Autistic traits in a population-based ADHD twin sample
Abstract
Background: Most diagnostic nomenclatures do not allow for the concurrent diagnosis of autism and attention‐deficit/hyperactivity disorder (ADHD). Clinic‐based studies suggest autistic symptoms are common in children with ADHD, but such studies are prone to referral bias. This study assesses whether children with ADHD selected from the general twin population have elevated levels of autistic traits. Methods: Nine hundred forty‐six twins identified by Missouri birth records were assigned to DSM‐IV ADHD diagnoses and seven population‐derived ADHD subtypes defined through latent class analysis of DSM‐IV ADHD symptoms. The Social Responsiveness Scale (SRS) was used as a quantitative measure of autistic traits. Linear regression was used to evaluate whether mean SRS scores differed between ADHD diagnostic groups. Results: Mean SRS scores for DSM‐IV predominantly inattentive subtype and combined subtype ADHD groups were significantly higher than for subjects without DSM‐IV ADHD ( p < .001, both comparisons). Five of the population‐derived ADHD subtypes (talkative‐impulsive, mild and severe inattentive, mild and severe combined) had significantly higher mean SRS scores compared to the latent class subtype with few ADHD symptoms ( p < .001, all comparisons). DSM‐IV combined subtype and the population‐derived severe combined subtype had the highest mean total SRS scores and the highest mean scores for each of the three autism symptom domains, with a substantial proportion of individuals scoring in the clinically significant range. Conclusions: This study provides population‐based evidence for clinically significant elevations of autistic traits in children meeting diagnostic criteria for ADHD. These results have implications for the design and interpretation of studies of both disorders.
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The study's data are in line with previous studies where LCA revealed that the most severe ADHD classes also had the most severe ASD symptoms.
“These data are also in line with previous studies addressing ASD symptoms in children with ADHD, in which LCA revealed that the most severe ADHD classes were also the classes with the most severe ASD symptoms”
In Reiersen et al.'s population-derived ADHD latent classes, almost all classes except one with merely hyperactive symptoms showed more ASD symptoms than the class without ADHD symptoms.
“Almost all classes (except one class that merely showed hyperactive symptoms) showed more ASD symptoms than the class without ADHD symptoms.”
Using DSM-IV derived ADHD subtypes, there was no significant difference between the predominantly inattentive and predominantly hyperactive-impulsive subtypes in ASD traits.
“Using DSM-IV derived ADHD subtypes, less distinctions between the subtypes were present, with no significant difference between the ADHD predominantly inattentive subtype and the ADHD predominantly hyperactive-impulsive subtype.”
Among Reiersen et al.'s ADHD classes, the class with the most severe ADHD symptoms also displayed the most severe ASD symptoms.
“However, among the various ADHD classes, the severity of ASD traits clearly differed, with the class having the most severe ADHD symptoms also displaying the most severe ASD symptoms.”
In line with Reiersen et al. (2007), we found elevated levels of subtle PDD symptoms in both boys and girls with ADHD.
“In line with the study by Reiersen et al. (2007), we found elevated levels of subtle PDD symptoms in both boys and girls with ADHD.”
From PDD symptoms in ADHD, an independent familial trait? (2009) · cites this paper as Reiersen et al. 2007
Clinically relevant PDD symptomatology in children with ADHD has been found to be more prevalent in girls than in boys.
“However, clinically relevant PDD symptomatology in children with ADHD has also been found to be more prevalent in girls than in boys (Reiersen et al. 2007).”
From PDD symptoms in ADHD, an independent familial trait? (2009) · cites this paper as Reiersen et al. 2007
Girls with ADHD had even higher gender and age specific CSBQ scores than boys.
“In fact, girls with ADHD had even higher gender and age specific CSBQ scores than boys, also similar to what Reiersen et al. (2007) found.”
From PDD symptoms in ADHD, an independent familial trait? (2009) · cites this paper as Reiersen et al. 2007
Nearly one third of boys and three-fourth of girls with combined type ADHD meet clinical cut-offs for autistic symptomatology.
“Especially children with the DSM-IV combined subtype have been recently shown to have elevated levels of PDD-symptoms, with nearly one third of boys and threefourth of girls with combined type ADHD meeting clinical cut-offs for autistic symptomatology (Reiersen et al. 2007).”
From PDD symptoms in ADHD, an independent familial trait? (2009) · cites this paper as Reiersen et al. 2007
A study by Reiersen and colleagues (2007) used parent SRS ratings to identify a subgroup of children with ADHD who had autistic traits.
“For example, Reiersen et al. (2007) identified a subgroup of ADHD children with autistic traits using parent ratings on the Social Responsiveness Scale (SRS; Constantino, Przybeck, Friesen, & Todd, 2000; Constantino & Todd, 2000; Constantino & Todd, 2003; Constantino et al., 2003; Constantino et al., 2004), a continuously distributed, single-factor measure of social reciprocity skills associated”
From Examining autistic traits in children with ADHD: does the autism spectrum extend to ADHD? (2011) · cites this paper as Reiersen et al. (2007)
The finding of elevated autistic trait ratings in ADHD is consistent with previous reports.
“This confirmed previous findings of elevated ratings of autistic traits in ADHD (Reiersen et al., 2007; Reiersen et al., 2008; Santosh, Baird, Pityaratstian, Tavare, & Gringras, 2006; Mulligan et al., 2009).”
From Examining autistic traits in children with ADHD: does the autism spectrum extend to ADHD? (2011) · cites this paper as Reiersen et al., 2007
The clinical presentation of children in the authors' sample is consistent with that of children in other studies.
“we highlight the consistency in the clinical presentation of children in our sample with children in other studies (i.e., Geurts et al., 2004; Reiersen et al., 2007).”
From Examining autistic traits in children with ADHD: does the autism spectrum extend to ADHD? (2011) · cites this paper as Reiersen et al., 2007
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- Authors
- Reiersen, A. M., Constantino, J. N., Volk, H. E., & Todd, R. D.
- Affiliations
- Washington University in St. Louis (US)
- Saint Louis University (US)
- Corresponding author
- Reiersen, Angela M.
- Venue
- Journal of Child Psychology and Psychiatry
- Publisher
- Wiley
- Published
- 2007-01-22
- Volume
- 48
- Issue
- 5
- Pages
- 464-472
- ISSN
- 0021-9630 (ISSN-L)
- 1469-7610
- OpenAlex
- W2131009185
- Cited by
- 352
- References
- 26
- Citations by year
- 2026: 2 · 2025: 9 · 2024: 18 · 2023: 12 · 2022: 16 · 2021: 16 · 2020: 11 · 2019: 12 · 2018: 13 · 2017: 20 · 2016: 25 · 2015: 25 · 2014: 44 · 2013: 33 · 2012: 24
- FWCI
- 11.05
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Child Psychology and Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health
- National Institute of Mental Health (F31MH074272, T32MH017104, R01MH052813, MH74272, MH-52813, MH 17104)
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (HD42541, R01HD042541)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
- Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
- Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
- Keywords
- autistic traits, autism spectrum disorder, attention deficit hyperactivity disorder, comorbidities, Social Responsiveness Scale, latent class analysis, ADHD subtypes, inattentive subtype, combined subtype, referral bias, children
- MeSH terms
- Adolescent, Adult, Attention Deficit Disorder with Hyperactivity, Autistic Disorder, Child, Child Behavior, Female, Humans, Male, Missouri, Twins, Diagnostic and Statistical Manual of Mental Disorders
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