Children with autism and attention deficit hyperactivity disorder. Relationships between symptoms and executive function, theory of mind, and behavioral problems
Open accessAbstract
BACKGROUND The underlying mechanisms of comorbidity between autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD) are still unknown. Executive function (EF) deficits and theory of mind (ToM) have been the most investigated cognitive processes. AIMS This study proposed to analyze EF, ToM and behavioral problems in children with ASD + ADHD, ADHD, ASD and typical development (TD). The relationship between ADHD and ASD symptoms with EF, ToM and behavioral problems in children with ASD + ADHD was also explored. METHODS AND PROCEDURES Participants were 124 children between 7 and 11 years old (22 ASD + ADHD, 35 ADHD, 30 ASD, and 37 TD), matched on age and IQ. Teachers evaluated EF, and parents assessed ToM skills and behavioral problems through Strengths and Difficulties Questionnaire (SDQ). OUTCOMES AND RESULTS Children with ASD + ADHD and ADHD showed impairments in EF whereas the difficulties in ToM skills of ASD + ADHD group were similar to ASD group. Inattention symptoms were significantly associated with EF metacognitive deficits and ToM difficulties in ASD + ADHD, while ASD symptoms were associated with total score in behavioral problems. CONCLUSIONS AND IMPLICATIONS These findings show the complex difficulties of children with both ASD and ADHD and support the need to take these difficulties into account when designing the treatments.
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- Findingown data§ Comparison of children with ASD, ASD+ADHD, ADHD, and TD on emotional and behavioral problems
The MANCOVA main effect of group on SDQ indicators was statistically significant.
“The MANCOVA performed to evaluate the main effect of group on the SDQ indicators was statistically significant [Wilk's Lambda (Λ) = .22,F (12,301) = 18.99, p < .001,η 2 p = .39].”
Quote in the paperSubstantial claim - Findingown data§ Comparison of children with ASD, ASD+ADHD, ADHD, and TD on executive functioning measures
In emotional control and initiative, significant differences were found only between the clinical ASD and ADHD groups.
“Finally, in the domains of emotional control and initiative, significant differences were only found between the clinical ASD and ADHD groups.”
Quote in the paperNot a substantial claim - Findingown data§ Comparison of children with ASD, ASD+ADHD, ADHD, and TD on emotional and behavioral problems
On hyperactivity, the two ADHD groups were more affected than the ASD group.
“Specifically, on hyperactivity the two groups with ADHD were more affected than the ASD group.”
Quote in the paperNot a substantial claim - Findingown data§ Multiple regression analyses measuring the contribution of inattention, H/I, and ASD symptoms to EF, ToM, and total SDQ in the comorbid ASD+ADHD group
None of inattention, hyperactivity/impulsivity, or ASD symptoms were significant predictors of the behavioral regulation index.
“None of the inattention, H/I, or ASD symptoms were significant predictors of the behavioral regulation index (BRI).”
Quote in the paperNot a substantial claim - Findingown data§ Comparison of children with ASD, ASD+ADHD, ADHD, and TD on emotional and behavioral problems
Total SDQ scores revealed significant differences between the ASD-alone group and the ASD+ADHD group.
“The results for the total score on the SDQ revealed significant differences between the group with ASD alone and the ASD+ADHD group (table 4).”
Quote in the paperSubstantial claim
- Findingown data§ Comparison of children with ASD, ASD+ADHD, ADHD, and TD on emotional and behavioral problems
For peer problems, the two ASD groups had higher scores than the ADHD group.
“For peer problems, the two groups with ASD presented higher scores than the group of children with ADHD.”
Quote in the paperNot a substantial claim - Findingown data§ Multiple regression analyses measuring the contribution of inattention, H/I, and ASD symptoms to EF, ToM, and total SDQ in the comorbid ASD+ADHD group
Only two of the four multiple regression models were significant.
“Four separate multiple regression analyses were carried out to dimensionally explore whether the inattention, H/I, and ASD symptoms are differentially related to the main indices of executive functioning, the ToMI, and the total difficulties on the SDQ in the comorbid ASD+ADHD group.Only two models were significant (see Table 5).”
Quote in the paperNot a substantial claim - Findingown data§ Comparison of children with ASD, ASD+ADHD, ADHD, and TD on executive functioning measures
The MANCOVA main effect of group on executive functioning indicators was statistically significant.
“The MANCOVA carried out to evaluate the main effect of group on the executive functioning indicators was statistically significant [Wilk's Lambda (Λ) = .26,F(30,317) = 6.20, p < .001,η 2 p = .36].”
Quote in the paperSubstantial claim - Findingown data§ Comparison of children with ASD, ASD+ADHD, ADHD, and TD on executive functioning measures
The ASD+ADHD group differed from the other two clinical groups by having the highest scores on attention shifting.
“The ASD+ADHA group was significantly different from the other two clinical groups because they showed the highest scores on the attention shifting domain.”
Quote in the paperNot a substantial claim - Findingown data§ Comparison of children with ASD, ASD+ADHD, ADHD, and TD on social cognition measures (emotion recognition and ToMI Inventory)
On the AR test, no significant differences were found among the clinical groups.
“On the AR test, no significant differences were found among the clinical groups, unlike on the ToMI, where there were significant differences between the group with ADHD alone and the two groups with ASD symptomatology (ASD and ASD+ADHD) on all the scales and the total score (see table 3).”
Quote in the paperNot a substantial claim - Findingown data§ Multiple regression analyses measuring the contribution of inattention, H/I, and ASD symptoms to EF, ToM, and total SDQ in the comorbid ASD+ADHD group
In the ASD+ADHD group, ASD symptoms were a significant individual predictor of total difficulties on the SDQ (β = .53, t = 2.7, p = .014), with 34% explained variance.
“The ASD symptoms were a significant individual predictor of the total difficulties on the SDQ (β = .53,t = 2.7, p = .014),with 34% of the explained variance.”
Quote in the paperSubstantial claim - Findingown data§ Comparison of children with ASD, ASD+ADHD, ADHD, and TD on social cognition measures (emotion recognition and ToMI Inventory)
The MANCOVA main effect of group on social cognition indicators was statistically significant.
“The MANCOVA performed to evaluate the main effect of group on the social cognition indicators was statistically significant [Wilk's Lambda (Λ) = .27,F(15,312) = 12.65, p < .001,η 2 p = .35].”
Quote in the paperSubstantial claim - Findingown data§ Comparison of children with ASD, ASD+ADHD, ADHD, and TD on social cognition measures (emotion recognition and ToMI Inventory)
Post hoc analyses revealed significant differences between the TD group and clinical groups on all social cognition variables.
“Post hoc analyses revealed significant differences between the TD group and the clinical groups on all the variables analyzed.”
Quote in the paperSubstantial claim - Findingown data§ Comparison of children with ASD, ASD+ADHD, ADHD, and TD on social cognition measures (emotion recognition and ToMI Inventory)
On the ToMI, significant differences were found between the ADHD-alone group and the two ASD groups on all scales and the total score.
“On the AR test, no significant differences were found among the clinical groups, unlike on the ToMI, where there were significant differences between the group with ADHD alone and the two groups with ASD symptomatology (ASD and ASD+ADHD) on all the scales and the total score (see table 3).”
Quote in the paperSubstantial claim - Findingown data§ DISCUSSION
The ASD+ADHD group had more emotional and behavioral difficulties than the ASD-only and ADHD-only groups.
“the ASD+ADHD group showed more emotional and behavioral difficulties than the two pure clinical groups”
Quote in the paperSubstantial claim- Rests on an assumption: The four groups are comparable on relevant confounders despite observed differences in parental education, sex, and medication.
- Findingown data§ DISCUSSION
The comorbid and ADHD groups showed a similar profile on the two general indices BRI and MI and on inhibitory control, working memory, planning, organization of materials, and monitoring.
“By contrast, the results showed a similar profile between the comorbid group and the ADHD group on the two general indices, BRI and MI, and on the domains of inhibitory control, working memory, planning, organization of materials, and monitoring.”
