Abstract
Currently, both the DSM-IV-TR and ICD-10 preclude the diagnosis of Attention Deficit/Hyperactivity Disorder (ADHD) in cases that present with an Autism Spectrum Disorder (ASD). This criterion will be removed in the upcoming DSM-V, but the relationship between ASD and ADHD, and in particular the prevalence of ADHD among the ASD population, remains controversial. Previous studies have reported clinically significant ADHD symptoms in one-third to three-quarters of ASD-affected individuals (probands). In our sample of 1,838 simplex children and adolescents with ASD, we found that less than 16 % met clinically significant levels of ADHD symptoms, per parent report. When both parent and teacher reports were considered, the comorbidity rate was even lower, at 2 %.
References
Achenbach, T. (1991). Manual for teacher’s report form and 1991 profile. Burlington, VT: University of VT, Department of Psychiatry.
Achenbach, T. M., & Rufle, T. M. (2000). The child behavior checklist and related forms for assessing behavioral/emotional problems and competencies. Pediatrics in Review, 21, 265–271.
American Psychiatric Association. (2000) Diagnostic and statistical manual of mental disorders (4th ed.) text revision (DSM-IV-TR). American Psychiatric Association, Arlington, VA.
American Psychiatric Association. (2011) Diagnostic and statistical manual of mental disorders (5th ed.) (DSM-V). American Psychiatric Association, Arlington, VA.
Brieber, S., Neufang, S., Bruning, N., Kamp-Becker, I., Remschmidt, H., Herpertz-Dahlmann, B., et al. (2007). Structural brain abnormalities in adolescents with autism spectrum disorder and patients with attention deficit/hyperactivity disorder. Journal of Child Psychology and Psychiatry, 48, 1251–1258. doi:10.1111/j.1469-7610.2007.01799.x.
Carpenter, E., Loo, S. K., Yang, M., Dang, J., & Smalley, S. L. (2009). Social functioning difficulties in ADHD: Association with PDD risk. Clinical Child Psychology and Psychiatry, 14, 329–344. doi:10.1177/1359104508100890.
Cuccaro, M. L., Shao, Y., Bass, M. P., Abramson, R. K., Ravan, S. A., Wright, H. H., et al. (2003). Behavioral comparisons in autistic individuals from multiplex and singleton families. Journal of Autism and Developmental Disorders, 33, 87–91.
de Bruin, E. I., Ferdinand, R. F., Meester, S., de Nijs, P. F. A., & Verheil, F. (2007). High rates of psychiatric comorbidity in PDD-NOS. Jouranl of Autism and Developmental Disorders, 37, 877–886. doi:10.1007/s10803-006-0215-x.
Elliott, C. D. (2007). Differential Ability Scales (2nd ed.). San Antonio, TX: Harcourt Assessment, Inc.
Fischbach, G. D., & Lord, C. (2010). The Simons simplex collection: A resource for identification of autism genetic risk factors. Neuron, 68, 192–195. doi:10.1016/j.neuron.2010.10.006.
Frazier, J. A., Biederman, J., Bellordre, C. A., Garfield, S. B., Geller, D. A., Coffey, B. J., et al. (2001). Should the diagnosis of Attention-Deficit/Hyperactivity disorder be considered in children with Pervasive Developmental Disorder? Journal of Attention Disorders, 4, 203–211. doi:10.1177/108705470100400402.
Gargaro, B. A., Rinehart, N. J., Bradshaw, J. L., Tonge, B. J., & Sheppard, D. M. (2011). Autism and ADHD: How far have we come in the comorbidity debate? Neuroscience and Behavioral Reviews, 35, 1081–1088. doi:10.1016/j.neubiorev.2010.11.002.
Geurts, H. M., Verte, S., Oosterlaan, J., Roeyers, H., & Sergeant, J. A. (2004). How specific are executive functioning deficits in attention deficit hyperactivity disorder and autism? Journal of Child Psychology and Psychiatry, 45, 839–854.
