ADHD and Autism Comorbidity: A Comprehensive Review Based on Expert Consensus Recommendations and Latest Research Findings
Attention deficit/hyperactivity disorder (ADHD) and Autism spectrum disorder (ASD) frequently co-exist. ADHD and ASD have traditionally been diagnosed and treated separately, with their established clinical guidance.
ASD was an exclusion criterion in both the DSM-IV and ICD-10. [Murphy et al., 2016]
They were not recognised as co-existing conditions until 2013, when the DSM-5 diagnostic manual was updated to reflect the clinical evidence. [APA, 2013]
In children, the cooccurrence of ADHD symptoms in ASD ranges between 53 and 78%, whereas, in community samples, it is lower at 28–31%. [Young et al., 2020]
A meta-analysis of the co-occurrence of ASD symptoms in young people from clinical and community ADHD samples found a comorbidity rate of 21%. [Hollingdale et al., 2020]
ADHD presents in 30–80% of individuals with ASD, and ASD presents in 20–50% of individuals with ADHD. [Lau-Zhu ,2019].
This suggests that ADHD symptoms may be more likely found in people with ASD than vice versa.
This article summarises the main recommendations for diagnosing and managing comorbid ADHD and ASD based on The 2017 Expert Consensus meeting [Young et al., 2020]and additional review articles found in the references.
Christakou, A., Murphy, C. M., Chantiluke, K., Cubillo, A. I., Smith, A. B., Giampietro, V., … & Rubia, K. (2013). Disorder-specific functional abnormalities during sustained attention in youth with attention deficit hyperactivity disorder (ADHD) and with autism. Molecular psychiatry, 18(2), 236-244.
Shen, C., Luo, Q., Chamberlain, S. R., Morgan, S., Romero-Garcia, R., Du, J., … & Sahakian, B. J. (2020). What is the link between attention-deficit/hyperactivity disorder and sleep disturbance? A multimodal examination of longitudinal relationships and brain structure using large-scale population-based cohorts. Biological psychiatry, 88(6), 459-469.
Pagan C, Goubran-Botros H, Delorme R, Benabou M, Lemière N, Murray K, Amsellem F, Callebert J, Chaste P, Jamain S, Fauchereau F, Huguet G, Maronde E, Leboyer M, Launay JM, Bourgeron T. Disruption of melatonin synthesis is associated with impaired 14-3-3 and miR-451 levels in patients with autism spectrum disorders. Sci Rep. 2017 May 18;7(1):2096
Reddihough, D.S.; Marraffa, C.; Mouti, A.; O’Sullivan, M.; Lee, K.J.; Orsini, F.; Hazell, P.; Granich, J.; Whitehouse, A.J.O.; Wray, J.; et al. Effect of Fluoxetine on Obsessive-Compulsive Behaviors in Children and Adolescents with Autism Spectrum Disorders: A Randomized Clinical Trial. J. Am. Med. Assoc. 2019, 322, 1561–1569