Quote in the paperSubstantial claim - Findingown data§ DISCUSSION
ASD symptoms accounted for more of the variance in the comorbid group's more severe social and behavioral problems than did ADHD symptoms.
“the ASD symptoms could better explain the more severe social and behavioral problems observed in the comorbid group.”
Quote in the paperSubstantial claim - Findingown data§ DISCUSSION
No differences in emotion recognition were found among the clinical groups (ASD, ADHD, and ASD+ADHD).
“However, no differences in ER were observed among the clinical groups analyzed.”
Quote in the paperNot a substantial claim- Rests on an assumption: The four groups are comparable on relevant confounders despite observed differences in parental education, sex, and medication.
- Findingown data§ DISCUSSION
In regression analyses, inattention symptoms were negatively associated with metacognitive executive processes and theory-of-mind skills.
“The regression analyses revealed that inattention symptoms had a negative impact on the metacognitive executive processes and ToM skills.”
- Also stated in: § DISCUSSION · boosted
“the findings support a strong relationship between inattention symptoms and ToM difficulties”
Quote in the paperSubstantial claim0 of 2 sources checked- cites Columbi and Ghaziddin, 2017
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- cites Sinzig et al., 2008
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- Rests on an assumption: The associations between symptoms and outcomes are causal in the direction stated (e.g., inattention symptoms cause or worsen metacognitive and theory-of-mind difficulties; ADHD symptoms worsen functioning).
- Also stated in: § DISCUSSION · boosted
- Findingown data§ DISCUSSION
In the comorbid group, no relationships were detected between the behavioral regulation index and ADHD symptoms.
“our study did not detect relationships between the behavioral regulation index (BRI) and the ADHD symptoms in the comorbid group.”
Quote in the paperSubstantial claim - Findingown data§ DISCUSSION
In the four-group comparison, children with ASD and children with ASD+ADHD showed a similar level of impairment in using theory-of-mind skills in everyday social contexts.
“the comparative analyses of the social cognition measures in the four groups revealed the existence of a similar impairment in the groups with ASD (ASD and ASD+ADHD) in their capacity to apply ToM skills in social contexts in daily life”
Quote in the paperSubstantial claim- Rests on an assumption: The four groups are comparable on relevant confounders despite observed differences in parental education, sex, and medication.
- Findingcitation§ DISCUSSION
Autism symptom severity largely accounts for the adaptive and social problems seen in children with ASD and comorbid ADHD symptoms.
“the severity of the autism symptoms would largely explain the adaptive and social problems of children with ASD and comorbid ADHD symptoms (Ashwood et al., 2015).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Ashwood et al., 2015
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- Premisecitation§ INTRODUCTION
An estimated 37% to 85% of children with ASD have comorbid ADHD symptoms.
“Between 37-85% of children with ASD are estimated to present comorbid ADHD symptoms (Leitner, 2014), which may be due to common etiological mechanisms.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Leitner, 2014 source
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- Premisecitation§ INTRODUCTION
Research on the psychological processes underlying the ASD+ADHD association has mainly focused on executive functioning and theory of mind impairments.
“Specifically, the research on psychological processes underlying the ASD+ADHD association has mainly revolved around impairments in executive functioning (EF) and theory of mind (TOM) (Antshell et al., 2016;Doyle et al., 2017), which have been shown to have important effects on social adaptation (Ashwood et al., 2015;Lyall et al., 2017).”
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- cites Doyle et al., 2017
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- Premisecitation§ INTRODUCTION
The adaptive and social functioning of people with ASD are affected by inattention and hyperactivity/impulsivity symptoms.
“The adaptive and social functioning of people with ASD are also affected by the inattention and hyperactivity/impulsivity symptomatology (Ashwood et al., 2015;Jang et al, 2013;Lyall et al., 2017;Rao and Landa, 2014;Sikora et al., 2012;Tureck et al., 2013;Yerys et al., 2009).”
Quote in the paperSubstantial claim0 of 3 sources checked - Premisecitation§ INTRODUCTION
No specific deficits in spatial working memory have been found in the ASD+ADHD group.
“Moreover, in the ASD+ADHD group, worse performance has been observed on verbal working memory (Andersen et al., 2013;Sinzig et al., 2008b;Takeuchi et al., 2013;Yerys et al., 2009), although no specific deficits have been found in spatial working memory (Gomarus et al., 2009;Sinzig et al., 2008b;Takeuchi et al., 2013).”
Quote in the paperNot a substantial claim0 of 3 sources checked- cites Gomarus et al., 2009
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- cites Sinzig et al., 2008b
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- cites Takeuchi et al., 2013
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- Premisecitation§ INTRODUCTION
Inhibitory problems appear to be shared by the ASD+ADHD and ADHD groups.
“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).”
Quote in the paperNot a substantial claim0 of 3 sources checked - Premisecitation§ INTRODUCTION
The few studies on planning and cognitive flexibility indicate a greater planning deficit in the ASD+ADHD group.
“The few studies that have examined the domains of planning and cognitive flexibility indicate a greater planning deficit in the ASD+ADHD group (Pitzianti et al., 2016;Unterrainer et al., 2016), although in some cases the differences were only marginally significant (Colombi et al., 2017).”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites Pitzianti et al., 2016
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- cites Unterrainer et al., 2016
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- Premisecitation§ INTRODUCTION
In the youngest groups (under 10 years old), children with ASD and ASD+ADHD perform worse on the Facial Emotion Matching task than children with ADHD.
“In the youngest groups (under 10 years old), children with ASD and ASD+ADHD obtain worse performance on the Facial Emotion Matching task than children with ADHD.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Bühler et al., 2011 source
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- Study design and conductreasoning§ METHOD Participants
The 22 children with ASD and clinical ADHD symptoms met diagnostic criteria for both ASD and ADHD.
“Likewise, to confirm the diagnosis of the 22 children with ASD and clinical symptoms of ADHD, they had to meet the diagnostic criteria for ASD and ADHD.”
Quote in the paperSubstantial claim - Premisecitation§ INTRODUCTION
The ASD+ADHD group generally shows an executive profile with deficits characteristic of both disorders.
“The ASD+ADHD group generally shows an executive profile with deficits that are characteristic of both disorders.”
Quote in the paperSubstantial claim - Premisecitation§ INTRODUCTION
Increased sustained attention and inhibitory control problems probably worsen the capacity of children with ASD and ASD+ADHD to recognize facial emotions.
“Increased sustained attention and inhibitory control problems probably worsen the capacity of children with ASD and ASD+ADHD to recognize facial emotions (Sinzig et al., 2008;Van der Meer et al., 2012).”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites Sinzig et al., 2008
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- cites Van der Meer et al., 2012 source
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- Premisecitation§ INTRODUCTION
In the ASD+ADHD group, verbal working memory performance is worse.
“Moreover, in the ASD+ADHD group, worse performance has been observed on verbal working memory (Andersen et al., 2013;Sinzig et al., 2008b;Takeuchi et al., 2013;Yerys et al., 2009), although no specific deficits have been found in spatial working memory (Gomarus et al., 2009;Sinzig et al., 2008b;Takeuchi et al., 2013).”
Quote in the paperNot a substantial claim0 of 3 sources checked- cites Andersen et al., 2013 source
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- cites Sinzig et al., 2008b
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- cites Takeuchi et al., 2013
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- Interpretationown data§ DISCUSSION
The findings largely confirmed the hypothesis that the ASD+ADHD group would show more pronounced executive functioning impairment than the ASD and TD groups.
“With regard to the executive functioning rated by the teachers, the findings largely confirmed the proposed hypothesis, with the ASD+ADHD group presenting a more pronounced impairment than the ASD group and the TD group.”
Quote in the paperSubstantial claim - Premisecitation§ INTRODUCTION
When children and adolescents with ASD, ADHD, and ASD+ADHD are compared on emotion recognition tasks, differences between groups depend on developmental stage.
“When comparing children and adolescents with ASD, ADHD, and ASD+ADHD on emotion recognition tasks, differences have been detected between the groups depending on the developmental stage.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Bühler et al., 2011 source
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- Interpretationown data§ DISCUSSION
Among the symptoms examined, inattention problems have the strongest effect on metacognitive processes and theory-of-mind difficulties.
