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Adult ADHD in Other Neurodevelopmental Disorders

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The Burden of Adult ADHD in Comorbid Psychiatric and Neurological Disorders

Abstract

Neurodevelopmental disorders are a group of conditions characterized by impaired growth and development of the brain. ADHD is frequently found in people affected by autism spectrum disorders, intellectual disability, specific learning disability, communication disorder, and motor disorders, increasing the personal and social burden of each condition and causing poor response to standard treatment.

The diagnosis of ADHD in people with other neurodevelopmental disorders is particularly challenging for clinicians, because of some overlapping features that can easily mask the ADHD presentation. This is particularly true for people with Intellectual Disability (ID), because of the “diagnostic overshadowing,” that is, the tendency to refer any behavioral or psychological symptoms solely to ID, rather than a comorbid condition. Adults with comorbid ADHD + ID are characterized by a more severe and also atypical ADHD presentation, coupled with a less favorable pattern of improvement over the lifespan than adults without ID.

In consideration of the accumulated evidence indicating the frequent comorbidity between ADHD and autism spectrum disorder (ASD), it is now possible to make a diagnosis of ADHD in people with ASD. The ADHD-ASD comorbidity represents a more severe phenotype characterized by higher autistic traits, greater impairment in adaptive behavior, and increased risk for other psychiatric conditions such as anxiety, depression, and sleep problems. The recognition of such comorbidity has a high clinical utility, as the presence of ADHD can hinder the efficacy of social skills training programs.

When assessing the presence of ADHD in other neurodevelopmental disorders, clinicians should focus carefully on the developmental presentation of each condition. There are some tools that can be of help during the diagnostic process.

For what concerns treatment, there is evidence supporting the use of ADHD medication in such clinical populations, but clinicians should be aware of the different effect sizes and risk of side effects.

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Pallanti, S., Salerno, L. (2020). Adult ADHD in Other Neurodevelopmental Disorders. In: The Burden of Adult ADHD in Comorbid Psychiatric and Neurological Disorders. Springer, Cham. https://doi.org/10.1007/978-3-030-39051-8_7

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