ORIGINAL RESEARCH article
Front. Psychiatry
Sec. Autism
This article is part of the Research TopicWomen in Psychiatry 2025: AutismView all 10 articles
Cognitive and Emotional Profiles in Children with ASD, ADHD, and Comorbid Presentations: Evidence for a Distinct Clinical Phenotype
Provisionally accepted
Antonio Narzisi1*
Federica Barbetti1
Maddalena Fabbri Destro2
Stefano Berloffa1
Pamela Fantozzi1Valentina Viglione1
Rosy Muccio1
Elena Valente1Ilaria Accorinti1
Elisa Foti1
Annarita Milone1
Ramona Cardillo3
Gabriele Masi1- 1Stella Maris Foundation (IRCCS), Calambrone, Italy
- 2Istituto di Neuroscienze Consiglio Nazionale delle Ricerche Sede di Parma, Parma, Italy
- 3Universita degli Studi di Padova, Padua, Italy
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Background: Autism Spectrum Disorder (ASD) and Attention-Deficit/Hyperactivity Disorder (ADHD) frequently co-occur, yet their comorbid presentation (ASD+ADHD) remains under-characterized. Clarifying cognitive and behavioral profiles is crucial for accurate diagnosis and effective intervention. Methods: A total of 207 children and adolescents (ages 6–16) were assessed using the Wechsler Intelligence Scale for Children – Fourth Edition (WISC-IV) and the Child Behavior Checklist (CBCL 6–18). Participants were grouped into ASD (n = 21), ADHD (n = 103), and ASD+ADHD (n = 83) cohorts. Group differences were analyzed through ANOVAs with Bonferroni corrections; Pearson correlations explored associations between cognitive indices and behavioral outcomes. Results: Children with ASD+ADHD scored significantly lower than the ASD group in working memory, processing speed, and full-scale IQ, while no significant differences emerged between the ASD+ADHD and ADHD groups. Behaviorally, ADHD participants exhibited higher externalizing symptoms (e.g., aggression, rule-breaking), while the ASD group showed greater withdrawn/depressed traits. The comorbid group presented the broadest dysregulation, with elevated scores across both internalizing and externalizing domains, including Sluggish Cognitive Tempo and obsessive-compulsive symptoms. Notably, protective associations between cognitive abilities and behavioral regulation, present in ASD and ADHD, were absent in the ASD+ADHD group. Conclusions: Findings suggest that ASD+ADHD comorbidity represents a distinct clinical profile, marked by compounded cognitive impairments and pervasive emotional-behavioral dysregulation. These patterns underscore the need for differential diagnostic approaches and tailored interventions that account for the unique neurocognitive architecture of comorbid presentations.
Keywords: ADHD, ASD, Behavioral dysregulation, CBCL, cognitive profile, Comorbidity, executive functioning, WISC-IV
Received: 11 Dec 2025; Accepted: 03 Feb 2026.
Copyright: © 2026 Narzisi, Barbetti, Fabbri Destro, Berloffa, Fantozzi, Viglione, Muccio, Valente, Accorinti, Foti, Milone, Cardillo and Masi. 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) or licensor 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: Antonio Narzisi
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