“Our study suggests that inattention problems would have the most impact on the metacognitive processes and ToM difficulties.”
Quote in the paperSubstantial claim- Rests on an assumption: The associations between symptoms and outcomes are causal in the direction stated (e.g., inattention symptoms cause or worsen metacognitive and theory-of-mind difficulties; ADHD symptoms worsen functioning).
- Interpretationcitation§ DISCUSSION
The findings align with research showing greater executive functioning impairment in children with ASD+ADHD and ADHD alone compared with children with ASD.
“The findings are framed within the line of research that shows greater impairment in the executive functioning of children with ASD+ADHD and ADHD alone, compared to children with ASD (Adamo et al., 2014;Bühler et al., 2011;Chantiluke et al., 2014;Lundervold et al., 2016;Sinzig et al., 2008b;Tye et al., 2014).”
Quote in the paperNot a substantial claim0 of 3 sources checked - Premisecitation§ DISCUSSION
Similar results were obtained by Yerys et al. (2009) when comparing executive functioning in children with TD, ASD, and ASD+ADHD using the parent version of the BRIEF.
“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.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Yerys et al., 2009 source
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- Premisecitation§ DISCUSSION
Comorbid ASD+ADHD adversely affects adaptive and social functioning.
“in spite of the negative repercussions of this comorbidity on adaptive and social functioning (Rao and Landa, 2014)”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Rao and Landa, 2014
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- Interpretationown data§ DISCUSSION
Theory-of-mind difficulties are primary deficits in children with autism spectrum disorder.
“thus reinforcing the idea that ToM difficulties are primary deficits in children with ASD (Baron-Cohen et al., 2000).”
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- Premisecitation§ DISCUSSION
Many children with ASD+ADHD remain undiagnosed or untreated.
“a large percentage of children with ASD+ADHD have not been diagnosed or treated (Joshi et al., 2017)”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Joshi et al., 2017 source
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- Interpretationown data§ DISCUSSION
Comorbid ADHD symptoms had a greater impact on attention shifting problems in children with ASD, negatively affecting their flexibility in focusing attention according to changing environmental demands.
“Moreover, the comorbid ADHD symptoms had a greater impact on the attention shifting problems of children with ASD, negatively affecting their flexibility in focusing their attention according to the changing demands of the environment.”
Quote in the paperSubstantial claim - Study design and conductown data§ DISCUSSION
The small sample, particularly the comorbid ASD+ADHD group, may limit how far the results can be generalized.
“One of them is the low number of participants, especially in the comorbid ASD+ADHD group, which could affect the generalization of the results.”
Quote in the paperNot a substantial claim - Premisecitation§ DISCUSSION
Comorbid ASD+ADHD adversely affects academic capabilities.
“and academic capabilities (Lyall et al., 2017)”
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- Interpretationown data§ DISCUSSION
ADHD symptoms make the social, adaptive, and behavioral functioning of children with ASD worse.
“which means that the presence of ADHD symptoms worsens the social, adaptive, and behavioral functioning of children with ASD.”
Quote in the paperSubstantial claim- Rests on an assumption: The associations between symptoms and outcomes are causal in the direction stated (e.g., inattention symptoms cause or worsen metacognitive and theory-of-mind difficulties; ADHD symptoms worsen functioning).
- May combine two claims. 26
- The quote only partly states this claim. 1
- Classified as probably not a substantial claim. 18
May combine two claims. The quote only partly states this claim.
Findingown data§ Comparison of children with ASD, ASD+ADHD, ADHD, and TD on executive functioning measuresANCOVAs showed significant group differences on inhibition, shift, emotional control, BRI, initiative, working memory, planning, organization of material, monitoring, and MI.
“The confirmation ANCOVAs showed significant differences on Inhibition, F1,117 = 20.13,p < .001,η 2 p = .34;shift, F1,117 = 22.18, p < .001,η 2 p = .36;Emotional control, F1,117 = 11.81,p < .001,η 2 p = .23,and the BRI, F1,117 = 19.84,p < .001,η 2 p = .33.The confirmation ANCOVAs also yielded statistically significant differences between the groups on the metacognitive processes: initiative, F1,117”
Quote in the paperSubstantial claimMay combine two claims.
Findingown data§ Comparison of children with ASD, ASD+ADHD, ADHD, and TD on executive functioning measuresPost hoc analyses revealed significant differences between the TD group and clinical groups on all BRIEF variables except inhibition and organization of materials, where TD and ASD had lower scores than the two groups with ADHD symptoms.
“The post hoc analyses revealed significant differences between the TD group and the clinical groups on all the BRIEF variables analyzed in this study, except inhibition and organization of materials, where the TD group and the ASD group showed a significantly lower score than the two groups with ADHD symptoms.”
Quote in the paperSubstantial claimMay combine two claims.
Findingown data§ Comparison of children with ASD, ASD+ADHD, ADHD, and TD on emotional and behavioral problemsPost hoc analyses revealed significant differences between the TD group and clinical groups on all SDQ scales except behavioral problems, where ASD and TD did not differ.
“Post hoc analyses revealed significant differences between the TD group and the clinical groups on all the SDQ scales, except the behavioral problems subscale, where the ASD group and the TD group did not present significant differences.”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown data§ Comparison of children with ASD, ASD+ADHD, ADHD, and TD on executive functioning measuresThe ASD group had significantly lower scores than the ADHD and ASD+ADHD groups on working memory, planning, monitoring, and the two general indexes BRI and MI.
“Likewise, the ASD group showed a significantly lower score than the two groups with ADHD symptoms (ADHD and ASD+ADHD) on the executive domains of working memory, planning, monitoring, and the two general indexes from the BRI and MI (table 2).”
Quote in the paperSubstantial claimMay combine two claims.
Findingown data§ Comparison of children with ASD, ASD+ADHD, ADHD, and TD on social cognition measures (emotion recognition and ToMI Inventory)ANCOVAs showed significant group differences on emotion recognition, ToMI Early, ToMI Basic, ToMI Advanced, and total ToMI.
“The confirmation ANCOVAs showed significant differences on emotion recognition, F1,117 = 8.21, p < .001,η 2 p = .17;ToMI Early, F1,117= 22.82, p < .001,η 2 p = .37;ToMI Basic, F1,117= 37.46, p < .001,η 2 p = .49;ToMI Advanced, F1,117= 83.94, p < .001,η 2 p = .68,and the total score on the ToMI, F1,117 = 62.20, p < .001,η 2 p = .61.”
Quote in the paperSubstantial claimMay combine two claims.
Findingown data§ Multiple regression analyses measuring the contribution of inattention, H/I, and ASD symptoms to EF, ToM, and total SDQ in the comorbid ASD+ADHD groupIn the ASD+ADHD group, inattention symptoms were a significant individual predictor of theory of mind (β = -.52, t = -2.7, p = .013), with all indicators explaining 38% of the variance.
“The regressions carried out indicated that the inattention symptoms were a significant individual predictor of both the metacognitive index (β = .40,t = 2.3, p = .05)and theory of mind (β = -.52,t = -2.7,p = .013).All of the indicators together explain 33 and 38% of the variance, respectively.”
Quote in the paperSubstantial claimMay combine two claims.
Findingown data§ Multiple regression analyses measuring the contribution of inattention, H/I, and ASD symptoms to EF, ToM, and total SDQ in the comorbid ASD+ADHD groupIn the ASD+ADHD group, inattention symptoms were a significant individual predictor of the metacognitive index (β = .40, t = 2.3, p = .05), with all indicators explaining 33% of the variance.
“The regressions carried out indicated that the inattention symptoms were a significant individual predictor of both the metacognitive index (β = .40,t = 2.3, p = .05)and theory of mind (β = -.52,t = -2.7,p = .013).All of the indicators together explain 33 and 38% of the variance, respectively.”
Quote in the paperSubstantial claimMay combine two claims.
