Treatment for Co-Occurring Attention Deficit/Hyperactivity Disorder and Autism Spectrum Disorder

May combine two claims.

Research specifically on co-occurring ADHD and ASD has emerged recently, with more focus on etiology and phenomenology than intervention development.

“Research specifically focusing on co-occurring ADHD and ASD has only emerged recently, and many studies have focused primarily on questions of etiology and phenomenology, with less direct work on intervention development [11].”

• cites [11] Gargaro, 2011, Autism and ADHD: how far have we come in the comorbidity debate?, Neurosci Biobehav Rev sourceNot checked yet

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May combine two claims.

Psychostimulants are the most widely researched medications for ADHD alone, but findings on their efficacy and safety in co-occurring ADHD and ASD conflict.

“Psychostimulants are the most widely researched medications used to treat ADHD alone [26], but conflicting findings have been reported regarding the efficacy and safety of stimulants in cases of co-occurring ADHD and ASD.”

• cites [26] Greenhill, 2002, Practice parameter for the use of stimulant medications in the treatment of children, adolescents, and adults, J Am Academy Child Adolesc Psychiatry sourceNot checked yet

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Social skill interventions for children with ADHD are often clinically indicated but have limited treatment effectiveness.

“In contrast, social skill interventions to reduce social impairments (i.e., social and social communication problems often associated with ASD) for children with ADHD are often clinically indicated but have demonstrated limited treatment effectiveness [55].”

• cites [55] de Boo, 2007, Social incompetence in children with ADHD: possible moderators and mediators in social-skills training, Clin Psychol Rev sourceNot checked yet

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Santosh and colleagues found general ADHD symptom improvement and little difference in response between the ADHD-only and ASD-plus-ADHD groups.

“Based on a retrospective analysis of clinic cases and a small prospective clinical trial, Santosh et al. [41] reported overall improvement in ADHD symptoms, with few differences in treatment response between the groups.”

• cites [41] Santosh, 2006, Impact of comorbid autism spectrum disorders on stimulant response in children with attention deficit hyperactivity disorder: a retrospective and prospective effectiveness study, Child Care Health Dev sourceNot checked yet

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In that trial, children with ASD had more adverse effects and a lower highest tolerated dose than children without ASD.

“More adverse effects were reported in the children with ASD, and the highest tolerated dose was lower than that tolerated in children without ASD [24].”

• cites [24] Research Units on Pediatric Psychopharmacology (RUPP) Autism Network, 2005, Randomized, controlled, crossover trial of methylphenidate in pervasive developmental disorders with hyperactivity, Arch Gen Psychiatry sourceNot checked yet

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May combine two claims.

ADHD parent training usually follows manuals in group formats, teaching caregivers strategies for their child's behavior.

“For ADHD, parent interventions (“parent training”) typically involve manual, groupbased programs designed to teach parents strategies to manage the behaviors of their children (e.g., reduce impulsive behavior, increase focus on tasks) [59,60].”

• cites [59] Barkley, 1997Not checked yet

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• cites [60] McMahon, 2005Not checked yet

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May combine two claims.

In that trial, medication effects were limited to target ADHD symptoms, with no positive effects on irritability, social withdrawal, stereotypy, or inappropriate speech.

“Results also indicated that medication effects were restricted to the target ADHD symptoms (e.g., decreased hyperactivity and impulsivity), and no positive effects were found on other behaviors, such as irritability, social withdrawal, stereotypy, or inappropriate speech [24].”

• cites [24] Research Units on Pediatric Psychopharmacology (RUPP) Autism Network, 2005, Randomized, controlled, crossover trial of methylphenidate in pervasive developmental disorders with hyperactivity, Arch Gen Psychiatry sourceNot checked yet

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In a randomized placebo-controlled crossover trial of 72 children with autism and moderate-to-severe hyperactivity, methylphenidate reduced hyperactivity and impulsivity in about half, lower than 70-80% response in ADHD-only studies.

“Results indicated that stimulant medication was effective at reducing hyperactivity and impulsivity in approximately half of the participants, a response rate that is considerably lower than the rates of 70 to 80 % found in studies of methylphenidate for children with ADHD only [24,38,39].”

