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Attention-deficit/Hyperactivity Disorder in the Context of Autism Spectrum Disorders

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Abstract

Autism spectrum disorders (ASD) are frequently marked by symptoms consistent with attention-deficit/hyperactivity disorder (ADHD), namely inattention, hyperactivity, and impulsivity. Recent work has established that about half of the ASD population also meets diagnostic criteria for ADHD, although the comorbid diagnoses are precluded by the DSM-IV-TR. Individuals with co-occurring ASD and ADHD symptoms are more severely impaired, with significant deficits seen in social processing, adaptive functioning, and executive control. Children with ASD and ADHD symptoms are also prone to motor problems, which lead to especially poor outcomes. Recent work has also demonstrated high rates of ASD symptoms in a subset of children with ADHD. Medication studies have demonstrated the efficacy of methylphenidate, atomoxetine, and guanfacine, among others, in treating ADHD symptoms co-occurring with ASD. However, these effects were not as great as those seen when treating primary ADHD, and they are less well-tolerated in the ASD population.

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References

Papers of particular interest, published recently, have been highlighted as: •• Of major importance

  1. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, edn 4 (text revision). Washington, DC: American Psychiatric Association; 2000..

  2. Reiersen AM, Todd RT: Co-occurrence of ADHD and autism spectrum disorders: phenomenology and treatment. Expert Rev Neurother 2008, 8:657–669.

    Article  CAS  PubMed  Google Scholar 

  3. Goldstein S, Schwebach AJ: The comorbidity of pervasive developmental disorder and attention deficit hyperactivity disorder: results of a retrospective chart review. J Autism Dev Disord 2004, 34:329–339.

    Article  PubMed  Google Scholar 

  4. Sturm H, Fernell E, Gillberg C: Autism spectrum disorders in children with normal intellectual levels: associated impairments and subgroups. Dev Med Child Neurol 2004, 46:444–447.

    Article  PubMed  Google Scholar 

  5. Yoshida Y, Uchiyama T: The clinical necessity for assessing attention deficit/hyperactivity disorder (AD/HD) symptoms in children with high-functioning pervasive developmental disorder (PDD). Eur Child Adolesc Psychiatry 2004, 13:307–314.

    Article  PubMed  Google Scholar 

  6. Gadow KD, DeVincent CJ, Pomeroy J: ADHD symptom subtypes in children with pervasive developmental disorder. J Autism Dev Disord 2006, 36:271–283.

    Article  PubMed  Google Scholar 

  7. Gadow KD, DeVincent CJ, Pomeroy J, Azizian A: Psychiatric symptoms in preschool children with PDD and clinic and comparison samples. J Autism Dev Disord 2004, 34:379–393.

    Article  PubMed  Google Scholar 

  8. Gadow KD, De Vincent CJ, Pomeroy J, Azizian A: Comparison of DSM-IV symptoms in elementary school-age children with PDD versus clinic and community samples. Autism 2005, 9:392–415.

    Article  PubMed  Google Scholar 

  9. de Boo GM, Prims PJ: Social incompetence in children with ADHD: possible moderators and mediators in social skills training. Clin Psychol Rev 2007, 27:78–97.

    Article  PubMed  Google Scholar 

  10. Santosh PJ, Mijovic A: Social impairment in hyperkinetic disorder-relationship to psychopathology and environmental stressors. Eur Child Adolesc Psychiatry 2004, 13:141–150.

    Article  PubMed  Google Scholar 

  11. Reiersen AM, Constantino JN, Volk HE, Todd RD: Autistic traits in a population-based ADHD twin sample. J Child Psychol Psychiatry 2007, 48:464–472.

    Article  PubMed  Google Scholar 

  12. Pennington BF, Ozonoff S: Executive functions and developmental psychopathology. J Child Psychol Psychiatry 1996, 37:51–87.

    Article  CAS  PubMed  Google Scholar 

  13. •• Corbett BA, Constantine LJ, Hendren R, et al.: Examining executive functioning in children with autism spectrum disorder, attention deficit hyperactivity disorder and typical development. Psychiatry Res 2009, 166:210–222. This study characterizes the severe deficits in EC among children with ASD compared with children with ADHD and typically developing children. The observed overlap of EC deficits seen in children with ADHD further suggests that a significant number of children with ASD present with cognitive profiles consistent with ADHD.

    Article  PubMed  Google Scholar 

  14. Happe F, Booth R, Charlton R, Hughes C: Executive function deficits in autism spectrum disorders and attention-deficit/hyperactivity disorder: examining profiles across domains and ages. Brain Cogn 2006, 61:25–39.

    Article  PubMed  Google Scholar 

  15. Klin A, Saulnier CA, Sparrow SS, et al.: Social and communication abilities and disabilities in higher functioning individuals with autism spectrum disorders: the Vineland and the ADOS. J Autism Dev Disord 2007, 37:748–759.

    Article  PubMed  Google Scholar 

  16. Constantino JN, Gruber CP, Davis S, et al.: The factor structure of autistic traits. J. Child Psychol Psychiatry 2004, 45:719–726.