Findingown data§ Comparison of children with ASD, ASD+ADHD, ADHD, and TD on emotional and behavioral problemsANCOVAs showed significant group differences on emotional symptoms, behavioral problems, hyperactivity, peer problems, and total SDQ.
“The confirmation ANCOVAs showed significant differences on the scales of emotional symptoms, F1,117 = 12.33, p < .001,η 2 p = .24;behavioral problems, F1,117= 6.61, p < .001,η 2 p = .14;hyperactivity, F1,117 = 37.92, p < .001,η 2 p = .49;peer problems, F1,117 = 59.96, p < .001,η 2 p = .60,and the total score on the SDQ, F1,117 = 42.14, p < .001,η 2 p = .52.”
Quote in the paperSubstantial claimMay combine two claims.
Findingown data§ DISCUSSIONThe emotion recognition findings align with Bühler et al. (2011) but conflict with studies reporting greater impairment in the comorbid ASD+ADHD group.
“These results, similar to those found by Bühler et al. (2011), diverge from other studies that observed greater impairments in facial recognition of emotions in the comorbid group (ASD+ADHD)”
Quote in the paperNot a substantial claim0 of 3 sources checked- cites Bühler et al. (2011) source
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- cites Groom et al., 2017
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- cites Oerlemans et al., 2014
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- Rests on an assumption: The four groups are comparable on relevant confounders despite observed differences in parental education, sex, and medication.
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Premisecitation§ INTRODUCTIONExecutive functioning and theory of mind impairments have important effects on social adaptation.
“Specifically, the research on psychological processes underlying the ASD+ADHD association has mainly revolved around impairments in executive functioning (EF) and theory of mind (TOM) (Antshell et al., 2016;Doyle et al., 2017), which have been shown to have important effects on social adaptation (Ashwood et al., 2015;Lyall et al., 2017).”
Quote in the paperSubstantial claim0 of 2 sources checked- cites Ashwood et al., 2015
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- cites Lyall et al., 2017
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Premisecitation§ INTRODUCTIONThe DSM-5 permits a joint diagnosis of ASD and ADHD, justified by the high comorbidity and overlapping symptoms, especially inattention.
“Recently, for the first time, the DSM-5 (American Psychiatric Association (APA), 2013) allowed the joint diagnosis of ASD and ADHD (ASD+ADHD), based on the high comorbidity presented by the two disorders and the co-occurrence of symptoms, especially inattention (Visser et al., 2016).”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites American Psychiatric Association (APA), 2013
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- cites Visser et al., 2016
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Premisecitation§ INTRODUCTIONStudies highlight relationships between inattention and inhibitory control and verbal working memory problems, as well as between stereotyped behavior and flexibility problems.
“Studies on this topic highlight the relationship between inattention and inhibitory control and verbal working memory problems (Neely et al., 2016;Sinzig et al., 2008b;Takeuchi et al., 2013), as well as stereotyped behavior and flexibility problems (Sinzig et al., 2008b).”
Quote in the paperSubstantial claim0 of 3 sources checked- cites Neely et al., 2016 source
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- cites Sinzig et al., 2008b
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- cites Takeuchi et al., 2013
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Premisecitation§ INTRODUCTIONThe ASD+ADHD group shares emotional and behavioral problems with the ADHD group, but impairment in adaptive functioning of the ASD group also contributes.
“More specifically, the ASD+ADHD group shares emotional and behavioral problems with the ADHD group, but the impairment in adaptive functioning of the ASD group also participates (Craig et al., 2015).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Craig et al., 2015 source
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Premisecitation§ INTRODUCTIONThe literature suggests that ADHD symptoms contribute to increasing theory of mind difficulties in children with ASD, leading to less empathy development.
“The literature on cognition processes, ToM, and emotion recognition (ER) in children with ASD+ADHD, although scarce, suggests that the ADHD symptoms contribute to increasing ToM difficulties in children with ASD, leading to less development of empathy, measured by “Reading the Mind in the Eyes” (Columbi and Ghaziddin, 2017).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Columbi and Ghaziddin, 2017
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Premisecitation§ INTRODUCTIONDifficulties in shifting are not usually found in the ASD+ADHD group compared with the pure ASD group on laboratory tasks, but they have been identified using parent reports.
“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).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Yerys et al., 2009 source
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Premisecitation§ INTRODUCTIONChildren with ASD without ADHD show a reduction in behavior problems over time, whereas the ASD+ADHD group's behavioral difficulties remain and even increase.
“Children with ASD without associated manifestations of ADHD experience a reduction in behavior problems over time, whereas in the ASD+ADHD group, the behavioral difficulties remain and even present an incremental trajectory (Flouri et al., 2015).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Flouri et al., 2015
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Premisecitation§ INTRODUCTIONIn some cases, planning differences in the ASD+ADHD group were only marginally significant.
“The few studies that have examined the domains of planning and cognitive flexibility indicate a greater planning deficit in the ASD+ADHD group (Pitzianti et al., 2016;Unterrainer et al., 2016), although in some cases the differences were only marginally significant (Colombi et al., 2017).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Colombi et al., 2017
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May combine two claims.
Premisecitation§ INTRODUCTIONOn sustained attention tasks, children with ASD+ADHD perform worse and resemble the ADHD group in response time variability and attentional orientation impairments.
“Specifically, on sustained attention tasks, various studies show worse performance in children with ASD+ADHD, who were similar to the ADHD group in response time variability (Adamo et al., 2014;Lundervold et al., 2016) and attentional orientation impairments (Tye et al., 2014).”
Quote in the paperNot a substantial claim0 of 3 sources checked- cites Adamo et al., 2014
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- cites Lundervold et al., 2016 source
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- cites Tye et al., 2014
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Probably not a substantial claim: may not pass S3 (load-bearing).
Premisecitation§ INTRODUCTIONAfter controlling for reaction time speed, inattention, and inhibition, a greater impairment in affective prosody persists in the ASD+ADHD group.
“Moreover, after controlling reaction time speed, inattention, and inhibition, a greater impairment in affective prosody persists in the ASD+ADHD group (Oerlemans et al., 2014).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Oerlemans et al., 2014
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Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Study design and conductown data§ ProcedureThe study had ethics committee approval and obtained authorization and parental consent.
“This study had the approval of the Ethics Committee of the University of Valencia (Helsinki Declaration in the Convention of the European Council, 1964).It also obtained the authorization of the Board of Education of the Valencian Government to approach the schools and the oral and written consent of all the parents of the children included in the study, after informing them about the study ob”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductcitation§ Social CognitionThe NEPSY-II has high internal reliability coefficients (r ≥ .80).
“The internal reliability coefficients are high (r ≥ .80)(Brooks et al., 2010).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Brooks et al., 2010 source
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Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Study design and conductcitation§ Measures Executive functioningThe Spanish adaptation of the teacher BRIEF has test-retest reliability between .86 and .92, similar to the original version.
“The test-retest reliability of the Spanish adaptation of the teacher version of the BRIEF ranges between .86 and .92(Maldonado, 2016).These values are similar to those obtained for the original version of the questionnaire (Gioia et al., 2000).”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites Maldonado, 2016
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- cites Gioia et al., 2000 source
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Premisecitation§ INTRODUCTIONSometimes no inhibitory deficits have been found in the comorbid ASD+ADHD group.
“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).”
Quote in the paperNot a substantial claim0 of 3 sources checkedProbably not a substantial claim: may not pass S3 (load-bearing).
Premisecitation§ INTRODUCTIONElectrophysiological studies show atypical processing of face and gaze in children with ASD and ADHD+ASD compared with children with ADHD and typical development.
“Likewise, electrophysiological studies have shown atypical processing of the face and gaze in children with ASD and ADHD+ASD, compared to children with ADHD and TD (Groom et al., 2017;Tye et al., 2014;Tye et al., 2014).”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites Groom et al., 2017
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- cites Tye et al., 2014
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Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Premisecitation§ INTRODUCTIONThese results suggest that children with ASD lack theory of mind prerequisites, whereas deficits in mentalist skills in ADHD could develop later due to difficulties in social relationships.