• cites [24] Research Units on Pediatric Psychopharmacology (RUPP) Autism Network, 2005, Randomized, controlled, crossover trial of methylphenidate in pervasive developmental disorders with hyperactivity, Arch Gen Psychiatry sourceNot checked yet

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• cites [38] Greenhill, 2006, Efficacy and safety of immediate-release methylphenidate treatment for preschoolers with ADHD, J Am Acad Child Adolesc Psychiatry sourceNot checked yet

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• cites [39] Greenhill, 1996, Medication treatment strategies in the MTA Study: relevance to clinicians and researchers, J Am Acad Child Adolesc Psychiatry sourceNot checked yet

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ADHD symptoms can appear early, and subtypes may shift, yet impairment usually continues and may worsen with adult independence demands.

“Within ADHD, symptoms may emerge early and diagnostic subtypes may not be stable for a period of time [73,74], but impairment associated with ADHD symptoms typically persists and can be exacerbated by increased demands for independent functioning in adulthood [75,76].”

• cites [73] Sonuga-Barke, 2005, Varieties of preschool hyperactivity: multiple pathways from risk to disorder, Dev Sci sourceNot checked yet

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• cites [74] Todd, 2008, Predictors of stability of attention-deficit/hyperactivity disorder subtypes from childhood to young adulthood, J Am Acad Child Adolesc Psychiatry sourceNot checked yet

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• cites [75] Lahey, 2005, Instability of the DSM-IV Subtypes of ADHD from preschool through elementary school, Arch Gen Psychiatry sourceNot checked yet

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A small placebo-controlled study reported atomoxetine improved hyperactive and impulsive symptoms, not inattention, in youths with ASD, and caused fewer adverse events than stimulant trials.

“A small placebo-controlled efficacy trial indicated positive effects in terms of the reduction of hyperactivity and impulsivity, but not inattention in youth with ASD, with fewer adverse events as compared to stimulant trials [43].”

• cites [43] Arnold, 2006, Atomoxetine for hyperactivity in autism spectrum disorders: placebo-controlled crossover pilot trial, J Am Acad Child Adolesc Psychiatry sourceNot checked yet

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Treatment for ADHD and ASD originally developed using operant conditioning and later drew on social learning theory.

“Treatment for both ADHD (and related disruptive behaviors) and ASD originally developed using operant conditioning procedures, which have evolved in time to draw on a social learning theory [58].”

• cites [58] Brookman-Frazee, 2006, Parenting interventions for children with autism spectrum and disruptive behavior disorders: opportunities for cross-fertilization, Clin Child Fam Psychol Rev sourceNot checked yet

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The evidence backs methylphenidate for children with both conditions, while indicating that ASD patients may need closer side-effect monitoring and smaller doses.

“Although these findings support the use of methylphenidate in children with both ADHD and ASD, the results were also consistent with prior studies that have suggested a greater need for side effect monitoring and lower dosing in the context of ASD.”

May combine two claims.

Pharmacological treatment for ADHD reduces impairment from core ADHD symptoms and improves functioning in children and adults.

“Pharmacological treatment for ADHD is effective for reducing impairment associated with core ADHD symptoms (i.e., inattention, hyperactivity, impulsivity) and improving functioning in children and adults [25,26].”

• cites [25] Swanson, 2009, Psychopharmacology: concepts and opinions about the use of stimulant medications, J Child Psychol Psychiatry sourceNot checked yet

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• cites [26] Greenhill, 2002, Practice parameter for the use of stimulant medications in the treatment of children, adolescents, and adults, J Am Academy Child Adolesc Psychiatry sourceNot checked yet

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May combine two claims.

A secondary analysis of RUPP data linked methylphenidate to better joint attention initiation and response, improved self-regulation, and a more regulated affective state in 33 ASD children.

“Results indicated that methylphenidate use was associated with several positive social outcomes, including improved initiation for joint attention, improved response to bids for joint attention, better selfregulation, and more regulated affective state [50].”

• cites [50] Jahromi, 2009, Positive effects of methylphenidate on social communication and self-regulation in children with pervasive developmental disorders and hyperactivity, J Autism Dev Disord sourceNot checked yet

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May combine two claims.

Research using parent and teacher reports found notable ADHD symptom decreases in children with both ADHD and ASD; roughly half responded, and 12 participants had minimal side effects.

“Additional research using parents and teachers as informants showed significant reductions in ADHD symptoms among children with ADHD and ASD.Approximately half of the participants were classified as responders (i.e., global improvement rating in the “muchto-moderate” range for 6 of 14 participants), and side effects were rated as “minimally present” in 12 of the participants [44].”

