Autism and ADHD: Overlapping and Discriminating Symptoms.

Abstract Children with ADHD and autism have some similar features, complicating a differential diagnosis. The purpose of our study was to determine the degree to which core ADHD and autistic symptoms overlap in and discriminate between children 2–16 years of age with autism and ADHD. Our study demonstrated that 847 children with autism were easily distinguished from 158 children with ADHD. All children with autism had 15 or more of the 30 Checklist for Autism Spectrum Disorder symptoms (mean 22), and none of the children with ADHD did (mean 4). Three of the symptoms were present only in children with autism. Almost all 30 symptoms were found in over half of the children with autism, whereas none were present in the majority of children with ADHD-Inattentive type (ADHD-I) or in children with ADHD-Combined type (ADHD-C) without comorbid oppositional-defiant disorder. In contrast, ADHD symptoms were common in autism. Children with low and high functioning autism and ADHD-C did not differ on maternal ratings of attention deficit, impulsivity, and hyperactivity. For children with normal intelligence, nonsignificant differences were found between children with autism, ADHD-C, and ADHD-I on neuropsychological tests including measures of attention, working memory, processing speed, and graphomotor skills.

[1]  S. Calhoun,et al.  Does DSM-IV Asperger's Disorder Exist? , 2001, Journal of abnormal child psychology.

[2]  Patricia Howlin,et al.  Outcome in High-Functioning Adults with Autism with and Without Early Language Delays: Implications for the Differentiation Between Autism and Asperger Syndrome , 2003, Journal of autism and developmental disorders.

[3]  M. Prior,et al.  Comparison of clinical symptoms in autism and Asperger's disorder. , 1996, Journal of the American Academy of Child and Adolescent Psychiatry.

[4]  R. Greene,et al.  Are Students with ADHD More Stressful to Teach? , 2002 .

[5]  D. Robin,et al.  Attention-deficit hyperactivity symptomatology after traumatic brain injury: a prospective study. , 1998, Journal of the American Academy of Child and Adolescent Psychiatry.

[6]  D. Robin,et al.  Traumatic brain injury in children and adolescents: psychiatric disorders at one year. , 1998, The Journal of neuropsychiatry and clinical neurosciences.

[7]  S. Mayes,et al.  Brief Report: Excellent Agreement Between Two Brief Autism Scales (Checklist for Autism Spectrum Disorder and Social Responsiveness Scale) Completed Independently by Parents and the Autism Diagnostic Interview-Revised , 2011, Journal of autism and developmental disorders.

[8]  E. Bixler,et al.  ADHD subtypes and comorbid anxiety, depression, and oppositional-defiant disorder: differences in sleep problems. , 2008, Journal of pediatric psychology.

[9]  S. Calhoun,et al.  WISC-IV and WISC-III Profiles in Children With ADHD , 2006, Journal of attention disorders.

[10]  S. Faraone,et al.  Should the diagnosis of Attention-Deficit/ Hyperactivity disorder be considered in children with Pervasive Developmental Disorder? , 2001 .

[11]  D. Efron,et al.  The diagnostic outcomes of children with suspected attention deficit hyperactivity disorder following multidisciplinary assessment , 2010, Journal of paediatrics and child health.

[12]  E. Bixler,et al.  Nonsignificance of Sleep Relative to IQ and Neuropsychological Scores in Predicting Academic Achievement , 2008, Journal of developmental and behavioral pediatrics : JDBP.

[13]  Christopher Gillberg,et al.  Autism spectrum disorders in children with normal intellectual levels: associated impairments and subgroups. , 2004, Developmental medicine and child neurology.

[14]  M. Appelbaum,et al.  Effects of diets high in sucrose or aspartame on the behavior and cognitive performance of children. , 1994, The New England journal of medicine.

[15]  Keith E. Beery,et al.  Developmental Test of Visual-Motor Integration , 2012 .

[16]  Christopher Gillberg,et al.  Narrative skills, cognitive profiles and neuropsychiatric disorders in 7-8-year-old children with late developing language. , 2007, International journal of language & communication disorders.