Gillberg, C., & Billstedt, E. (2000). Autism and Asperger syndrome: Coexistence with other clinical disorders. Acta Psychiatrica Scandinavica, 102, 321–330. doi:10.1034/j.1600-0447.2000.102005321.x.
Goldstein, S., & Schwebach, A. J. (2004). The comorbidity of pervasive developmental disorder and attention deficit hyperactivity disorder: Results of a retrospective chart review. Journal of Autism and Developmental Disorders, 34, 329–339.
Gotham, K., Pickles, A., & Lord, C. (2009). Standardizing ADOS scores for a measure of severity in autism spectrum disorders. Journal of Autism and Developmental Disorders, 39, 693–705. doi:10.1007/s10803-008-0674-3.
Hattori, J., Ogino, T., Abiru, K., Nakano, K., Oka, M., & Ohtsuka, Y. (2006). Are pervasive developmental disorders and attention-deficit/hyperactivity disorder distinct disorders? Brain & Development, 28, 371–374.
Holtmann, M., Bolte, S., & Poustka, F. (2006). Attention deficit hyperactivity disorder symptoms in pervasive developmental disorders: Association with autistic behavior domains and coexisting psychopathology. Psychopathology, 641.
Kanner, L. (1943). Autistic disturbances of affective contact. Nervous Child, 2, 217–250.
Kenworthy, L., Yerys, B. E., Gutermuth Anthony, L., & Wallace, G. L. (2008). Understanding executive control in autism spectrum disorders in the lab and in the real world. Neuropsychological Review, 18, 320–338. doi:10.1007/s11065-008-9077-7.
Lee, D. O., & Ousley, O. Y. (2006). Attention-deficit hyperactivity disorder symptoms in a clinic sample of children and adolescents with pervasive developmental disorders. Journal of Child and Adolescent Psycopharmacology, 16, 737–746. doi:10.1089/cap.2006.16.737.
Leyfer, O. T., Folstein, S. E., Bacalman, S., Davis, N. O., Dinh, E., Morgan, J., et al. (2006). Comorbid psychiatric disorders in children with autism: Interview development and rates of disorders. Journal of Autism and Developmental Disorders, 36, 849–861. doi:10.1007/s10803-006-0123-0.
Lichtenstein, P., Carlstrom, E., Rastam, M., Gillberg, C., & Anckarsater, H. (2010). The genetics of autism spectrum disorders and related neuropsychiatric disorders in childhood. American Journal of Psychiatry, 167, 1357–1363.
Lord, C., Risi, S., Lambrecht, L., Cook, E. H., Leventhal, B. L., DiLavore, P. C., et al. (2000). The Autism Diagnostic Observation Schedule—Generic: A standard measure of social and communication deficits associated with the spectrum of autism. Journal of Autism and Developmental Disorders, 30, 205–223. doi:10.1023/A:1005592401947.
Lord, C., Rutter, M., & Couteur, A. L. (1994). Autism diagnostic interview—revised A revised version of a diagnostic interview for caregivers of individuals with possible pervasive developmental disorders. Journal of Autism and Developmental Disorders, 24, 659–685.
Mullen, E. M. (2005). Mullen scales of early learning. San Antonio, TX: Pearson Clinical Assessment.
Nijmeijer, J. S., Hoekstra, P. J., Minderaa, R. B., Buitelaar, J. K., Altink, M. E., Buschgens, C. J. M., et al. (2009). PDD symptoms in ADHD, an independent familial trait? Journal of Abnormal Child Psychology, 37, 443–453. doi:10.1007/s10802-008-9282-0.
Pandolfi, V., Magyar, C. I., & Dill, C. A. (2009). Confirmatory factor analysis of the child behavior checklist 1.5–5 in a sample of children with autism spectrum disorder. Journal of Autism and Developmental Disorders, 39, 986–995. doi:10.1007/s10803-009-0716-5.
Reiersen, A. M., Constantino, J. N., Grimmer, M., Martin, N. G., & Todd, R. D. (2008). Evidence for shared genetic influences on self-reported ADHD and autistic symptoms in young adults Australian twins. Twin Research in Human Genetics, 11, 579–585. doi:10.1375/twin.11.6.579.
