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Guidance for identification and treatment of individuals with attention deficit/hyperactivity disorder and autism spectrum disorder based upon expert consensus
Open accessAbstract
Background: Individuals with co-occurring hyperactivity disorder/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) can have complex presentations that may complicate diagnosis and treatment. There are established guidelines with regard to the identification and treatment of ADHD and ASD as independent conditions. However, ADHD and ASD were not formally recognised diagnostically as co-occurring conditions until the Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5) was published in 2013. Hence, awareness and understanding of both conditions when they co-occur is less established and there is little guidance in the clinical literature. This has led to uncertainty among healthcare practitioners when working with children, young people and adults who present with co-existing ADHD and ASD. The United Kingdom ADHD Partnership (UKAP) therefore convened a meeting of professional experts that aimed to address this gap and reach expert consensus on the topic that will aid healthcare practitioners and allied professionals when working with this complex and vulnerable population. Method: UK experts from multiple disciplines in the fields of ADHD and ASD convened in London in December 2017. The meeting provided the opportunity to address the complexities of ADHD and ASD as a co-occurring presentation from different perspectives and included presentations, discussion and group work. The authors considered the clinical challenges of working with this complex group of individuals, producing a consensus for a unified approach when working with male and female, children, adolescents and adults with co-occurring ADHD and ASD. This was written up, circulated and endorsed by all authors. Results: The authors reached a consensus of practical recommendations for working across the lifespan with males and females with ADHD and ASD. Consensus was reached on topics of (1) identification and assessment using rating scales, clinical diagnostic interviews and objective supporting assessments; outcomes of assessment, including standards of clinical reporting; (2) non-pharmacological interventions and care management, including psychoeducation, carer interventions/carer training, behavioural/environmental and Cognitive Behavioural Therapy (CBT) approaches; and multi-agency liaison, including educational interventions, career advice, occupational skills and training, and (3) pharmacological treatments. Conclusions: The guidance and practice recommendations (Tables 1, 4, 5, 7, 8 and 10) will support healthcare practitioners and allied professionals to meet the needs of this complex group from a multidisciplinary perspective. Further research is needed to enhance our understanding of the diagnosis, treatment and management of individuals presenting with comorbid ADHD and ASD.
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“The current evidence base supports conceptualizing ADHD–ASD overlap as a distinct hybrid phenotype rather than a mere comorbidity”
From ADHD in Adulthood: Clinical Presentation, Comorbidities, and Treatment Perspectives (2025) · cites this paper as [50]
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“This places ADHD among the most heritable psychiatric disorders”
From ADHD in Adulthood: Clinical Presentation, Comorbidities, and Treatment Perspectives (2025) · cites this paper as [50]
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“This is complicated by the fact that some autistic people, particularly those with co-occurring attention deficit hyperactivity disorder, may have become distracted (Young et al, 2020)”
From Autistic SPACE: a novel framework for meeting the needs of autistic people in healthcare settings (2023) · cites this paper as Young et al, 2020
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“Similar treatment guidelines published to date are either now outdated or offer guidance on one co-occurring condition but may not serve as a reference across multiple symptom domains, present which drugs may be used in ASD without walking through the nuanced decision-making process of choosing and prescribing a drug to match the unique needs of individual patients, or do not specifically discuss”
From Pharmacological treatment in autism: a proposal for guidelines on common co-occurring psychiatric symptoms (2025) · cites this paper as [31]
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Cognitive Profiles of Children With Autism Spectrum Disorder on the Japanese Version of WISC-IV:
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“In addition, females with ADHD differ from males in their symptom profile, co-occurring conditions and functional impairments (Biederman et al., 2005; Young et al., 2020a).”
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A US national update of health condition prevalence among privately-insured autistic adults
Longo, A., Radford, D., & Hand, B. N. (2024) · Journal of Comparative Effectiveness Research · doi:10.57264/cer-2023-0051 · Cited by 5
Polygenic profiles define aspects of clinical heterogeneity in ADHDPreprint
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“, avoiding family outings or social events) or the use of compensatory strategies leading to underestimation of the functional impact of difficulties.(25) Another possibility is that the full constellation of questions ruling out an ASD diagnosis is not asked at the time of initial assessment.”