    Article  PubMed  Google Scholar 

  17. •• Yerys BE, Wallace GL, Sokoloff JL, et al.: Attention deficit/hyperactivity disorder symptoms moderate cognition and behavior in children with autism spectrum disorders. Autism Res 2009, 2:322–333. This article suggests that children with ASD and ADHD symptoms present with worse impairments in adaptive behavior and working memory compared with children with ASD alone on a variety of neuropsychological tests. It presents good evidence for the argument that ADHD has a major impact on the expression of cognition and behavior in ASD.

    PubMed  Google Scholar 

  18. Pitcher TM, Piek JP, Hay DA: Fine and gross motor ability in males with ADHD. Dev Med Child Neurol 2003, 45:525–535.

    Article  PubMed  Google Scholar 

  19. Mahone EM, Powell SK, Loftis CW, et al.: Motor persistence and inhibition in autism and ADHD. J Int Neuropsychol Soc 2006, 12:622–631.

    Article  PubMed  Google Scholar 

  20. Jansiewicz EM, Goldberg MC, Newschaffer CJ, et al.: Motor signs distinguish children with high functioning autism and Asperger’s syndrome from controls. J Autism Dev Disord 2006, 36:613–621.

    Article  PubMed  Google Scholar 

  21. Dziuk MA, Gidley Larson JC, Apostu A, et al.: Dyspraxia in autism: association with motor, social, and communicative deficits. Dev Med Child Neurol 2007, 49:734–739.

    Article  CAS  PubMed  Google Scholar 

  22. Mostofsky SH, Dubey P, Jerath VK, et al.: Developmental dyspraxia is not limited to imitation in children with autism spectrum disorders. J Int Neuropsychol Soc 2006, 12:314–326.

    Article  PubMed  Google Scholar 

  23. Gillberg C: Deficits in attention, motor control, and perception: a brief review. Arch Dis Child 2003, 88:904–910.

    Article  CAS  PubMed  Google Scholar 

  24. Hellgren L, Gillberg IC, Bagenholm A, Gillberg C: Children with deficits in attention, motor control and perception (DAMP) almost grown up: psychiatric and personality disorders at age 16 years. J Child Psychol Psychiatry 1994, 35:1255–1271.

    Article  CAS  PubMed  Google Scholar 

  25. •• Reiersen AM, Constantino JN, Todd RD: Co-occurrence of motor problems and autistic symptoms in attention-deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry 2008, 47:662–672. This article demonstrates the vulnerability of children with ASD with co-occurring ADHD symptoms and motor problems to more severe impairments in the core features of ASD. It also provides implications for clinical assessment and practice.

    Article  PubMed  Google Scholar 

  26. Gilger JW, Kaplan BJ: Atypical brain development: a conceptual framework for understanding developmental learning disabilities. Dev Neuropsychol 2001, 20:465–481.

    Article  CAS  PubMed  Google Scholar 

  27. Kaplan BJ, Crawford S, Cantwell M, et al.: Comorbidity, co-occurrence, continuum: what’s in a name? Child Care Health Dev 2006, 32:723–731.

    Article  CAS  PubMed  Google Scholar 

  28. Smalley SL, Loo SK, Yang MH, Cantor RM: Toward localizing genes underlying cerebral asymmetry and mental health. Am J Med Genet B Neuropsychiatr Genet 2005, 135:79–84.

    Google Scholar 

  29. Nieoullon A: Dopamine and the regulation of cognition and attention. Prog Neurobiol 2002, 67:53–83.

    Article  CAS  PubMed  Google Scholar 

  30. Stigler KA, Desmond LA, Posey DJ, et al.: A naturalistic retrospective analysis of psychostimulants in pervasive developmental disorders. J Child Adolesc Psychopharmacol 2004, 14:49–56.

    Article  PubMed  Google Scholar 

  31. Langworthy-Lam KS, Aman MG, Van Bourgondien ME: Patterns and prevalence of use of psychoactive medicines in individuals with autism in the Autism Society of North Carolina. J Child Adolesc Psychopharmacol 2002, 12:311–321.

    Article  PubMed  Google Scholar 

  32. Research Units on Pediatric Psychopharmacology (RUPP) Autism Network: Randomized, controlled, crossover trial of methylphenidate in pervasive developmental disorders with hyperactivity. Arch Gen Psychiatry 2005, 62:1266–1274.

    Article  Google Scholar 

  33. Posey DJ, Aman MG, McCracken JT, et al.: Positive effects of methylphenidate on inattention and hyperactivity in pervasive developmental disorders: an analysis of secondary measures. Biol Psychiatry 2007, 61:538–544.

    Article  CAS  PubMed  Google Scholar 

  34. Jahromi LB, Kasari CL, McCracken JT, et al.: Positive effects of methylphenidate on social communication and self-regulation in children with pervasive developmental disorders and hyperactivity. J Autism Dev Disord 2009, 39:395–404.