• cites [44] Zeiner, 2011, Response to atomoxetine in boys with high-functioning autism spectrum disorders and attention deficit/hyperactivity disorder, Acta Paediatr sourceNot checked yet

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For ASD, supported treatments also include behavioral therapy for anxiety and aggression, plus group social skills training.

“Other evidence-based interventions for ASD include behavioral treatments for anxiety and aggression and group social skills training [57].”

• cites [57] Vismara, 2010, Behavioral treatments in autism spectrum disorder: what do we know?, Ann Rev Clinical Psychol sourceNot checked yet

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Some medications show potential for treating stereotyped or repetitive behaviors in ASD, but efficacy data are weaker.

“Although some medications have demonstrated the potential to treat stereotyped or repetitive behaviors associated with ASD, efficacy data on these treatments has been less strong [30].”

• cites [30] Williams, 2010, Selective serotonin reuptake inhibitors (SSRIs) for autism spectrum disorders (ASD), Cochrane Database Syst Rev sourceNot checked yet

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May combine two claims.

Evidence supports parent behavior training for childhood ADHD and cognitive behavioral therapy for adults with ADHD.

“For ADHD, empirical support exists for behavioral training for parents of children with ADHD [53] and cognitive behavioral therapy for affected adults [54].”

• cites [53] AACAP, 2007, Practice parameter for the assessment and treatment of children and adolescents with attention-deficit/hyperactivity disorder, J Am Acad Child Adolesc Psychiatry sourceNot checked yet

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• cites [54] Safren, 2006, Cognitive-behavioral approaches to ADHD treatment in adulthood, J Clin PsychiatryNot checked yet

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May combine two claims.

Only risperidone and aripiprazole are formally approved for ASD, and both target irritability.

“Only 2 medications have been formally approved for use with individuals with ASD and both of these medicines target irritability: risperidone (Risperdal, Janssen Pharmaceutical Inc.; Titusville, NJ) and aripiprazole (Abilify, Otsuka America Pharmaceutical Inc.; Rockville, MD) [27][28][29].”

• cites [27] Canitano, 2011, Psychopharmacology in autism: an update, Prog Neuropsychopharmacol Biol Psychiatry sourceNot checked yet

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• cites [28] Canitano, 2008, Risperidone in the treatment of behavioral disorders associated with autism in children and adolescents, Neuropsychiatr Dis Treat sourceNot checked yet

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• cites [29] Curran, 2011, Aripiprazole in the treatment of irritability associated with autistic disorder in paediatric patients: profile report, CNS Drugs sourceNot checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Cases of pure ADHD are relatively uncommon; most individuals also have a co-occurring psychiatric or developmental condition.

“It is widely believed that cases of “pure” ADHD are relatively uncommon, with the majority of individuals also affected by a co-occurring psychiatric disorder (e.g., anxiety, oppositional defiant disorder) or a developmental condition (e.g., learning disability, ASD) [68,69].”

• cites [68] Taurines, 2010, Developmental comorbidity in attention-deficit/hyperactivity disorder, Atten Defic Hyperact Disord sourceNot checked yet

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• cites [69] Kadesjo, 2001, The comorbidity of ADHD in the general population of Swedish school-age children, J Child Psychol Psychiatry sourceNot checked yet

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In a risperidone-plus-parent-training trial, the combined group showed less aggression and larger hyperactivity decreases than the medication-only group.

“Results indicated that children who received parent training in addition to pharmacological treatment (i.e., risperidone) had lower rates of aggression and greater reductions in hyperactivity as compared to children who only received medication [63].”

• cites [63] Aman, 2009, Medication and parent training in children with pervasive developmental disorders and serious behavior problems: results from a randomized clinical trial, J Am Acad Child Adolesc Psychiatry sourceNot checked yet

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May combine two claims.

Current diagnostic rules prevent diagnosing ADHD and ASD in the same person, with ASD excluding ADHD.

“Current nosology, however, precludes diagnosis of both disorders to the same individual and specifies that the presence of an ASD is an exclusion criterion for ADHD [3,4].”

• cites [3] American Psychiatric Association, 2000Not checked yet

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• cites [4] World Health Organization, 1992Not checked yet

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May combine two claims.

Neuroimaging and neuropsychological studies have shown that executive functioning deficits are common in both ADHD and ASD, with slightly different areas of impairment.

