Are Autism Spectrum Disorder and Attention-Deficit/Hyperactivity Disorder Different Manifestations of One Overarching Disorder? Cognitive and Symptom Evidence From a Clinical and Population-Based Sample

• Published in: Journal of the American Academy of Child and Adolescent Psychiatry Vol. 51; no. 11; pp. 1160 - 1172.e3
• Main Authors: van der Meer, Jolanda M.J., M.Sc, Oerlemans, Anoek M., M.Sc, van Steijn, Daphne J., M.Sc, Lappenschaar, Martijn G.A., M.D, de Sonneville, Leo M.J., Ph.D, Buitelaar, Jan K., M.D., Ph.D, Rommelse, Nanda N.J., Ph.D
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.11.2012; Elsevier; Elsevier BV
• Subjects: Adolescence; Adolescent; Adolescents; Age; Attention Deficit Disorder with Hyperactivity - classification; Attention Deficit Disorder with Hyperactivity - etiology; Attention Deficit Hyperactivity Disorder; attention-deficit/hyperactivity disorder (ADHD); Autism; autism spectrum disorder (ASD); Autism Spectrum Disorders; Autistic spectrum disorders; Child; Child & adolescent psychiatry; Child Development Disorders, Pervasive - classification; Child Development Disorders, Pervasive - etiology; Children; cognition; Cognition & reasoning; Cognitive Ability; Cognitive deficits; Cognitive Processes; Communication; Comorbidity; Comparative Analysis; Conners Rating Scales; Data processing; Emotional Response; Emotions; Executive function; Female; heterogeneity; Humans; Inventories; latent class analysis (LCA); Male; Morbidity; Neuropsychological Tests - statistics & numerical data; Parents; Pediatrics; Pervasive Developmental Disorders; Population Surveillance - methods; Psychiatric Status Rating Scales - statistics & numerical data; Psychiatry; Questionnaires; Rating Scales; Studies; Styles; Symptoms; Symptoms (Individual Disorders); attention-deficit/hyperactivity disorder (ADHD); autism spectrum disorder (ASD); cognition; latent class analysis (LCA); heterogeneity
• ISSN: 0890-8567; 1527-5418
• DOI: 10.1016/j.jaac.2012.08.024

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.