Cited by 299Autism Spectrum Disorder ResearchAttention Deficit Hyperactivity DisorderChild Nutrition and Feeding Issues

Attention deficit/hyperactivity disorder symptoms moderate cognition and behavior in children with autism spectrum disorders

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Yerys, Benjamin E., Wallace, Gregory L., Sokoloff, Jennifer L., Shook, Devon A., James, Joette D., Kenworthy, Lauren·2009·Autism Research

Abstract

Recent estimates suggest that 31% of children with autism spectrum disorders (ASD) meet diagnostic criteria for attention deficit/hyperactivity disorder (ADHD), and another 24% of children with ASD exhibit subthreshold clinical ADHD symptoms. Presence of ADHD symptoms in the context of ASD could have a variety of effects on cognition, autistic traits, and adaptive/maladaptive behaviors including: exacerbating core ASD impairments; adding unique impairments specific to ADHD; producing new problems unreported in ASD or ADHD; having no clear impact; or producing some combination of these scenarios. Children with ASD and co‐morbid ADHD symptoms (ASD+ADHD; n =21), children with ASD without ADHD (ASD; n =28), and a typically developing control group ( n =21) were included in the study; all groups were matched on age, gender‐ratio, IQ, and socioeconomic status. Data were collected on verbal and spatial working memory, response inhibition, global executive control (EC), autistic traits, adaptive functioning, and maladaptive behavior problems. In this sample, the presence of ADHD symptoms in ASD exacerbated impairments in EC and adaptive behavior and resulted in higher autistic trait, and externalizing behavior ratings. ADHD symptoms were also associated with greater impairments on a lab measure of verbal working memory. These findings suggest that children with ASD+ADHD symptoms present with exacerbated impairments in some but not all domains of functioning relative to children with ASD, most notably in adaptive behavior and working memory. Therefore, ADHD may moderate the expression of components of the ASD cognitive and behavioral phenotype, but ASD+ADHD may not represent an etiologically distinct phenotype from ASD alone.

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  • Working memory impairments remain notable among youth with ASD when ADHD symptoms are controlled and among individuals without co-occurring ADHD.

    “Impairments on tests intended to measure working memory remain notable among youth with ASD when controlling for symptoms of ADHD65 and among individuals without co-occurring ADHD.66 67”

    From Executive function deficits in attention-deficit/hyperactivity disorder and autism spectrum disorder (2024) · cites this paper as [65]

    The Results (Executive Control; page not available) report a significant verbal working-memory deficit for the ASD+ADHD group versus typically developing children, but no significant group differences in spatial working memory. The Discussion (Executive Control; page not available) suggests that the verbal deficit may be unique to the ASD+ADHD group, contrary to the claim that working-memory impairments remain notable when ADHD symptoms are accounted for. (LLM, conf=0.84)

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  • Children with ASD continue to show poor inhibitory control test performance after ADHD symptoms are controlled.

    “Similarly, children with ASD continue to show poor inhibitory control test performance after controlling for ADHD symptoms.65”

    From Executive function deficits in attention-deficit/hyperactivity disorder and autism spectrum disorder (2024) · cites this paper as [65]

    The Results (Executive Control; page unavailable) report no significant group differences on the laboratory response-inhibition test, including for children with ASD without elevated ADHD symptoms versus typically developing controls. The Discussion (Executive Control; page unavailable) reiterates that finding, although it questions the test’s sensitivity. The paper therefore does not find the poor test performance asserted in the claim. (LLM, conf=0.88)

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  • When ADHD symptoms are controlled in ASD samples, working memory effect sizes remain medium for verbal (d=0.53) and spatial (d=0.50) tests.