“Neuroimaging and neuropsychological studies have shown that executive functioning deficits are common in both ADHD and ASD, with slightly different areas of impairment observed [11,[108][109][110][111].”

• cites [11,[108][109][110][111]Not checked yet

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Current understanding of developmental trajectories in co-occurring ADHD and ASD is limited by a lack of longitudinal studies.

“Current understanding of developmental trajectories in cooccurring ADHD and ASD is limited by a paucity of longitudinal studies.”

Classified as probably not a substantial claim. May combine two claims.

Past research samples have generally excluded participants with complex psychopathology, so there is little data to inform treatment decision-making for most patients.

“Because past research samples have generally excluded participants with complex psychopathology, there is little data to inform treatment decisionmaking for the majority of patients.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Social deficits in ASD are characterized by features such as lack of interest or enjoyment in social engagement, inability to reciprocally participate in interactions, and lack of emotional engagement with others.

“Social deficits in ASD are characterized by features, such as a lack of interest or enjoyment in social engagement, inability to reciprocally participate in interactions, and lack of emotional engagement with others [96].”

• cites [96] Carter, 2005, Social development in autismNot checked yet

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In a community sample of more than 300 pairs of 2-year-old twins, ASD and ADHD symptoms showed modest but statistically significant correlations (r=0.23-0.26) on the Child Behavior Checklist, with associations in both social and nonsocial autistic-like traits.

“Results indicated modest but statistically significant correlations (r00.23-0.26) between ASD and ADHD symptoms, as measured by the Child Behavior Checklist, with associations apparent in both social and nonsocial autistic-like traits [10].”

• cites [10] Ronald, 2010, Exploring the relationship between autistic-like traits and ADHD behaviors in early childhood: findings from a community twin study of 2-year-olds, J Abnorm Child Psychol sourceNot checked yet

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Past research suggests that ADHD and ASD can be differentiated from one another on a neuropsychological level during childhood and adulthood.

“Overall, past research has suggested that ADHD and ASD can be differentiated from 1 another on a neuropsychological level during childhood and adulthood [109, 113].”

• cites [109] Ozonoff, 1999, Brief report: specific executive function profiles in three neurodevelopmental disorders, J Autism Dev Disord sourceNot checked yet

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• cites [113] Bramham, 2009, Executive functioning differences between adults with attention deficit hyperactivity disorder and autistic spectrum disorder in initiation, planning and strategy formation, Autism sourceNot checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing).

Investigators are testing novel agents, such as intranasal oxytocin, for social difficulties.

“Similarly, exploratory research is being conducted on new agents, including intranasal oxytocin to target social impairments [31].”

• cites [31] Wink, 2010, Emerging drugs for the treatment of symptoms associated with autism spectrum disorders, Expert Opinion on Emerging Drugs sourceNot checked yet

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Some evidence suggests high rates of substance use disorders in cases of co-occurring ADHD and ASD, even though substance use disorders are common in ADHD and rarely observed in ASD.

“Finally, some evidence suggests high rates of substance use disorders, which are common in ADHD, but are rarely observed in ASD, in cases of co-occurring ADHD and ASD [91].”

• cites [91] Santosh, 2006, Does pervasive developmental disorder protect children and adolescents against drug and alcohol use?, Eur Child Adolesc Psychiatry sourceNot checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing).

Co-occurrence of ADHD and ASD has been reported in a clinical sample of adults who also had high rates of other psychiatric comorbidity.

“At the same time, cooccurrence has also been reported in a clinical sample of adults who experienced ADHD and ASD along with high rates of other psychiatric comorbidity [83,84].”

• cites [83] Nyden, 2010, Adults with autism spectrum disorders and ADHD neuropsychological aspects, Res Dev Disabil sourceNot checked yet

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• cites [84] Stahlberg, 2004, Bipolar disorder, schizophrenia, and other psychotic disorders in adults with childhood onset AD/HD and/or autism spectrum disorders, J Neural Transm sourceNot checked yet

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The literature points to a separate phenotype defined by both ADHD and ASD symptoms, with treatment needs spanning several domains.

“In summary, research suggests the existence of a distinct phenotype characterized by both co-occurring symptoms and the unique needs for treatment that address multiple domains.”

May combine two claims. The quote only partly states this claim.

Growth mixture modeling identified two social communication paths and four hyperactive-inattentive paths.