BackgroundPsychopathologies Associated with ASD: Anxiety, OCD, Depression, and ADHD
Braconnier, M. L., Garza, I., & Moskowitz, L. J. (2022) · Autism and child psychopathology series · doi:10.1007/978-3-030-88538-0_2 · Cited by 4
Clinical Neuropsychological Profile and Interventions for Co-Occurrence of ADHD and ASD
Theodoratou, M., Kougioumtzis, G. Α., Yotsidi, V., Andriopoulou, P., Megari, K., Koundourou, C., Siouti, Z., & Argyrides, M. (2024) · Advances in psychology, mental health, and behavioral studies (APMHBS) book series · doi:10.4018/979-8-3693-4022-6.ch011 · Cited by 4
Pharmacological Treatment of Autism Spectrum Disorder: A Systematic Review of Treatment Guidelines
Tomiyama, S., Yoshida, K., Tani, H., & Uchida, H. (2025) · Pharmacopsychiatry · doi:10.1055/a-2514-4452 · Cited by 6
A multimodal approach for ADHD with coexisting ASD detection for children
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“We call it Bokoa jwa tlhaloganyo”: Setswana parents’ perspective on autism spectrum disorder
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“Children with co-existing ASD and ADHD have increased risk for negative psychosocial outcomes and treating ADHD symptoms could reduce these risks (Leader et al., 2022; Rodrigues et al., 2021; Young et al., 2020).”
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“ADHD has a unique treatment pathway (NICE guideline, 2018; Young et al., 2020) with pharmacotherapy available for YP through CAMHS (Cortese et al., 2018; Mechler et al., 2022) alongside other multimodal treatments (Drechsler et al., 2020), such as non-violent resistance (NVR, Smith et al., 2022).”
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“This broad spectrum of co-occurring conditions can obscure the clinical picture and reinforces the necessity for a multidisciplinary diagnostic approach [10,11].”
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ADHD, Distractibility, and ABA
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Progress Monitoring During the Treatment of Autism and Developmental Disorders
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Assessment of Attention-Deficit/Hyperactivity Disorder in Young Autistic Children
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“In recognition of this gap, expert-informed consensus recommendations for the assessment and treatment of co-occurring autism and ADHD were recently published (Young et al., 2020).”
ADHD Co-Occurring Conditions: A Multidisciplinary Approach
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Metadata
- Authors
- Young, S., Hollingdale, J., Absoud, M., Bolton, P., Branney, P., Colley, W., Craze, E., Dave, M., Deeley, Q., Farrag, E., Gudjonsson, G., Hill, P., Liang, H.-L., Murphy, C., Mackintosh, P., Murin, M., O’Regan, F., Ougrin, D., Rios, P., Stover, N., Taylor, E., & Woodhouse, E.
- Affiliations
- South London and Maudsley NHS Foundation Trust (GB)
- King's College London (GB)
- Hertfordshire Community NHS Trust (GB)
- Anna Freud Centre (GB)
- Santa Barbara Museum of Natural History (US)
- Corresponding author
- Young, Susan
- ORCID
- Venue
- BMC Medicine
- Published
- 2020-05-25
- Volume
- 18
- Issue
- 1
- Pages
- 146-146
- ISSN
- 1741-7015 (ISSN-L)
- PMC
- PMC7247165
- OpenAlex
- W3028177668
- Cited by
- 162
- References
- 118
- Citations by year
- 2026: 21 · 2025: 36 · 2024: 39 · 2023: 25 · 2022: 18 · 2021: 18 · 2020: 5
- FWCI
- 12.04
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- BMC Medicine (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Research Portal (King's College London) (publishedVersion, other-oa)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- King's College London
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London
- Menzies Centre for Australian Studies, King's College London, University of London
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
- Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
- Social Sciences › Psychology › Developmental and Educational Psychology › Behavioral and Psychological Studies
- Keywords
- attention deficit hyperactivity disorder, autism spectrum disorder, comorbidities, diagnosis, assessment, rating scales, clinical reporting, non-pharmacological treatment, psychoeducation, carer training, behavioral interventions, cognitive behavioral therapy, educational intervention, career guidance, pharmacotherapy, lifespan care, children, adolescents and adults
- MeSH terms
- Autism Spectrum Disorder, Adolescent, Adult, Attention Deficit Disorder with Hyperactivity, Child, Female, Humans, Male, Diagnostic and Statistical Manual of Mental Disorders, Young Adult
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