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Comorbidity and Autism Spectrum Disorder

Original Research ARTICLE Provisionally accepted The full-text will be published soon. Notify me

Front. Psychiatry | doi: 10.3389/fpsyt.2018.00717

The presence of comorbid ADHD and anxiety symptoms in autism spectrum disorder: Clinical presentation and predictors

 Einat Avni1*,  Esther Ben-Itzchak2 and Ditza A.Zachor1, 3
  • 1Department of child neurology, The Autism Center, Assaf Harofeh Medical Center, Israel
  • 2Bruckner center for research in autism spectrum disorder, Communication Disorder department, Ariel University, Israel
  • 3Department of Pediatrics, Sackler Faculty of Medicine, Tel Aviv University, Israel

High rates of attention deficit/hyperactivity disorder (ADHD) and anxiety symptoms have been documented in autism spectrum disorder (ASD), and have been associated with social and adaptive impairments. The study examined the frequency of clinically elevated ADHD and anxiety symptoms in an ASD group in comparison to a nonclinical group, compared the clinical presentation in the ASD group with and without ADHD and anxiety, assessed which child and familial variables add to the severity of Inattention, Hyperactivity/Impulsivity (HI), and anxiety symptoms, and evaluated whether having clinically elevated ADHD and/or anxiety symptoms adds to the prediction of adaptive functioning in ASD. The study included 260 participants diagnosed with ASD (mean age: 7.5±1.1), using standardized tests. The rate of clinically elevated ADHD and anxiety symptoms in ASD was 62.7% and 44.6% respectively, and symptom severity was significantly greater than the nonclinical sample. The entire population was divided into four subgroups: ASD alone, ASD+ADHD, ASD+anxiety, ASD+ADHD+anxiety, based on the parental behavioral questionnaire. The ASD alone group showed less severe autism symptoms in comparison to the other groups. Having ASD+ADHD symptoms was associated with greater impairments in socialization adaptive skills. Only the group with ASD+ADHD+anxiety was associated with poorer daily living adaptive skills.
Regression analyses for prediction of ADHD and anxiety symptoms revealed that being a female and having lower adaptive skills scores predicted higher Inattention severity; being older, having better cognition and more severe Restrictive Repetitive Behavior symptoms predicted more severe HI symptoms; being older and having more severe social impairments predicted higher anxiety scores. A regression analysis for the prediction of adaptive skills revealed that in addition to cognition and autism severity, the severity of Inattention symptoms added to the prediction of overall adaptive skills. In light of these findings, clinicians should diagnose these comorbidities in ASD early on, and provide effective interventions to reduce their negative impact on functioning, thereby improving outcome.

Keywords: Autism (ASD), ADHD (Attention Deficit and Hyperactivity Disorder), Anxiety, autism severity, Adaptive skills, cognitive abilities

Received: 08 Jul 2018; Accepted: 06 Dec 2018.

Edited by:

Richard E. Frye, Phoenix Children's Hospital, United States

Reviewed by:

ILIANA MAGIATI, National University of Singapore, Singapore
Daniel Stein, Edmond and Lily Safra Children's Hospital, Israel  

Copyright: © 2018 Avni, Ben-Itzchak and A.Zachor. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Dr. Einat Avni, Assaf Harofeh Medical Center, Department of child neurology, The Autism Center, Tel Aviv, Israel,