“Risk profiles were determined using latent class growth analysis and supported the presence of 2 social communication trajectories (i.e., low risk and persistently impaired) and 4 hyperactivity inattentive trait trajectories (i.e., low risk, childhood limited symptoms, intermediate level symptoms, persistently impaired).”

• cites [9] St. Pourcain, 2011, Links between co-occurring social-communication and hyperactive-inattentive trait trajectories, J Am Acad Child Adolesc Psychiatry sourceNot checked yet

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Classified as probably not a substantial claim. May combine two claims.

These findings add to the discussion of shared etiology between ADHD and ASD and highlight the types of social skills deficits that may characterize co-occurring ADHD and ASD.

“These findings not only add to the discussion of shared etiology between the disorders but also highlight the types of deficits in social skills that may characterize co-occurring ADHD and ASD.”

May combine two claims.

Children with ASD and co-occurring ADHD failed to gain social skills, whereas children with ASD without ADHD and children with ASD and anxiety both increased in overall social skills after the intervention.

“Children with ASD and co-occurring ADHD failed to gain social skills, whereas children with ASD without ADHD and children with ASD and anxiety both increased in overall social skills after the intervention [23].”

• cites [23] Antshel, 2011, Comorbid ADHD and anxiety affect social skills group intervention treatment efficacy in children with autism spectrum disorders, J Dev Behav Pediatr sourceNot checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Cross-sectional research suggests that comorbid psychiatric conditions may be present from childhood into adulthood, but it is unclear when different problems emerge developmentally.

“Cross-sectional research suggests that comorbid psychiatric conditions may be present from childhood into adulthood, but it is not clear when different problems emerge in the course of development.”

May combine two claims.

The presence of ADHD is consistently associated with impaired performance on inhibition tasks (e.g., Stroop) and sustained attention tasks (e.g., continuous performance task).

“The presence of ADHD is consistently associated with impaired performance on inhibition tasks (e.g., Stroop tasks) and sustained attention tasks (e.g., continuous performance task) [110].”

• cites [110] Barkley, 1997, Behavioral inhibition, sustained attention, and executive functions: constructing a unifying theory of ADHD, Psychol Bull sourceNot checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Social deficits associated with ADHD are often viewed as a direct result of ADHD core symptoms: inattention may cause missed social cues, impulsivity may lead to inappropriate speaking and upsetting peers, and hyperactivity may interfere with organized activities and lead to peer avoidance.

“In many cases, social deficits associated with ADHD are viewed as a direct result of ADHD core symptoms: inattentive behaviors may lead a child to miss social cues during an activity with peers; impulsive behavior may result in a child speaking out inappropriately and upsetting peers; hyperactive behaviors interfere with organized activities and lead to avoidance of peers.”

May combine two claims.

Children with the social communication type of impairments were more likely to experience repetitive behaviors, speech/language impairment, and developmental problems similar to ASD.

“Children with the social communication type of impairments were more likely to experience repetitive behaviors, speech/language impairment, and developmental problems similar to ASD [97].”

• cites [97] Santosh, 2004, Social impairment in hyperkinetic disorder — relationship to psychopathology and environmental stressors, Eur Child Adolesc Psychiatry sourceNot checked yet

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The treatment literature suggests that neither pharmacotherapy nor social skills training has a positive effect on social outcomes for children with ADHD alone.

“Currently, the treatment literature suggests that neither pharmacotherapy treatment nor social skills training has a positive effect on social outcomes for children with ADHD alone [55,100,101].”

• cites [55] de Boo, 2007, Social incompetence in children with ADHD: possible moderators and mediators in social-skills training, Clin Psychol Rev sourceNot checked yet

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• cites [100] Nijmeijer, 2008, Attention-deficit/hyperactivity disorder and social dysfunctioning, Clin Psychol Rev sourceNot checked yet

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• cites [101] Storebo, 2011, Social skills training for Attention Deficit Hyperactivity Disorder (ADHD) in children aged 5 to 18 years, Cochrane Database Syst RevNot checked yet

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Research suggests that children with ADHD are rejected more often by peers and have fewer friends than typically developing peers.

“Research suggests that children with ADHD are rejected more often by their peers [94] and have fewer friends than typically developing peers [95].”

