-R): factor structure, reliability, and criterion validity.J Abnorm Child Psychol. 1998; 26: 257-268
- Social Communication Questionnaire (SCQ).Western Psychological Services, Los Angeles, CA2003
- Handbook of Psychological Assessment.3rd ed. Wiley, New York1997
Kaufman AS, Balgopal R, Kaufman JC, McLean JE. WISC-III Short Forms: Psychometric Properties vs. Clincal Relevance vs. Practical Utility. Paper presented at the Annual Meeting of the Mid-South Educational Research Association. Nashville, TN, November 9-11, 1994.
- Mplus User's Guide.Muthén and Muthén, Los Angeles2006
- Why IQ is not a covariate in cognitive studies of neurodevelopmental disorders.J Int Neuropsychol Soc. 2009; 15: 331-343
- Statistical Package for the Social Sciences, SPSS/PC+.McGraw-Hill, New York1992
- Statistical Power Analysis for the Behavioral Sciences.2nd Edition. Erlbaum, Hillsdale, NJ1988
- Controlling the false discovery rate: a practical and powerful approach to multiple testing.J R Stat Soc Series B. 1995; 57: 289-300
- Deciding on the number of classes in latent class analysis and growth mixture modeling—a Monte Carlo simulation study.Struct Equat Model. 2007; 14: 535-569
- Dissociation in performance of children with ADHD and high-functioning autism on a task of sustained attention.Neuropsychologia. 2007; 45: 2234-2245
- Neuropsychological intra-individual variability explains unique genetic variance of ADHD and shows suggestive linkage to chromosomes 12, 13, and 17.Am J Med Genet B Neuropsychiatr Genet. 2012; 159B: 131-140
- Intra-subject variability in attention-deficit hyperactivity disorder.Biol Psychiatry. 2006; 60: 1088-1097
- Intra-individual variability in ADHD, autism spectrum disorders and Tourette's syndrome.Neuropsychologia. 2008; 46: 3030-3041
- Emotion recognition in autism: verbal and nonverbal information.Dev Psychopathol. 1997; 9: 579-593
- Attention-deficit/hyperactivity disorder and social dysfunctioning.Clin Psychol Rev. 2008; 28: 692-708
- Beyond words: how do children with ADHD and/or conduct problems process nonverbal information about affect?.J Am Acad Child Adolesc Psychiatry. 2000; 39: 1160-1167
- The role of simple emotion recognition skills among school aged boys at risk of ADHD.J Abnorm Child Psychol. 2007; 35: 363-378
- Autism: cognitive deficit or cognitive style?.Trends Cogn Sci. 1999; 3: 216-222
- Are motor inhibition and cognitive flexibility dead ends in ADHD?.J Abnorm Child Psychol. 2007; 35: 957-967
- Stopping and changing in adults with ADHD.Psychol Med. 2005; 35: 807-816
- The role of internalizing and externalizing liability factors in accounting for gender differences in the prevalence of common psychopathological syndromes.Psychol Med. 2008; 38: 51-61
- The Psychology of Survey Response.Cambridge University Press, New York2000
References
- Amsterdam Neuropsychological Tasks; a computer-aided assessment program.Comput Psychol. 1999; 6: 187-203
- Amsterdam Neuropsychological Tasks: scientific and clinical applications.Tijdschrift voor Neuropsychologie. 2005; 1: 27-41
- Amsterdam Neuropsychological task: a computer aided assessment program.in: Cognitive ergonomics, clinical assessment and computer-assisted learning: computers in psychology. 6. Swets and Zeitlinger, Lisse, the Netherlands1999: 204-217
- On the origin of mixing costs: exploring information processing in pure and mixed blocks of trials.Acta Psychologica. 1996; 94: 145-188
- Wechsler Preschool and Primary Scale of Intelligence—Revised.Psychological Corporation, San Antonio, TX1989
- WAIS-III Nederlandstalige Bewerking.Psychological Corporation, London2000
- WISC-III Handleiding.Psychological Corporation, London2002
Article Info
Publication History
Published online: September 03, 2012
Accepted:
August 28,
2012
Footnotes
Clinical guidance is available at the end of this article.
Supplemental material cited in this article is available online.
This study was partly funded by the Netherlands Organisation for Scientific Research (NWO) by grants 91610024 (N.N.J.R.), 056-13-015 (J.K.B.), and by Neurotechnology Solutions Ltd.
Disclosure: Dr. de Sonneville is the director of Sonares B.V., a company which commercially distributes the Amsterdamse Neuropsychologische Taken (ANT) program. He has served on the advisory board for, on the speakers' bureau for, and as a consultant to Danone, Eli Lilly and Co., Friesland Campina, and Global Pharma Consultancy. Dr. Buitelaar has served on the advisory board for, on the speakers' bureau for, and as a consultant to Janssen-Cilag B.V., Eli Lilly and Co., Bristol-Myers Squibb, Organon/Shering Plough, U.C.B., Shire, Medice, Roche, and Servier. Drs. van der Meer, Oerlemans, van Steijn, Lappenschaar, and Rommelse report no biomedical financial interests or potential conflicts of interest.
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Copyright
© 2012 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.