    Article  PubMed  Google Scholar 

  35. Greenhill LL, Swanson JM, Vitiello B, et al.: Impairment and deportment responses to different methylphenidate doses in children with ADHD: the MTA titration trial. J Am Acad Child Adolesc Psychiatry 2001, 40:180–187.

    Article  CAS  PubMed  Google Scholar 

  36. Handen BL, Johnson CR, Lubetsky M: Efficacy of methylphenidate among children with autistic disorder and symptoms of attention-deficit hyperactivity disorder. J Autism Dev Disord 2000, 30:245–255.

    Article  CAS  PubMed  Google Scholar 

  37. Avery R, Franowicz JCS, Studholme C, et al.: The alpha-2A adrenoceptor agonist, guanfacine, increases regional cerebral blood flow in dorsolateral prefrontal cortex and improves accuracy in monkeys performing a spatial working memory task. Neuropsychopharmacology 2000, 23:240–249.

    Article  CAS  PubMed  Google Scholar 

  38. Posey DJ, Putney JL, Sasher TA, et al.: Guanfacine treatment of hyperactivity and inattention in pervasive developmental disorders: a retrospective analysis of 80 cases. J Child Adolesc Psychopharmacol 2004, 14:233–241.

    Article  PubMed  Google Scholar 

  39. Scahill L, Aman MG, McDougle CJ, et al.: A prospective open trial of guanfacine in children with pervasive developmental disorders. J Child Adolesc Psychopharmacol 2006, 16:589–598.

    Article  PubMed  Google Scholar 

  40. Posey DJ, Wiegand RE, Wilkerson J, et al.: Opel-label atomoxetine for attention-deficit/hyperactivity disorder symptoms associated with high-functioning pervasive developmental disorders. J Child Adolesc Psychopharmacol 2006, 16:599–610.

    Article  PubMed  Google Scholar 

  41. Troost PW, Steenhuis MP, Tuynman-Qua HG, et al.: Atomoxetine for attention-deficit/hyperactivity disorder symptoms in children with pervasive developmental disorders: a pilot study. J Child Adolesc Psychopharmacol 2006, 16:611–619.

    Article  PubMed  Google Scholar 

  42. Arnold LE, Aman MG, Cook AM, et al.: Atomoxetine for hyperactivity in autism spectrum disorders: placebo-controlled crossover pilot trial. J Am Acad Child Adolesc Psychiatry 2006, 45:1196–1205.

    Article  PubMed  Google Scholar 

  43. Hazell P: Drug therapy for attention-deficit/hyperactivity disorder-like symptoms in autistic disorder. J Paediatr Child Health 2007, 43:19–24.

    Article  PubMed  Google Scholar 

  44. Yoo JH, Valdovinos JG, Williams DC: Relevance of donepezil in enhancing learning and memory in special populations: a review of the literature. J Autism Dev Disord 2007, 37:1883–1901.

    Article  PubMed  Google Scholar 

  45. Doyle RL, Frazier J, Spencer TJ, et al.: Donepezil in the treatment of ADHD-like symptoms in youths with pervasive developmental disorder: a case series. J Atten Disord 2006, 9:543–549.

    Article  PubMed  Google Scholar 

  46. McCracken JT, McGough J, Shah B, et al.; Research Units on Pediatric Psychopharmacology Autism Network: Risperidone in children with autistic disorder and serious behavioral problems. N Engl J Med 2002, 347:314–321.

    Article  CAS  PubMed  Google Scholar 

  47. Findling RL, McNamara NK, Gracious BL, et al.: Quetiapine in nine youths with autistic disorder. J Child Adolesc Psychopharmacol 2004, 14:287–294.

    Article  PubMed  Google Scholar 

  48. Stigler KA, Posey DJ, McDougle CJ: Aripiprazole for maladaptive behavior in pervasive developmental disorders. J Child Adolesc Psychopharmacol 2004, 14:455–463.

    Article  PubMed  Google Scholar 

  49. Pennington BF: The Development of Psychopathology: Nature and Nurture. New York: Guilford Press; 2002.

    Google Scholar 

  50. American Psychiatric Association: Reports of the DSM-V Neurodevelopmental Disorders Work Group. Available at http://www.psych.org/MainMenu/Research/DSMIV/DSMV/DSMRevisionActivities/DSMVWorkGroupReports/NeurodevelopmentalDisordersWorkGroupReport.aspx. Accessed July 14, 2010.

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Authors and Affiliations

  1. Division of Autism Services, Penn State Milton S. Hershey Medical Center, Mail Code HO73, 500 University Drive, Hershey, PA, 17033-0850, USA

    Michael J. Murray

  2. Department of Psychiatry, Penn State College of Medicine, Mail Code HO73, 500 University Drive, Hershey, PA, 17033-0850, USA

    Michael J. Murray

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Correspondence to Michael J. Murray.

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Murray, M.J. Attention-deficit/Hyperactivity Disorder in the Context of Autism Spectrum Disorders. Curr Psychiatry Rep 12, 382–388 (2010). https://doi.org/10.1007/s11920-010-0145-3

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