• cites [94] Hoza, 2005, What aspects of peer relationships are impaired in children with attention-deficit/hyperactivity disorder?, J Consult Clin Psychol sourceNot checked yet

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• cites [95] Mikami, 2010, The importance of friendship for youth with attention-deficit/hyperactivity disorder, Clin Child Fam Psychol Rev sourceNot checked yet

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Taurines et al. proposed that different co-occurring conditions arise and influence ADHD differentially during development.

“In the case of ADHD, Taurines et al. [68] proposed that different cooccurring conditions arise and influence ADHD differentially during the course of development.”

• cites [68] Taurines, 2010, Developmental comorbidity in attention-deficit/hyperactivity disorder, Atten Defic Hyperact Disord sourceNot checked yet

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In children classified in the ADHD plus ASD group, significantly more problematic behaviors were reported, including oppositional behavior, withdrawn/depressed, and total problems on the Child Behavior Checklist.

“Of the children classified in the ADHD, plus the ASD group, significantly more problematic behaviors were also reported including oppositional behavior, withdrawn/ depressed, and total problems as measured by the Child Behavior Checklist (CBCL) [18].”

• cites [18] Grzadzinski, 2011, Examining autistic traits in children with ADHD: does the autism spectrum extend to ADHD?, J Autism Dev Disord sourceNot checked yet

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St. Pourcain and colleagues tracked more than 5000 people from age 4 through 17, measuring social communication and hyperactive-inattentive traits repeatedly.

“St. Pourcain et al. [9] followed over 5000 participants from ages 4 to 17 years and assessed social communication and hyperactive inattentive traits at multiple time points.”

• cites [9] St. Pourcain, 2011, Links between co-occurring social-communication and hyperactive-inattentive trait trajectories, J Am Acad Child Adolesc Psychiatry sourceNot checked yet

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In adults with ADHD, ASD, and co-occurring ADHD/ASD, a recent study found overall impairment in executive functioning but no evidence that co-occurring ADHD and ASD was associated with greater deficits.

“In contrast to these findings among children, results from a recent study of adults with ADHD, ASD, and co-occurring ADHD/ASD found overall impairment in executive functioning in these groups, but there was no evidence that co-occurring ADHD and ASD was associated with greater deficits [83].”

• cites [83] Nyden, 2010, Adults with autism spectrum disorders and ADHD neuropsychological aspects, Res Dev Disabil sourceNot checked yet

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Treatment research from the fields of ADHD and ASD suggests benefits of early identification and intervention, and this is also likely critical for cases of co-occurrence.

“Treatment research from the fields of ADHD and ASD suggest benefits of early identification and intervention, and this is also likely to be critical for cases of co-occurrence [51,128].”

• cites [51] Dawson, 2011, Behavioral interventions in children and adolescents with autism spectrum disorder: a review of recent findings, Curr Opin Pediatr sourceNot checked yet

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• cites [128] Sonuga-Barke, 2011, Early detection and intervention for attention-deficit/hyperactivity disorder, Expert Rev Neurother sourceNot checked yet

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Probably not a substantial claim: may not pass S4 (based). May combine two claims.

Heterogeneity in functioning is a hallmark feature of both ADHD and ASD, with wide variability in presentation among individuals within each diagnostic category.

“Heterogeneity in functioning is a hallmark feature of both ADHD and ASD, with wide variability in presentation among individuals within each diagnostic category.”

Probably not a substantial claim: may not pass S2 (checkable).

Early identification relies on improved diagnostic measures to facilitate assessment procedures and identification of co-occurring symptoms.

“However, early identification relies on improved diagnostic measures to facilitate assessment procedures and identification of co-occurring symptoms.”

May combine two claims.

With respect to psychosocial treatment, very few studies have examined behavioral interventions that directly address co-occurring symptoms, and existing treatment studies have rarely examined outcomes based on co-occurring symptom profiles.

“With respect to psychosocial treatment, very few studies have examined behavioral interventions that directly address cooccurring symptoms, and existing treatment studies have rarely examined outcomes based on co-occurring symptoms profiles [23].”

• cites [23] Antshel, 2011, Comorbid ADHD and anxiety affect social skills group intervention treatment efficacy in children with autism spectrum disorders, J Dev Behav Pediatr sourceNot checked yet

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Even fewer studies have been published on intervention specifically to address executive function in the context of ASD, and no known studies have examined this question in individuals with co-occurring ADHD and ASD symptoms.

