Elsevier

Neuroscience & Biobehavioral Reviews

Volume 71, December 2016, Pages 529-541
Neuroscience & Biobehavioral Reviews

Review article
Changing ASD-ADHD symptom co-occurrence across the lifespan with adolescence as crucial time window: Illustrating the need to go beyond childhood

https://doi.org/10.1016/j.neubiorev.2016.09.003Get rights and content

Highlights

  • •

    Current literature on ASD-ADHD co-occurrence is strongly biased on childhood.

  • •

    ASD/ADHD constellations peak during adolescence, driven by those who still have the symptoms.

  • •

    Strong emphasis in this developmental periodon social adaptation and executive functioning may explain this pattern.

  • •

    Adolescence may be –after early childhood– a second crucial time window for change in symptoms (for better or worse).

  • •

    A full lifespan approach towards ASD-ADHD co-occurrence into old age brings novel opportunities.

Abstract

Literature on the co-occurrence between Autism Spectrum Disorder (ASD) and Attention-Deficit/Hyperactivity Disorder (ADHD) is strongly biased by a focus on childhood age. A review of the adolescent and adult literature was made on core and related symptoms of ADHD and ASD. In addition, an empirical approach was used including 17,173 ASD-ADHD symptom ratings from participants aged 0 to 84 years. Results indicate that ASD/ADHD constellations peak during adolescence and are lower in early childhood and old age. We hypothesize that on the border of the expected transition to independent adulthood, ASD and ADHD co-occur most because social adaptation and EF skills matter most. Lower correlations in childhood and older age may be due to more diffuse symptoms reflecting respectively still differentiating and de-differentiating EF functions. We plea for a strong research focus in adolescence which may –after early childhood– be a second crucial time window for catching-up pattern explaining more optimal outcomes. We discuss obstacles and oppportunities of a full lifespan approach into old age.

Section snippets

Background and aim

Autism spectrum disorder (ASD) and Attention-Deficit/Hyperactivity Disorder (ADHD) frequently co-occur. In clinical practice, we daily struggle deciding if one, or the other, or both disorders, best describe the child’s problems (e.g., Costello et al., 2011, Grzadzinski et al., 2016, Miodovnik et al., 2015). In part, this co-occurrence may be due to common etiologial mechanisms (Johnson et al., 2015, Rommelse et al., 2010, Rommelse et al., 2011, Rommelse and Hartman, 2016, Ronald and Hoekstra,

Literature review

Electronic literature searches via PubMed were conducted for articles that were published in the English language (unlimited by date of publication). We searched for empirical studies with respondents beyond age 12. We used broad search terms in order not to miss out on relevant work, subsequently scrutinizing abstracts, and the full text, in selected papers that reported on findings relevant in relation to developmental aspect of core symptoms, related (social) behavior, and executive

Empirical illustration of a lifespan approach in studying co-occurring ASD and ADHD symptomatology

We supplement the literature review with an empirical illustration. Participants came from various clinical, high risk, community, and healthy samples. A total of 17,173 ASD and ADHD symptom ratings were obtained from participants aged 0 to 84 years. In the Supplementary file, an overview of the number of paired ADHD-ASD ratings by study and instrument are listed. Prior to statistical modeling, we plot the association between ASD and ADHD separately for major developmental periods. Fig. 3 shows

Discussion

In this discussion we will first reflect on the methodological obstacles that stand in the way of a lifespan approach. Next, we will discuss how we may understand the curvilinear pattern of association across the lifespan found in the empirical illustration by relating it to the lifespan literature reviewed above.

Authorship contributions

NR and CH developed the study concept. Data analyses were performed by CH. Data interpretation was done by CH. NR, HG. CH and NR drafted the paper, and JB, BF and HG provided critical revisions. All authors approved the final version of the paper for submission.

Conflict of interest

None of the authors report potential conflicts of interest.

Acknowledgements

We want to thank the researchers (Marieke Altink, Yvette de Bruijn, Cathelijne Buschgens, Ellen Fliers, Anoek Oerlemans, Iris Oosterling, Sascha Roos, Saskia de Ruiter, Daphne van Steijn, Janne Visser, Anne van Lammeren, Ernst Horwitz) who collected data or shared their (unpublished) data with us. We additionally want to thank TRAILS (www.trails.nl).

References (190)

  • E. Fizke et al.

    Executive function plays a role in coordinating different perspectives: particularly when one's own perspective is involved

    Cognition

    (2014)
  • Q. Gao et al.

    Childhood predictors of persistent ADHD in early adulthood: results from the first follow-up study in China

    Psychiatry Res.

    (2015)
  • L. Hechtman

    Prospective follow-up studies of ADHD: helping establish a valid diagnosis in adults

    J. Am. Acad. Child Adolesc. Psychiatry

    (2011)
  • A. Hintzen et al.

    Social needs in daily life in adults with Pervasive Developmental Disorders

    Psychiatry Res.

    (2010)
  • E.H. Horwitz et al.

    Clinical assessment of ASD in adults using self-and other-report: psychometric properties and validity of the Adult Social Behavior Questionnaire (ASBQ)

    Res. Autism Spectr. Dis.

    (2016)
  • K.H. Lagattuta et al.

    Beyond Sally's missing marble: further development in children's understanding of mind and emotion in middle childhood

    Adv. Child Dev. Behav.

    (2015)
  • APA

    Diagnostic and Statistical Manual of Disorders, Fourth Edition, Text Revision

    (2000)
  • L.A. Adler et al.

    Assessing adolescents using ADHD rating scales

    J. Clin. Psychiatry

    (2011)
  • J.C. Agnew-Blais et al.

