From the Guidelines
Children with co-occurring autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) should undergo comprehensive neuropsychological assessment to identify distinct cognitive profiles and guide tailored interventions, as they often demonstrate more severe impairments in executive functioning, attention, and social cognition compared to children with either condition alone. These children typically require multimodal treatment approaches, including behavioral interventions like applied behavior analysis (ABA) therapy, cognitive-behavioral therapy (CBT), and sometimes medication management 1.
Key Considerations
- Neuropsychological testing often shows deficits in cognitive flexibility, response inhibition, working memory, and sustained attention in children with co-occurring ASD and ADHD.
- Stimulant medications such as methylphenidate (10-60 mg daily) or amphetamine derivatives (5-30 mg daily) may help manage ADHD symptoms, while selective serotonin reuptake inhibitors might address anxiety and repetitive behaviors associated with ASD 1.
- Medication response can be variable in this population, necessitating careful monitoring, with studies suggesting that methylphenidate can be effective in about 40% of children with intellectual disability and ADHD, with an effect size of 0.39 to 0.52 1.
Treatment Approach
- Early identification through comprehensive neuropsychological assessment is crucial, as it allows for targeted interventions that address the specific cognitive and behavioral challenges these children face, potentially improving long-term outcomes across academic, social, and adaptive functioning domains.
- A multimodal treatment approach, including behavioral interventions and medication management, should be tailored to the individual child's needs, taking into account the presence of co-occurring conditions and the potential for variable medication response.
Important Considerations for Treatment
- The presence of autistic symptoms or the severity of ADHD symptoms does not appear to moderate the efficacy of methylphenidate in children with intellectual disability and ADHD 1.
- Comprehensive assessment and ongoing monitoring are essential to ensure that the treatment approach is effective and adjusted as needed to optimize outcomes for children with co-occurring ASD and ADHD.
From the Research
Neuropsychological Studies in Children with Co-occurring ASD and ADHD
- Children with co-occurring autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) often exhibit significant impairments, including deficits in social processing, adaptive functioning, and executive control 2.
- The prevalence of co-occurring ASD and ADHD in children is estimated to be around 1.2% in the United States, with males, older children, and those with poor health or public health insurance being more likely to have co-occurring ASD and ADHD 3.
- Studies have shown that children with co-occurring ASD and ADHD are more severely impaired than those with ASD alone, with significant deficits in social processing, adaptive functioning, and executive control 2, 4.
Treatment of ADHD Symptoms in Children with Co-occurring ASD and ADHD
- Pharmacological treatments, such as methylphenidate and atomoxetine, have been shown to be effective in reducing ADHD symptoms in children with co-occurring ASD and ADHD 5, 2.
- Methylphenidate has been found to reduce hyperactivity and inattention in children with co-occurring ASD and ADHD, with a moderate to large effect size 5.
- Atomoxetine has also been found to reduce inattention and hyperactivity in children with co-occurring ASD and ADHD, with a moderate effect size 5.
Comorbidities and Treatment Modalities
- Children with co-occurring ASD and ADHD are more likely to have comorbid mental, behavioral, and developmental disorders, such as anxiety, depression, and behavior or conduct problems 4.
- Psychotropic medication and behavioral treatment are commonly used to treat children with co-occurring ASD and ADHD, with males and older children being more likely to receive behavioral treatment and psychotropic medication, respectively 4.
- A multidisciplinary approach is necessary to support the complex needs of children with co-occurring ASD and ADHD, including early developmental screening and surveillance, and coordinated strategies for early identification and intervention 4, 3.