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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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“…by the fact that some autistic people, particularly those with co-occurring attention deficit hyperactivity disorder, may have become distracted (Young et al, 2020), so a simple prompt such as ‘are you still thinking?’ can sometimes be helpful. emotional space Identifying, processing and…”
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Kassin, S. M., Cleary, H. M. D., Gudjonsson, G. H., Leo, R. A., Meissner, C. A., Redlich, A. D., & Scherr, K. C. (2025) · Law and Human Behavior · doi:10.1037/lhb0000593 · Cited by 194
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“For ADHD symptoms, educational–behavioural support and environmental modification should be implemented first 208 , and if substantial impairments remain, medication treatment should follow meta-analysis-guided recommendations: methylphenidate as the first choice, followed by second-line options…”
Role of gastrointestinal health in managing children with autism spectrum disorder
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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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