    Evaluation of the persistence: remission, and emergence of Attention-Deficit/Hyperactivity Disorder in young adulthood

    JAMA Psychiatry

    (2016)
  • F.S. Ahmed et al.

    Executive function mechanisms of theory of mind

    J. Autism Dev. Disord.

    (2011)
  • R.M. Alderson et al.

    Attention-Deficit/Hyperactivity Disorder (ADHD) and working memory in adults: a meta-analytic review

    Neuropsychology

    (2013)
  • G. Alessandri et al.

    Prosociality during the transition from late adolescence to young adulthood: the role of effortful control and ego-resiliency

    Pers. Soc. Psychol. Bull.

    (2014)
  • M. Allemand et al.

    Empathy development in adolescence predicts social competencies in adulthood

    J. Pers.

    (2015)
  • P.N. Andersen et al.

    Working memory arrest in children with high-functioning autism compared to children with Attention-Deficit/Hyperactivity Disorder: results from a 2-year longitudinal study

    Autism

    (2015)
  • J.R. Andrews-Hanna et al.

    Cognitive control in adolescence: neural underpinnings and relation toself-report behaviors

    PLoS One

    (2011)
  • A.B. Arnett et al.

    Cognitive and behavioral indicators of ADHD symptoms prior to school age

    J. Child Psychol. Psychiatry

    (2013)
  • P. Asherson et al.

    Is ADHD a valid diagnosis in adults? Yes

    BMJ

    (2010)
  • D.A. Baribeau et al.

    Examining and comparing social perception abilities across childhood-onset neurodevelopmental disorders

    J. Am. Acad. Child Adolesc. Psychiatry

    (2015)
  • R.A. Barkley et al.

    Predicting impairment in major life activities and occupational functioning in hyperactive children as adults: self-reported executive function (EF) deficits versus EF tests

    Dev. Neuropsychol.

    (2011)
  • R.A. Barkley et al.

    The persistence of attention deficit/hyperactivity disorder into young adulthood as a function of reporting source and definition of disorder

    J. Abnorm. Psychol.

    (2002)
  • J.A. Bastiaansen et al.

    Diagnosing autism spectrum disorders in adults: the use of Autism Diagnostic Observation Schedule (ADOS) module 4

    Autism Dev. Disord.

    (2011)
  • A.J. Baxter et al.

    The epidemiology and global burden of autism spectrum disorders

    Psychol. Med.

    (2014)
  • S.F. van den Bergh et al.

    Age related differences of executive functioning problems in everyday life of children and adolescents in the autism spectrum

    J. Autism Dev. Disord.

    (2014)
  • M.G. Berman et al.

    Dimensionality of brain networks linked to life-long individual differences in self-control

    Nat. Commun.

    (2013)
  • A. Bernier et al.

    Social factors in the development of early executive functioning: a closer look at the caregiving environment

    Dev. Sci.

    (2012)
  • A. Bernier et al.

    A secure base from which to regulate: attachment security in toddlerhood as a predictor of executive functioning at school entry

    Dev. Psychol.

    (2015)
  • J. Biederman et al.

    Stability of executive function deficits into young adult years: a prospective longitudinal follow-up study of grown up males with ADHD

    Acta Psychiatr. Scand.

    (2007)
  • J. Biederman et al.

    Stability of executive function deficits in girls with ADHD: a prospective longitudinal follow up study into adolescence

    Dev. Neuropsychol.

    (2008)
  • J. Biederman et al.

    Cognitive development in adults with Attention-Deficit/Hyperactivity Disorder: a controlled study in medication-naive adults across the adult life cycle

    J. Clin. Psychiatry

    (2011)
  • E. Billstedt et al.

    Autism in adults: symptom patterns and early childhood predictors. Use of the DISCO in a community sample followed from childhood

    J. Child Psychol. Psychiatry

    (2007)
  • S.R. Boelema et al.

    Executive functioning shows differential maturation from early to late adolescence: longitudinal findings from a TRAILS study

    Neuropsychology

    (2014)
  • A.M. Boonstra et al.

    Executive functioning in adult ADHD: a meta-analytic review

    Psychol. Med.

    (2005)
  • G. Borst et al.

    Inhibition of misleading heuristics as a core mechanism for typical cognitive development: evidence from behavioural and brain-imaging studies

    Dev. Med. Child Neurol.

    (2015)
  • B.E. Boyer et al.

    Planning skills of adolescents with ADHD

    Atten. Disord.

    (2014)
  • I. Castelli et al.

    Mapping levels of theory of mind in Alzheimer's disease: a preliminary study

    Aging Ment. Health

    (2011)
  • A. Caye et al.

    Attention-Deficit/Hyperactivity Disorder trajectories from childhood to young adulthood: evidence from a birth cohort supporting a late-onset syndrome

    JAMA Psychiatry

    (2016)
  • S.F. Chen et al.

    Deficits in executive functions among youths with autism spectrum disorders: an age-stratified analysis

    Psychol. Med.

    (2016)
  • J. Clegg et al.

    Conceptual issues in neurodevelopmental disorders: lives out of synch

    Curr. Opin. Psychiatry

    (2013)
  • W.E. Copeland et al.

    Diagnostic transitions from childhood to adolescence to early adulthood

    J. Child Psychol. Psychiatry

    (2013)
  • W.E. Copeland et al.

    Adult functional outcomes of common childhood psychiatric problems: a prospective, longitudinal study

    JAMA Psychiatry

    (2015)

    • Cited by (0)

    View full text
    © 2016 Elsevier Ltd. All rights reserved.