    “When ADHD symptoms are controlled for among ASD samples, effect sizes remain medium for verbal (d=0.53) and spatial tests (d=0.50).42,65”

    From Executive function deficits in attention-deficit/hyperactivity disorder and autism spectrum disorder (2024) · cites this paper as [65]

    The Results (Executive Control; page unavailable) report medium effect sizes for verbal working memory when comparing ASD+ADHD with ASD, and for spatial working memory when comparing ASD+ADHD with other groups. The paper compares groups defined by ADHD symptoms rather than reporting an analysis that controls for those symptoms; the passages do not give the claimed d=0.53 or d=0.50. Spatial working-memory differences were not statistically significant. (LLM, conf=0.86)

    Experimental — accuracy not yet measured
  • Children with ASD continue to show impaired set shifting compared with neurotypical individuals after co-occurring ADHD symptoms are controlled, with a medium effect size (d=0.61) across tasks.

    “children with ASD continue to show impaired performance on tests intended to measure set shifting compared to neurotypical individuals after controlling for co-occurring ADHD symptoms, with a medium effect size (d=0.61) across tasks.65”

    From Executive function deficits in attention-deficit/hyperactivity disorder and autism spectrum disorder (2024) · cites this paper as [65]

    The Results (Executive Control; page unavailable) report that children with ASD without elevated ADHD symptoms had more impaired parent-rated shifting than typically developing children. The Methods (Participants; page unavailable) show that ADHD symptoms were addressed by separating the ASD groups, not by statistically controlling for them. The paper does not establish impaired performance across set-shifting tasks or report the claimed across-task effect size of d=0.61. (LLM, conf=0.86)

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  • Comorbid ADHD is associated with worse adaptive function in ASD.

    “relates to worse adaptive function (Yerys et al., 2009)”

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Research works printed but not linked: 3

  1. Cambridge Cognition CANTAB 1996 Cambridge Cognition Limited Cambridge, England
  2. Sparrow S Balla D Cicchetti D Vineland Adaptive Behavior Scales (Interview Edition, Survey Form) 1984 American Guidance Service Circle Pines, MN
  3. Wechsler D Wechsler Scales of Intelligence – Third Edition 1991 Psychological Corporation San Antonio, TX

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Authors
Yerys, B. E., Wallace, G. L., Sokoloff, J. L., Shook, D. A., James, J. D., & Kenworthy, L.
Affiliations
  • Children's National (US)
  • National Institute of Mental Health (US)
  • Georgetown University (US)
Corresponding author
Yerys, Benjamin E.
Venue
Autism Research
Publisher
Wiley
Published
2009-12
Volume
2
Issue
6
Pages
322-333
ISSN
  • 1939-3792 (ISSN-L)
  • 1939-3806
OpenAlex
W2023794469
Cited by
299
References
77
Citations by year
2026: 7 · 2025: 18 · 2024: 11 · 2023: 9 · 2022: 21 · 2021: 23 · 2020: 14 · 2019: 25 · 2018: 25 · 2017: 23 · 2016: 13 · 2015: 21 · 2014: 30 · 2013: 24 · 2012: 21
FWCI
5.58
Type
journal article
Language
en
Open access
Locations
  • Autism Research (publishedVersion, public-domain)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institutes of Health
  • National Institute of Mental Health (U54MH066417)
  • National Center for Research Resources (M01RR013297)
  • Eunice Kennedy Shriver National Institute of Child Health and Human Development (T32HD046388, U54HD061221, P30HD040677)
Topics
  • Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
  • Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
  • Health Sciences › Medicine › Psychiatry and Mental health › Child Nutrition and Feeding Issues
Keywords
autism spectrum disorder, attention deficit hyperactivity disorder, comorbidities, executive function, working memory, response inhibition, adaptive behavior, maladaptive behavior, autistic traits, externalizing problems, children
MeSH terms
Adaptation, Psychological, Adolescent, Attention Deficit Disorder with Hyperactivity, Autistic Disorder, Child, Child Behavior Disorders, Child Development Disorders, Pervasive, Cognition Disorders, Female, Humans, Male, Memory, Short-Term, Neuropsychological Tests, Personality Assessment, Psychometrics, Social Adjustment, Comorbidity, Asperger Syndrome, Executive Function

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