Rommelse, N. N. J., Franke, B., Geurts, H. M., Hartman, C. A., & Buitelaar, J. K. (2010). Shared heritability of attention-deficit/hyperactivity disorder and autism spectrum disorder. European Child and Adolescent Psychiatry, 19, 281–295. doi:10.1007/s00787-010-0092-x.
Ronald, A., Edelson, L. R., Asherson, P., & Saudino, K. J. (2009). Exploring the relationship between autistic-like traits and ADHD behaviors in early childhood: Findings from a community twin study of 2-year-olds. Journal of Abnormal Child Psychology, 38, 185–196. doi:10.1007/s10802-009-9366-5.
Simonoff, E., Pickles, A., Charman, T., Chandler, S., Loucas, T., & Baird, G. (2008). Psychiatric disorders in children with autism spectrum disorders: Prevalence, comorbidity, and associated factors in a population-derived sample. Journal of the American Academy of Child and Adolescent Psychiatry, 47, 921–929. doi:10.1097/CHI.0b013e318179964f.
Sinzig, J., Walter, D., & Doepfner, M. (2009). Attention deficit/hyperactivity disorder in children and adolescents with autism spectrum disorder: Symptom or syndrome? Journal of Attention Disorders, 13, 117–126. doi:10.1177/1087054708326261.
Sinzing, J., Morsch, D., Bruning, N., Schmidt, M. H., & Lehmkuhl, G. (2008). Inhibition, flexibility, working memory and planning in autism spectrum disorders with and without comorbid ADHD-symptoms. Child and Adolescent Psychiatry and Mental Health, 2. doi:10.1186/1753-2000-2-4.
Smalley, S. L., Kustanovich, V., Minassian, S. L., Stone, J. L., Ogdie, M. N., McGough, J. J., et al. (2002). Genetic linkage of attention-deficit/hyperactivity disorder on chromosome 16p13, in a region implicated in autism. American Journal of Human Genetics, 71, 959–963.
Veenstra-VanderWeele, J., & Cook, E. H. (2004). Molecular genetics of autism spectrum disorder. Molecular Psychiatry, 9, 819–832.
Wechsler, D. (1999). Wechsler abbreviated scale of intelligence. San Antonio, TX: The Psychological Corporation.
Wechsler D (2003) Wechsler Intelligence Scale for Children (WISC-IV) (4th ed.). San Antonio, TX: The Psychological Corporation.
World Health Organization. (2004). International statistical classification of diseases and health related problems (ICD). Geneva: World Health Organization.
Yerys, B. E., Wallace, G. L., Sokoloff, J. L., Shook, D. A., James, J. D., & Kenworthy, L. (2009). Attention deficit/hyperactivity disorder symptoms moderate cognition and behavior in children with autism spectrum disorders. Autism Research, 2, 322–333. doi:10.1002/aur.103.
Yoshida, Y., & Uchiyama, T. (2004). The clinical necessity for assessing attention deficit/hyperactivity disorder (AD/HD) symptoms in children with high-functioning pervasive developmental disorder (PDD). European Childhood and Adolescent Psychiatry, 13, 307–314. doi:10.1007/s00787-004-0391-1.
Zelko, F. A. (1991). Comparison of parent-completed behavior rating scales: Differentiating boys with ADD from psychiatric and normal controls. Journal of Developmental and Behavioral Pediatrics, 12, 31–37.
Acknowledgments
The authors wish to thank Dr Leonard Rappaport for constant support and review of this paper. This study was supported in part by grants from the Simons Foundation, Boston Autism Consortium and the National Institutes of Health (MH85143 and MH083565-01).
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Hanson, E., Cerban, B.M., Slater, C.M. et al. Brief Report: Prevalence of Attention Deficit/Hyperactivity Disorder Among Individuals with an Autism Spectrum Disorder. J Autism Dev Disord 43, 1459–1464 (2013). https://doi.org/10.1007/s10803-012-1677-7
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10803-012-1677-7