“These results suggest that children with ASD lack ToM prerequisites, whereas deficits in mentalist skills in ADHD could develop later, due to their difficulties in social relationships (Bühler et al., 2011).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Bühler et al., 2011 source
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Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Study design and conductcitation§ Emotional and behavioral functioningThe SDQ has good statistical and psychometric properties (.73) and good reliability in the Spanish population (.76).
“The SDQ has good statistical and psychometric properties (.73) measured with Cronbach's alpha (Goodman, 2001), and it has shown good reliability in the Spanish population (.76) (Rodríguez et al., 2012).”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites Goodman, 2001 source
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- cites Rodríguez et al., 2012
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May combine two claims.
Study design and conductcitation§ METHOD ParticipantsASD diagnosis was confirmed using recommended cut-off points for the SCQ and ADI-R, administered by an accredited psychologist.
“To confirm the ASD diagnosis, recommended cut-off points for the Social Communication Questionnaire (SCQ; Rutter et al., 2003a) and the revised autism diagnostic interview (ADI-R; Rutter et al., 2003b) were used, and these instruments were administered by a psychologist from the research team who was accredited in their application.”
Quote in the paperSubstantial claim0 of 2 sources checked- cites Rutter et al., 2003a
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- cites Rutter et al., 2003b
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Classified as probably not a substantial claim. May combine two claims.
Study design and conductown data§ Data analysisGroup differences were analyzed with MANCOVAs and ANCOVAs controlling for sex, vocabulary, and parental education, with Bonferroni correction.
“To do so, three multivariate analyses of covariance (MANCOVAs) were conducted, using sex, vocabulary, and the educational level of the parents as covariates.The differences on the tests were verified through covariate analyses of variance (ANCOVAs).For the additional ANCOVAs, the level of significance was established at p <.005 in the comparisons of the different executive functioning domains, af”
Quote in the paperSubstantial claimMay combine two claims.
Study design and conductcitation§ METHOD ParticipantsParticipants had IQ within normal limits (>80) measured with the K-BIT and were matched on age and IQ.
“The participants had an intellectual capacity (IQ) within the limits of normality (>80), measured with the K-BIT (Kaufman and Kaufman, 2000), and they were matched on age and IQ.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Kaufman and Kaufman, 2000
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Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Premisecitation§ DISCUSSIONCurrent research concentrates on childhood, even though cognitive and social processes are known to change across development.
“The research is currently focused on childhood, in spite of evidence that changes occur in the cognitive and social processes throughout development (Hartman et al., 2017).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Hartman et al., 2017
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Interpretationreasoning§ DISCUSSIONThe defining features of comorbid ASD+ADHD substantially influence how treatments are evaluated and designed.
“The characteristics that define comorbid ASD+ADHD have important effects on the evaluation and design of treatments.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Premisecitation§ DISCUSSIONChanges over time in the adaptive and social functioning of children with ASD seem partly driven by comorbid ADHD symptoms, which may worsen behavior problems.
“The evolution of the adaptive and social functioning of children with ASD seems to be determined, in part, by the influence of the comorbid ADHD symptoms, which could worsen the behavior problems (Flouri et al., 2015)”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Flouri et al., 2015
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Premisecitation§ DISCUSSIONComorbid symptoms in ASD have received insufficient attention.
“Until now, the topic of comorbid symptoms in ASD has not received enough attention”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Joshi et al., 2017 source
Not checked in the free run.
May combine two claims.
Interpretationreasoning§ DISCUSSIONThe findings point to an additive deficit in the comorbid ASD+ADHD group, which shares difficulties with both conditions across executive, cognitive, and everyday social functioning.
“the findings suggest the existence of an additive deficit in the comorbid ASD+ADHD group, which shared difficulties with both disorders in executive, cognitive, and social functioning in everyday life.”
Quote in the paperSubstantial claim- Rests on an assumption: The four groups are comparable on relevant confounders despite observed differences in parental education, sex, and medication.
Classified as probably not a substantial claim.
Interpretationreasoning§ DISCUSSIONThis study adds to prior work by assessing a broad set of executive, social-cognitive, and behavioral problems in children with ASD+ADHD.
“The present study extends the previous literature by studying a wide range of executive processes, social cognition processes, and behavioral problems in children with ASD+ADHD.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Premisecitation§ DISCUSSIONPrior work has reported significant links between inhibitory control and inattention symptoms in children with ASD.
“although significant associations have also been found between inhibitory control and inattention symptoms in children with ASD (Neely et al., 2016)”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Neely et al., 2016 source
Not checked in the free run.
The paper relies on this without support.
The associations between symptoms and outcomes are causal in the direction stated (e.g., inattention symptoms cause or worsen metacognitive and theory-of-mind difficulties; ADHD symptoms worsen functioning).
“which means that the presence of ADHD symptoms worsens the social, adaptive, and behavioral functioning of children with ASD.”
The paper relies on this without support.
The four groups are comparable on relevant confounders despite observed differences in parental education, sex, and medication.
“Parental education 3.5 (.96) 3.4 (1.0) 1.8 (1.4) 3.1 (1.2) 14.65 -.000*”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Inattentive symptoms are significantly associated with EF deficits in metacognition for those with ASD+ADHD.
“Inattentive symptoms were also significantly associated with EF deficits in metacognition for those with ASD+ADHD indicating that metacognitive EF may be linked to inattention for those with ASD+ADHD (Berenguer et al., 2018).”
From Heterogeneity of executive function revealed by a functional random forest approach across ADHD and ASD (2020) · cites this paper as Berenguer et al., 2018
Statistics recomputed
Every reported test result, recomputed from its test statistic and degrees of freedom. A result shows as not adding up only once an independent check has confirmed it.
- ConsistentF(30, 317) = 6.2reported p < .001 · recomputed p < .001
“F(30,317) = 6.20, p < .001”
- ConsistentF(15, 312) = 12.65reported p < .001 · recomputed p < .001
“F(15,312) = 12.65, p < .001”
- ConsistentF(12, 301) = 18.99reported p < .001 · recomputed p < .001
“F (12,301) = 18.99, p < .001”
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
Claim of greater difficulties than both pure groups exceeds the reported comparisons
MajorThe discussion says the comorbid group had more emotional and behavioral difficulties than both pure clinical groups. For total SDQ difficulties, the table reports a significant difference from ASD alone but not from ADHD alone; several individual scales likewise show no significant difference from ADHD.
“the ASD+ADHD group showed more emotional and behavioral difficulties than the two pure clinical groups”
“| SDQ Tot | 5.43 3.48 17.43 6.04 19.80 | 6.87 22.63 | 5.24 | 1<2,3,4; 2<4 | | | | | |”
Metacognitive regression coefficient does not match its t statistic
MajorThe reported coefficient divided by its standard error is about 2.04, not 2.33. With 18 residual degrees of freedom, that difference could change whether the inattention predictor meets the conventional 0.05 significance threshold.
Reported 2.33 · recomputed 2.038462
“| Inattention | .53 | .26 | .40 | 2.33* |”
Group-test numerator degrees of freedom are mislabeled
MinorAn omnibus comparison of four groups has three numerator degrees of freedom, not one. The reported residual degrees of freedom of 117 also fit four groups and three covariates, making the displayed F1,117 label inconsistent with the analysis described.
“The confirmation ANCOVAs showed significant differences on Inhibition, F1,117 = 20.13,p < .001,η 2 p = .34;”
“using sex, vocabulary, and the educational level of the parents as covariates.”
SDQ regression coefficient does not match its t statistic
MinorThe ASD-symptom coefficient divided by its standard error is about 2.95, rather than the reported 2.73. The gap is too large to result from rounding the displayed coefficient and standard error.
Reported 2.73 · recomputed 2.945946
“| ASD Symptoms | 1.09 | .37 | .53 | 2.73* |”
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Campos, C., Pasion, R., Azeredo, A., Ramião, E., Mazer, P., Macedo, I., & Barbosa, F. (2022) · Clinical Psychology Review · doi:10.1016/j.cpr.2022.102145 · Cited by 84 · see citing works
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Xiang, H., Lin, L., Chen, W., Li, C., Liu, X., Li, J., Ren, Y., & Guo, V. Y. (2022) · BMC Public Health · doi:10.1186/s12889-022-14910-2 · Cited by 70 · see citing works
“Fourth, children with excessive screen time usually have attention problems [42], which have been demonstrated to be associated with lower scores of HRQOL and more behavioral problems [43, 44].”