[17]  J. Constantino,et al.  Autistic traits in a population-based ADHD twin sample. , 2007, Journal of child psychology and psychiatry, and allied disciplines.

[18]  G. Chase,et al.  ADHD Subtypes and Co-Occurring Anxiety, Depression, and Oppositional-Defiant Disorder , 2009, Journal of attention disorders.

[19]  Heather R. Purichia,et al.  Comparison of Scores on the Checklist for Autism Spectrum Disorder, Childhood Autism Rating Scale, and Gilliam Asperger’s Disorder Scale for Children with Low Functioning Autism, High Functioning Autism, Asperger’s Disorder, ADHD, and Typical Development , 2009, Journal of autism and developmental disorders.

[20]  S. Calhoun,et al.  Processing speed in children with clinical disorders , 2005 .

[21]  Claire Hughes,et al.  Executive function deficits in autism spectrum disorders and attention-deficit/hyperactivity disorder: Examining profiles across domains and ages , 2006, Brain and Cognition.

[22]  J. Lalonde,et al.  Attention-Deficit Hyperactivity Disorder Subtypes and Comorbid Disruptive Behaviour Disorders in a Child and Adolescent Mental Health Clinic , 1998, Canadian journal of psychiatry. Revue canadienne de psychiatrie.

[23]  DSM-IV-Defined Asperger Syndrome: Cognitive, Behavioral and Early History Differentiation from High-Functioning Autism , 2000 .

[24]  P. J. Krantz,et al.  Age at intervention and treatment outcome for autistic children in a comprehensive intervention program , 1985 .

[25]  S. Calhoun,et al.  Similarities and Differences in Wechsler Intelligence Scale for Children—Third Edition (WISC-III) Profiles: Support for Subtest Analysis in Clinical Referrals , 2004, The Clinical neuropsychologist.

[26]  H. Tachimori,et al.  Cognitive and Symptom Profiles in High-Functioning Pervasive Developmental Disorder Not Otherwise Specified and Attention-Deficit/Hyperactivity Disorder , 2006, Journal of autism and developmental disorders.

[27]  S. Mayes,et al.  Can Asperger's Disorder Be Differentiated From Autism Using DSM-IV Criteria? , 2006 .

[28]  S. Calhoun,et al.  WISC-IV and WIAT-II Profiles in Children With High-Functioning Autism , 2008, Journal of autism and developmental disorders.

[29]  M. Prior,et al.  Comparison of Asperger syndrome and high-functioning autistic children on a Test of Motor Impairment , 1995, Journal of autism and developmental disorders.

[30]  S. Calhoun,et al.  Influence of IQ and Age in Childhood Autism: Lack of Support for DSM-IV Asperger's Disorder , 2004 .

[31]  F. Volkmar,et al.  How unspecified are disorders of children with a pervasive developmental disorder not otherwise specified? A study of social problems in children with PDD-NOS and ADHD , 2000, European Child & Adolescent Psychiatry.

[32]  H. Geurts,et al.  Can the Children's Communication Checklist differentiate between children with autism, children with ADHD, and normal controls? , 2004, Journal of child psychology and psychiatry, and allied disciplines.

[33]  S. Calhoun,et al.  Variables Associated with Anxiety and Depression in Children with Autism , 2011 .

[34]  T. Clark,et al.  Autistic symptoms in children with attention deficit-hyperactivity disorder , 1999, European Child & Adolescent Psychiatry.

[35]  E. Bixler,et al.  Sleep Problems in Children with Autism, ADHD, Anxiety, Depression, Acquired Brain Injury, and Typical Development , 2009 .

[36]  P. Szatmari,et al.  Asperger's syndrome and autism: differences in behavior, cognition, and adaptive functioning. , 1995, Journal of the American Academy of Child and Adolescent Psychiatry.

[37]  N Amodei,et al.  HIV-associated changes in adaptive, emotional, and behavioral functioning in children and adolescents with hemophilia: results from the Hemophilia Growth and Development Study. , 2000, Journal of pediatric psychology.

[38]  A. Ghanizadeh.  Tactile Sensory Dysfunction in Children with ADHD , 2009, Behavioural neurology.

