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Attention deficit/hyperactivity disorder symptoms moderate cognition and behavior in children with autism spectrum disorders
Open accessAbstract
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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“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]
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In the citing paper
“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]
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In the citing paper
“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]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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]
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In the citing paper
“relates to worse adaptive function (Yerys et al., 2009)”
From Data‐driven identification of subtypes of executive function across typical development, attention deficit hyperactivity disorder, and autism spectrum disorders (2020) · cites this paper as Yerys et al., 2009
In the citing paper
“There is evidence that ADHD in ASD is associated with differences in autism symptomatology, executive functioning (Sinzig, Morsch, Bruning, Schmidt, & Lehmkuhl, 2008), and adaptive behaviors (Yerys et al., 2009)”
From WISC-IV profile in high-functioning autism spectrum disorders: Impaired processing speed is associated with increased autism communication symptoms and decreased adaptive communication abilities (2012) · cites this paper as Yerys et al., 2009
In the citing paper
“and profiles of executive impairment may differ between ASD individuals with and without ADHD (Sinzig, Morsch, Bruning, Schmidt, & Lehmkuhl, 2008; Yerys et al., 2009).”
From Atypical attentional networks and the emergence of autism (2013) · cites this paper as Yerys et al., 2009
In the citing paper
“Similarly, in autism, group differences on EF measures (compared to non-ASD mental age-matched controls) do not imply that all individuals with ASD have EF problems, particularly when considering the milder variants of the condition”
From Brain adaptation and alternative developmental trajectories (2015) · cites this paper as Yerys et al., 2009
In the citing paper
“Significant relationships between self-reported EF deficits and a variety of constructs that are associated with deficient implementation of EF in daily life have been reported, including academic procrastination (e.g., deficits in planning, organization, and initiation; Rabin et al. 2011), Attention Deficit Hyperactivity Disorder (ADHD; known to encompass multiple EF deficits, e.g., deficits in”
From Executive Function Deficits in Daily Life Prospectively Predict Increases in Depressive Symptoms (2014) · cites this paper as Yers et al. 2009
In the citing paper
“For example, difficulties in shifting are not usually found in the ASD+ADHD group, compared to the pure ASD group, on laboratory tasks, but they have been identified using parent reports (Yerys et al., 2009).”
From Children with autism and attention deficit hyperactivity disorder. Relationships between symptoms and executive function, theory of mind, and behavioral problems (2018) · cites this paper as Yerys et al., 2009
In the citing paper
“Inhibitory problems seem to be shared by the group with ASD+ADHD and the group with ADHD (Bühler et al., 2011;Chantiluke et al., 2014;Sinzig et al., 2008b;Tye et al., 2014), although sometimes no inhibitory deficits have been found in the comorbid group (Sinzig et al., 2008a;Van der Meer et al., 2012;Yerys et al., 2009).”
From Children with autism and attention deficit hyperactivity disorder. Relationships between symptoms and executive function, theory of mind, and behavioral problems (2018) · cites this paper as Yerys et al., 2009
In the citing paper
“Similar results were obtained by Yerys et al. (2009) when comparing the EF in children with TD, ASD, and ASD+ADHD, using the parent version of the BRIEF.”
From Children with autism and attention deficit hyperactivity disorder. Relationships between symptoms and executive function, theory of mind, and behavioral problems (2018) · cites this paper as Yerys et al., 2009
In the citing paper
“This is in accordance with the results of Yerys et al. [49] finding high levels of ADHD-like symptoms in children with HFA to be associated with impairment in verbal working memory.”
From Symptoms of ADHD in Children with High-Functioning Autism Are Related to Impaired Verbal Working Memory and Verbal Delayed Recall (2013) · cites this paper as [49]
In the citing paper
“Yerys et al. [115] found greater overall cognitive impairments, including poor overall global executive control, cognitive flexibility, and verbal working memory, in children with ASD who also had hyperactivity.”
From Treatment for Co-Occurring Attention Deficit/Hyperactivity Disorder and Autism Spectrum Disorder (2012) · cites this paper as [115]
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Lai, M.-C., Kassee, C., Besney, R., Bonato, S., Hull, L., Mandy, W., Szatmari, P., & Ameis, S. H. (2019) · The Lancet Psychiatry · doi:10.1016/s2215-0366(19)30289-5 · Cited by 1,892
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“There is preliminary evidence that when ADHD is comorbid with ASD, the risk for increased severity of psychosocial problems increases (Gadow et al., 2004; Yerys et al., 2009).”
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BackgroundInfluential
Metadata
- 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
- PMC
- PMC3012375
- 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
- green
- www.ncbi.nlm.nih.gov
- 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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