BackgroundCordova, M., Shada, K., Demeter, D. V., Doyle, O., Miranda-Dominguez, O., Perrone, A., Schifsky, E., Graham, A., Fombonne, E., Langhorst, B., et al. (2020) · NeuroImage: Clinical · doi:10.1016/j.nicl.2020.102245 · Cited by 54 · see citing works
Kindgren, E., Quiñones Perez, A., & Knez, R. (2021) · Neuropsychiatric Disease and Treatment · doi:10.2147/ndt.s290494 · Cited by 56 · see citing works
Zhang, M., Liu, Z., Ma, H., & Smith, D. M. (2020) · Frontiers in Behavioral Neuroscience · doi:10.3389/fnbeh.2020.564886 · Cited by 45 · see citing works
Grasso, M., Lazzaro, G., Demaria, F., Menghini, D., & Vicari, S. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19137731 · Cited by 42 · see citing works
“According to previous studies [31], this subscale of the SDQ allows us to highlight an aspect that is often associated with ADHD and is one of the main factors responsible for the impaired quality of life of individuals with ADHD.”
MethodResultInfluentialDellapiazza, F., Audras-Torrent, L., Michelon, C., & Baghdadli, A. (2021) · Research in Developmental Disabilities · doi:10.1016/j.ridd.2021.103930 · Cited by 40 · see citing works
Social cognition in autism and ADHD
Bölte, S. (2025) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2025.106022 · Cited by 46 · see citing works
“…reported social cognition to either have a direct or indirect effect on defining features, such as inattentive features in autism/ADHD combined (Berenguer et al., 2018), both social communication and interaction features as well as repetitive, restricted behaviors in autism (Jones et al.,…”
Lei, J., Charman, T., Leigh, E., Russell, A., Mohamed, Z., & Hollocks, M. J. (2022) · Autism Research · doi:10.1002/aur.2826 · Cited by 35 · see citing works
“Only one study used the teacher report version of the BRIEF (Berenguer et al., 2018).”
BackgroundMethodResultInfluentialRoselló, R., Martı́nez-Raga, J., Mira, Á., Pastor, J. C., Solmi, M., & Cortese, S. (2021) · Autism · doi:10.1177/13623613211065545 · Cited by 33 · see citing works
“…Ng et al., 2019, 2021; Rao & Landa, 2014; Salley et al., 2015; Scandurra et al., 2019; Turygin et al., 2015) and emotional/behavioral difficulties (Berenguer et al., 2018b; Carta et al., 2020; Chen et al., 2015; Craig et al., 2015; McClain et al., 2017; So et al., 2017; Yamawaki et al., 2020).”
BackgroundMethodInfluentialNonhuman primate genetic models for the study of rare diseases
Vallender, E. J., Hotchkiss, C. E., Lewis, A. D., Rogers, J., Stern, J. A., Peterson, S. M., Ferguson, B. M., & Sayers, K. (2023) · Orphanet Journal of Rare Diseases · doi:10.1186/s13023-023-02619-3 · Cited by 36 · see citing works
Sesso, G., Cristofani, C., Berloffa, S., Cristofani, P., Fantozzi, P., Inguaggiato, E., Narzisi, A., Pfanner, C., Ricci, F., Tacchi, A., et al. (2020) · Journal of Clinical Medicine · doi:10.3390/jcm9123839 · Cited by 28 · see citing works
“Additionally, a more recent study by Berenguer and colleagues [23] assessed EF profiles in children with ADHD, ASD, and ADHD+ASD, comparing them with a control group, by means of the Behavior Rating Inventory of Executive Function (BRIEF) scale.”
MethodZhao, X., Zhu, S., Cao, Y., Cheng, P., Lin, Y., Sun, Z., Jiang, W., & Du, Y. (2022) · Neuropsychiatric Disease and Treatment · doi:10.2147/ndt.s349247 · Cited by 27 · see citing works
Pérez‐Crespo, L., Canals, J., Suades-González, E., & Guxens, M. (2020) · Scientific Reports · doi:10.1038/s41598-020-63342-8 · Cited by 29 · see citing works
Lin, Q., Shi, Y., Huang, H., Jiao, B., Kuang, C., Chen, J., Rao, Y., Zhu, Y., Liu, W., Huang, R., et al. (2023) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-023-02165-0 · Cited by 28 · see citing works
Are Executive Dysfunctions Relevant for the Autism-Specific Cognitive Profile?
Hemmers, J., Baethge, C., Vogeley, K. T., & Falter‐Wagner, C. M. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.886588 · Cited by 29 · see citing works
Haza, B., Gosling, C. J., Ciminaghi, F., Conty, L., & Pinabiaux, C. (2024) · Journal of Child Psychology and Psychiatry · doi:10.1111/jcpp.14006 · Cited by 25 · see citing works
Solomon, M., Gordon, A., Iosif, A., Geddert, R., Krug, M. K., Mundy, P., & Hessl, D. (2021) · Autism Research · doi:10.1002/aur.2399 · Cited by 20 · see citing works
“, 2018], episodic memory [Ben Shalom, 2003], and processing speed than in vocabulary or word reading [Mayes & Calhoun, 2007]; that ADHD symptomswould be associated with EC deficits [Berenguer et al., 2018]; and that the ASD group would show continued poorer EC performance than TD through adolescence [Luna et al.”
BackgroundZhang, Y., Tian, H., Tao, Y., Li, Y., Wang, D., & Qin, L. (2023) · International Journal of Developmental Disabilities · doi:10.1080/20473869.2023.2215606 · Cited by 22 · see citing works
“For example, assessment using behavioral tests and teachers indicated that ASD children showed deficits in EFs in some studies (Berenguer et al. 2018, Ellis Weismer et al. 2018).”
Kim, H.-M., & Song, D. (2019) · Research in Developmental Disabilities · doi:10.1016/j.ridd.2019.103539 · Cited by 19 · see citing works
Wodka, E. L., Parish‐Morris, J., Annett, R. D., Carpenter, L. A., Dillon, E. F., Michaelson, J. J., Kim, S. H., Landa, R. J., the SPARK Consortium, & Kanne, S. (2021) · The Clinical Neuropsychologist · doi:10.1080/13854046.2021.1942554 · Cited by 19 · see citing works
“Those with co-occurring ASD + ADHD also present with atypical executive functioning and motor movement patterns (Berenguer et al., 2018).”
BackgroundLi, C., Zhang, R., Zhou, Y., Li, T., Qin, R., Li, L., Yuan, X., Wang, L., & Wang, X. (2023) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-023-02323-4 · Cited by 18 · see citing works
“ADHD usually displays more deficits in inhibitory control and sustained attention, whereas problems in planning and cognitive flexibility are often more serious in ASD [27].”
Emotional and social intelligence assessment model for student character reinforcement
Khilmiyah, A., & Wiyono, G. (2021) · International Journal of Educational Management · doi:10.1108/ijem-02-2020-0046 · Cited by 15 · see citing works
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Roselló, R., Martı́nez-Raga, J., Tomás, J. M., Mira, Á., & Cortese, S. (2022) · Child and Adolescent Mental Health · doi:10.1111/camh.12562 · Cited by 13 · see citing works
Mikami, M., Hirota, T., Adachi, M., Takahashi, M., Nishimura, T., Saito, M., Nakamura, K., & Yamada, J. (2022) · Research in Developmental Disabilities · doi:10.1016/j.ridd.2022.104394 · Cited by 12 · see citing works
Pozo-Rodríguez, M., Cruz, S., Zubizarreta, S. C.-P., Carracedo, Á., Tubío-Fungueiriño, M., & Fernández‐Prieto, M. (2026) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2026.106570 · Cited by 11 · see citing works
Multimodal Interventions Are More Effective in Improving Core Symptoms in Children With ADHD
Ning, K., & Wang, T. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.759315 · Cited by 10 · see citing works
“ADHD is usually characterized by a wide range of symptoms of inattention and transient attention, hyperactivity, and impulsivity disorders, which will cause severe impairment to their academic and daily life activities (2).”