[39]  Wilbur L. Smith,et al.  Traumatic brain injury in children and adolescents: psychiatric disorders at two years. , 1997, Journal of the American Academy of Child and Adolescent Psychiatry.

[40]  S. Calhoun,et al.  Anxiety, depression, and irritability in children with autism relative to other neuropsychiatric disorders and typical development , 2011 .

[41]  D. Lynam,et al.  ADHD Combined Type and ADHD Predominantly Inattentive Type Are Distinct and Unrelated Disorders , 2006 .

[42]  The external validity of Asperger disorder: lack of evidence from the domain of neuropsychology. , 2000 .

[43]  J. Hattori,et al.  Are pervasive developmental disorders and attention-deficit/hyperactivity disorder distinct disorders? , 2006, Brain and Development.

[44]  A. Azizian,et al.  Comparison of DSM-IV symptoms in elementary school-age children with PDD versus clinic and community samples , 2005, Autism : the international journal of research and practice.

[45]  P. Prins,et al.  Social incompetence in children with ADHD: possible moderators and mediators in social-skills training. , 2007, Clinical psychology review.

[46]  A. Gilchrist,et al.  Social and Psychiatric Functioning in Adolescents with Asperger Syndrome Compared with Conduct Disorder , 2000, Journal of autism and developmental disorders.

[47]  S. Calhoun,et al.  Variables Related to Sleep Problems in Children with Autism. , 2009 .

[48]  K. Mcburnett,et al.  A Review of Attention-Deficit/Hyperactivity Disorder Complicated by Symptoms of Oppositional Defiant Disorder or Conduct Disorder , 2010, Journal of developmental and behavioral pediatrics : JDBP.

[49]  S. Calhoun,et al.  Impact of IQ, Age, SES, Gender, and Race on Autistic Symptoms. , 2011 .

[50]  S. Mayes,et al.  Symptoms of Autism in Young Children and Correspondence with the DSM , 1999 .

[51]  R. Shalev,et al.  The impact of sex and subtypes on cognitive and psychosocial aspects of ADHD. , 2006, Developmental medicine and child neurology.

[52]  S. Calhoun,et al.  Learning, Attention, Writing, and Processing Speed in Typical Children and Children with ADHD, Autism, Anxiety, Depression, and Oppositional-Defiant Disorder , 2007, Child neuropsychology : a journal on normal and abnormal development in childhood and adolescence.

[53]  S. Hartley,et al.  Which DSM-IV-TR criteria best differentiate high-functioning autism spectrum disorder from ADHD and anxiety disorders in older children? , 2009, Autism : the international journal of research and practice.

[54]  R. Barkley,et al.  Comprehensive evaluation of attention deficit disorder with and without hyperactivity as defined by research criteria. , 1990, Journal of consulting and clinical psychology.

[55]  David M. Rocke,et al.  Examining executive functioning in children with autism spectrum disorder, attention deficit hyperactivity disorder and typical development , 2009, Psychiatry Research.

[56]  Janet B W Williams,et al.  Diagnostic and Statistical Manual of Mental Disorders , 2013 .

[57]  S. Faraone,et al.  Psychiatric, neuropsychological, and psychosocial features of DSM-IV subtypes of attention-deficit/hyperactivity disorder: results from a clinically referred sample. , 1998, Journal of the American Academy of Child and Adolescent Psychiatry.

[58]  S. Harris,et al.  Age and IQ at Intake as Predictors of Placement for Young Children with Autism: A Four- to Six-Year Follow-Up , 2000, Journal of autism and developmental disorders.

[59]  S. Calhoun,et al.  Frequency of Reading, Math, and Writing Disabilities in Children with Clinical Disorders. , 2006 .

[60]  S. Ozonoff,et al.  Did Asperger's cases have Asperger disorder? A research note. , 1997, Journal of child psychology and psychiatry, and allied disciplines.

[61]  A. Brereton,et al.  Psychopathology in Children and Adolescents with Autism Compared to Young People with Intellectual Disability , 2006, Journal of autism and developmental disorders.