“Even fewer studies have been published on intervention specifically to address executive function in the context of ASD, and no known studies have examined this question in individuals with co-occurring ADHD and ASD symptoms [122].”

• cites [122] Soorya, 2009, Psychosocial interventions for motor coordiantion, executive functions, and socialization deficits in ADHD and ASD, Prim PsychiatryNot checked yet

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Sinzig et al. found disorder-specific impairments consistent with past research, but children with ASD who had ADHD symptoms also displayed deficits in inhibition.

“Similarly, Sinzig et al. [116] found disorderspecific impairments consistent with past research, but noted that children with ASD who had ADHD symptoms also displayed deficits in inhibition.”

• cites [116] Sinzig, 2008, Inhibition, flexibility, working memory and planning in autism spectrum disorders with and without comorbid ADHD-symptoms, Child Adolesc Psychiatry Ment Health sourceNot checked yet

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Many clinicians and researchers have advocated for changes to diagnostic criteria to allow co-diagnosis of ADHD and ASD.

“Based on these studies and others, many clinicians and researchers have advocated for changes to the diagnostic criteria to allow co-diagnosis of ADHD and ASD [2,18].”

• cites [2] Reiersen, 2008, Co-occurrence of ADHD and autism spectrum disorders: phenomenology and treatment, Expert Rev Neurother sourceNot checked yet

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• cites [18] Grzadzinski, 2011, Examining autistic traits in children with ADHD: does the autism spectrum extend to ADHD?, J Autism Dev Disord sourceNot checked yet

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Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

Permitting co-diagnosis will facilitate advances in research by eliminating the exclusion of many patients and allowing more heterogeneous samples.

“Permitting co-diagnosis will facilitate advances in research by eliminating the exclusion of many patients and allowing more heterogeneous samples.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

These changes are currently being considered for the upcoming revision of the Diagnostic and Statistical Manual and will likely be incorporated into DSM-5.

“These changes are currently being considered for the upcoming revision of the Diagnostic and Statistical Manual and will likely be incorporated into the Diagnostic and Statistical Manual, Fifth Edition [125-127].”

• cites [125] 2012, American Psychiatric Association. DSM-5 development, A 10 attention deficit/hyperactivity disorderNot checked yet

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• cites [126] 2012, American Psychiatric Association, DSM-5 development. A 09 autism spectrum disorderNot checked yet

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• cites [127] Coghill, 2011, Do the diagnostic criteria for ADHD need to change? Comments on the preliminary proposals of the DSM-5 ADHD and Disruptive Behavior Disorders Committee, Eur Child Adolesc Psychiatry sourceNot checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Interest in the co-occurrence of ADHD and ASD has grown tremendously in the last decade, with multiple published studies addressing heritability and shared etiology, as well as common phenotypic and endophenotypic features.

“Interest in the co-occurrence of ADHD and ASD has grown tremendously in the last decade, with multiple published studies addressing questions of heritability and shared etiology [13,15,124], as well as common phenotypic and endophenotypic features [17,42].”

• cites [13] Smalley, 2002, Genetic linkage of attention-deficit/hyperactivity disorder on chromosome 16p13, in a region implicated in autism, Am J Hum Genet sourceNot checked yet

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• cites [15] Reiersen, 2008, Evidence for shared genetic influences on self-reported ADHD and autistic symptoms in young adult Australian twins, Twin Res Hum Genet sourceNot checked yet

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• cites [124] Sinzig, 2007, What do we know about the serotonergic genetic heterogeneity in attention-deficit/hyperactivity and autistic disorders?, Psychopathology sourceNot checked yet

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• cites [17] Rommelse, 2011, A review on cognitive and brain endophenotypes that may be common in autism spectrum disorder and attention-deficit/hyperactivity disorder and facilitate the search for pleiotropic genes, Neurosci Biobehav Rev sourceNot checked yet

  Not checked in the free run.

• cites [42] Murray, 2010, Attention-deficit/hyperactivity disorder in the context of autism spectrum disorders, Current Psychiatry Rep sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

Clinically, DSM-5 changes will provide diagnostic clarification for clinicians already treating patients with both ADHD and ASD symptoms and will facilitate pharmacological and psychosocial treatment studies to guide care.

“Clinically, DSM-5 changes will provide diagnostic clarification for clinicians who are already treating patients with both ADHD and ASD symptoms and will facilitate pharmacological and psychosocial treatment studies to guide care.”