BackgroundMarinopoulou, M., Billstedt, E., Wessman, C., Bornehag, C., & Hallerbäck, M. U. (2023) · Child Psychiatry & Human Development · doi:10.1007/s10578-023-01562-5 · Cited by 11 · see citing works
Vecchia, S. D., Milone, R., Cagiano, R., Calderoni, S., Santocchi, E., Pasquariello, R., Battini, R., & Muratori, F. (2021) · Children · doi:10.3390/children8060450 · Cited by 9 · see citing works
“The finding of VABS-II scores lower than the cognitive abilities may thus reflect executive functioning deficits typically associated with ASD, including planning and cognitive flexibility, even if difficulties in inhibitory control and sustained attention may also play a role [22].”
BackgroundIlahi, F., Hoff, E. V., Daukantaité, D., & Cervin, M. (2023) · BMC Psychiatry · doi:10.1186/s12888-023-05111-1 · Cited by 8 · see citing works
“These results indicate that even when EF in youth with neurodevelopmental disorders, where EF difficulties are prominent [38], are accounted for, youth with OCD and anxiety disorders still exhibit EF difficulties compared to peers.”
BackgroundEmotion processing difficulties in ADHD: a Bayesian meta-analysis study
Soler-Gutiérrez, A.-M., Sánchez-Carmona, A., Albert, J., Hinojosa, J. A., Cortese, S., Bellato, A., & Mayas, J. (2025) · European Child and Adolescent Psychiatry · doi:10.1007/s00787-025-02647-3 · Cited by 6 · see citing works
“Indeed, most studies found higher accuracy in the control group compared to those with ADHD [11, 24, 57, 62, 81, 105], or no significant differences [31, 32, 71, 77, 83, 93].”
Baumeister, F., Bagioka, D. V., Rivoletti, L., & Durrleman, S. (2025) · Developmental Review · doi:10.1016/j.dr.2025.101186 · Cited by 8 · see citing works
Wu, M., Di, Y., Diao, Z., Yao, L., Qian, Z., Wei, C., Zheng, Q., Liu, Y., Han, J., Liu, Z., et al. (2020) · Behavioural Brain Research · doi:10.1016/j.bbr.2020.112836 · Cited by 8 · see citing works
Association of sugar-sweetened beverages with executive function in autistic children
Pan, S., Wang, X., Lin, L., Chen, J., Zhan, X., Jin, C., Ou, X., Gu, T., Jing, J., & Cai, L. (2022) · Frontiers in Nutrition · doi:10.3389/fnut.2022.940841 · Cited by 8 · see citing works
“Although previous studies indicated that SSB consumption was inversely related with EF in school-aged TD children, few studies investigated the relationship of SSB with EF in autistic children (35, 36).”
BackgroundVariability of theory of mind versus pragmatic ability in typical and atypical development
Babarczy, A., Dobó, D., Nagy, P., Mészáros, A., & Lukács, Á. (2024) · Journal of Communication Disorders · doi:10.1016/j.jcomdis.2024.106466 · Cited by 6 · see citing works
Memory and metamemory for actions in children with autism: Exploring global metacognitive judgements
Wojcik, D. Z., Moulin, C. J. A., & Souchay, C. (2022) · Research in Developmental Disabilities · doi:10.1016/j.ridd.2022.104195 · Cited by 6 · see citing works
Profiles of School Refusal Among Neurodivergent Youth
Granieri, J. E., Morton, H. E., Romanczyk, R. G., & Mattson, J. G. (2023) · European Education · doi:10.1080/10564934.2023.2251013 · Cited by 9 · see citing works
“Both of these high school refusal classes also had higher academic, self-care, and social support needs relative to other classes, consistent with literature reporting that support needs are often greatest for autistic youth with co-occurring ADHD (Berenguer et al., 2018).”
ResultHosiri, T., Sittanomai, N., Bumrungtrakul, T., & Boon‐yasidhi, V. (2023) · Siriraj Medical Journal/San Sirirat · doi:10.33192/smj.v75i3.260870 · Cited by 5 · see citing works
Cid-Duarte, S., Departamento de Psicología, U. D. O. (., Areces, D., Departamento de Psicología, U. D. O. (., Núñez, J. C., & Departamento de Psicología, U. D. O. (. (2022) · Revista de Psicología y Educación - Journal of Psychology and Education · doi:10.23923/rpye2023.01.232 · Cited by 6 · see citing works
Orui, M., Ishikuro, M., Obara, T., Noda, A., Shinoda, G., Murakami, K., Metoki, H., Kikuya, M., Nakaya, N., Nishimura, T., et al. (2025) · Psychiatry and Clinical Neurosciences Reports · doi:10.1002/pcn5.70095 · Cited by 4 · see citing works
Trastorno del espectro autista y cognición social: un estudio de revisión
Arias, M. L., Arias, Y. L. L., & Valencia, J. B. Z. (2022) · Psicoespacios · doi:10.25057/21452776.1483 · Cited by 3 · see citing works
de Oliveira, P. V., de Castro, M. L., Grecco, L. A. C., Rizzutti, S., & Muszkat, M. (2023) · Brain Imaging and Stimulation · doi:10.17267/2965-3738bis.2023.e4954 · Cited by 3 · see citing works
Casula, A., Belluardo, G., Antenucci, C., Bianca, F., Corallo, F., Ferraioli, F., Gargano, D., Giuffrè, S., Giunta, A. L. C., Torre, A. L., et al. (2025) · Medicina · doi:10.3390/medicina61030505 · Cited by 4 · see citing works
Liu, H., Li, T., Qin, R., Li, L., Ji, C., Yuan, X., Chen, B., Li, C., & Wang, X. (2025) · Behavioural Brain Research · doi:10.1016/j.bbr.2025.115787 · Cited by 3 · see citing works
Baumeister, F., Wolfer, P., Borrellas, E. V., Solaimani, E., Eigsti, I., & Durrleman, S. (2026) · Open Mind · doi:10.1162/opmi.a.349 · Cited by 3 · see citing works
“Results showed that autistic children had lower attention scores than NT children, consistent with existing research (e.g., Berenguer et al., 2018; Narzisi et al., 2013).”
Population-based detection of children ASD/ADHD comorbidity from atypical sensory processing
Fernández-Delgado, M., Cruz, S., Cernadas, E., Alateyat, H., Tubío-Fungueiriño, M., Sampaio, A., Carracedo, Á., & Fernández‐Prieto, M. (2024) · Applied Intelligence · doi:10.1007/s10489-024-05655-z · Cited by 3 · see citing works
“Autism spectrum disorder (ASD) and attention deficit/hyperactivity disorder (ADHD) show considerable symptomatology overlap [2] with rates ranging between 50 and 70% [3].”
Trajectories of attention problems in autistic children and relations to social skills outcomes
Richard, A., Duku, E., Bennett, T. A., Szatmári, P., Vaillancourt, T., Zwaigenbaum, L., Georgiades, S., Zaidman‐Zait, A., Kerns, C. M., Bedford, R., et al. (2025) · Development and Psychopathology · doi:10.1017/s0954579425000021 · Cited by 3 · see citing works
“…eating behavior (Harris et al., 2022), poorer daily executive functioning, and more internalizing and externalizing behavior difficulties (Berenguer et al., 2018; Yerys et al., 2009) compared to individuals with significant autism or ADHD symptoms alone (see Gliga et al. (2018) for…”
Friedman, S., Justine Shults, A., Barbaresi, W. J., Bax, A. C., Cacia, J., Deavenport‐Saman, A., LaRosa, A., Loe, I. M., Mittal, S., Vanderbilt, D. L., et al. (2024) · Journal of Developmental & Behavioral Pediatrics · doi:10.1097/dbp.0000000000001286 · Cited by 2 · see citing works
A transdiagnostic study of theory of mind in children and youth with neurodevelopmental conditions
Amorim, K., Vandewouw, M. M., Huynh, N., de Villa, K., Safati, C., Almonte, A., Nicolson, R., Kelley, E. A., Crosbie, J., Brian, J. A., et al. (2025) · Molecular Autism · doi:10.1186/s13229-025-00671-3 · Cited by 2 · see citing works
“While children with ADHD have scored similarly to NT children on tasks evaluating explicit knowledge of ToM [13], they score significantly lower on a parent-rated scale evaluating how they apply this knowledge to real-life scenarios [13, 14].”
InfluentialZhang, C., Xu, C., Zhang, B., & Zhou, T. (2025) · Development and Psychopathology · doi:10.1017/s0954579425100436 · Cited by 2 · see citing works
Perfil cognitivo y social en niños y niñas con Trastorno del Espectro Autista
Arroyave, T. Z., Reyes, A. C. D., Valencia, J. B. Z., Aldana, L. A., López, J. V. S., Duque, L. M. S., de Mejía, F. R., Galvis, C. A. N., Cardozo, M. O., Torres, L. R. G., et al. (2023) · Quaderns de Psicologia · doi:10.5565/rev/qpsicologia.1818 · Cited by 2 · see citing works
Ucuz, İ., Cicek, A. U., Cansel, N., Kilic, B., Çolak, C., Yazici, I. P., Kilic, F., & Kucukakcali, Z. (2021) · The Journal of Nervous and Mental Disease · doi:10.1097/nmd.0000000000001395 · Cited by 2 · see citing works
“…problems in several areas such as attention deficit, hyperactivity, and impulsivity, as well as emotional dysregulation, irritability, executive dysfunction, emotional problems, and behavioral problems (Ambrosini et al., 2013; Anastopoulos et al., 2011; Berenguer et al., 2018; Shaw et al., 2014).”
BackgroundINTERFACE CÉREBRO E MÁQUINA: ATIVIDADE NEURONAL NO TRANSTORNO DÉFICIT DE ATENÇÃO E HIPERATIVIDADE
da Silveira, F. M., & Rodrigues, F. D. A. A. (2021) · Revista Ibero-Americana de Humanidades, Ciências e Educação · doi:10.51891/rease.v7i10.2712 · Cited by 1 · see citing works
González‐Sala, F., Cerezuela, G. P., Sanz‐Cervera, P., & Mínguez, R. T. (2023) · Anales de Psicología · doi:10.6018/analesps.481531 · Cited by 1 · see citing works
“…the case of children with ASD, there is a deficit in executive functions, such as cognitive flexibility, planning, working memory, inhibitory control, and emotional regulation (Berenguer et al., 2018; Demetriou et al., 2018; Dubbelink & Geurts, 2017; Filipe et al., 2018; Hill, 2004; Ozonoff, 1997).”
BackgroundMadericova, K., & Talcott, J. B. (2026) · Journal of Clinical and Experimental Neuropsychology · doi:10.1080/13803395.2026.2703682 · Cited by 1 · see citing works
Oldrati, V., Ferrari, E., Butti, N., Gagliardi, C., Romaniello, R., Borgatti, R., Peruzzo, D., & Urgesi, C. (2025) · NeuroImage · doi:10.1016/j.neuroimage.2025.121512 · Cited by 1 · see citing works
Teoría de la mente y funcionamiento ejecutivo en niños
Tabares, Á. S. G., & Landínez-Martínez, D. (2024) · psicología desde el caribe · doi:10.14482/psdc.40.3.019.254 · Cited by 1 · see citing works
ADHS und hochfunktionale Autismus-Spektrum-Störungen
Schöttle, D., SCHIMMELMANN, B. G., & van Elst, L. T. (2019) · Nervenheilkunde · doi:10.1055/a-0959-2034 · Cited by 1 · see citing works
“[72] Berenguer C, Rosello B, Colomer C, et al.”
BackgroundAttention Deficit Hyperactivity Disorder (ADHD)
Vashishtha, S. (2020) · Advances in medical diagnosis, treatment, and care (AMDTC) book series · doi:10.4018/978-1-7998-5495-1.ch002 · Cited by 1 · see citing works
Abshirini, M., Asgari, P., Heidari, A., & Naderi, F. (2020) · Jundishapur Journal of Chronic Disease Care · doi:10.5812/jjcdc.103465 · Cited by 1 · see citing works
Goldsmith, C. (2021) · Archives in Neurology & Neuroscience · doi:10.33552/ann.2021.10.000727
Executive Functions, Social Impairment, Friendship Quality and Adjustment in HFA with ASD
Lieb, R. (2019) · Springer eBooks · doi:10.1007/978-1-4614-6435-8_102392-1
Executive Functions, Social Impairment, Friendship Quality, and Adjustment in HFA with ASD
Lieb, R. (2021) · Springer eBooks · doi:10.1007/978-3-319-91280-6_102392
Autism spectrum disorder on the basis of executive functioning profile
Ishtiaq, M., & Noreen, H. (2022) · Journal of Rehman Medical Institute · doi:10.52442/jrmi.v8i1.400
Interface cérebro e máquina: atividade neuronal no transtorno déficit de atenção e hiperatividade
da Silveira, F. M. (2022) · Journal · doi:10.56238/cpahjournalv5n2-002
Prática Clínica em Neuropsicologia Pediátrica em um Programa de Extensão
de Souza, E. T., Filadelfo, N. F., Santos, D. M., Pinheiro, C. D. J., & de Freitas, P. M. (2023) · Revista Brasileira de Extensão Universitária · doi:10.36661/2358-0399.2023v14n1.13152
APPROACHES TO MODELING AUTISM IN ATTENTION DEFICIT HYPERACTIVITY DISORDER
Traktirov, D. S., Malsagova, E. M., Muruzheva, Z. M., Pestereva, N. S., & Karpenko, M. N. (2023) · Russian Biomedical Research · doi:10.56871/rbr.2023.94.76.004
SNAP-25 Polymorphisms in Autism Spectrum Disorder: A Pilot Study towards a Possible Endophenotype
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“From a clinical point of view, in fact, impulsivity, inattention and hyperactivity are often present in individuals with autism spectrum disorder, and have a strong intersection with non-social autistic traits, such as repetitive behavior [36].”
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- Authors
- Berenguer, C., Roselló, B., Colomer, C., Baixauli, I., & Miranda, A.
- Affiliations
- Universitat de València (ES)
- Valencia Catholic University Saint Vincent Martyr (ES)
- Corresponding author
- Berenguer, Carmen
- Venue
- Research in Developmental Disabilities
- Publisher
- Elsevier BV
- Published
- 2018-12
- Volume
- 83
- Pages
- 260-269
- ISSN
- 0891-4222 (ISSN-L)
- OpenAlex
- W2898260092
- Semantic Scholar
- 269618a1681491758c26c41eb610933e8ae0dba5
- Cited by
- 85
- References
- 55
- Citations by year
- 2026: 8 · 2025: 13 · 2024: 7 · 2023: 18 · 2022: 15 · 2021: 12 · 2020: 8 · 2019: 4
- FWCI
- 3.58
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Research in Developmental Disabilities (publishedVersion)
- PubMed (publishedVersion)
- LA Referencia (Red Federada de Repositorios Institucionales de Publicaciones Científicas) (publishedVersion, other-oa)
- Repositori UJI (Universitat Jaume I) (submittedVersion, public-domain)
- Repository of Digital Objects for Teaching Research and Culture (University of Valencia) (submittedVersion, other-oa)
- Topics
- Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
- Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
- Social Sciences › Psychology › Neuropsychology and Physiological Psychology › Developmental and Educational Neuropsychology
- Keywords
- autism spectrum disorder, attention deficit hyperactivity disorder, comorbidities, executive function, theory of mind, behavioral problems, inattention, metacognitive deficits, children, Strengths and Difficulties Questionnaire
- MeSH terms
- Problem Behavior, Behavior Observation Techniques, Metacognition, Attention, Attention Deficit Disorder with Hyperactivity, Autistic Disorder, Child, Female, Humans, Male, Spain, Executive Function, Theory of Mind
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