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Cited by 82Autism Spectrum Disorder ResearchAttention Deficit Hyperactivity DisorderDevelopmental and Educational Neuropsychology

Symptoms of ADHD in Children with High-Functioning Autism Are Related to Impaired Verbal Working Memory and Verbal Delayed Recall

Open access
Andersen, Per Normann, Hovik, Kjell Tore, Skogli, Erik Winther, Egeland, Jens, Øie, Merete·2013·PLoS ONE
DOI 10.1371/journal.pone.0064842PMC PMC3661504
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Abstract

Symptoms similar to those found in Attention-Deficit/Hyperactivity Disorder (ADHD) often occur in children with Autism Spectrum Disorders (ASD). The objective of the current study was to compare verbal working memory, acquisition and delayed recall in children with High-Functioning Autism (HFA) to children with ADHD and typically developing children (TDC). Thirty-eight children with HFA, 79 with ADHD and 50 TDC (age 8-17) were assessed with a letter/number sequencing task and a verbal list-learning task. To investigate the possible influence of attention problems in children with HFA, we divided the HFA group into children with (HFA+) or without (HFA-) "attention problems" according to the Child Behaviour Checklist 6-18. The children with HFA+ displayed significant impairment compared to TDC on all three neurocognitive measures, while the children with HFA- were significantly impaired compared to TDC only on the working memory and acquisition measures. In addition, the HFA+ group scored significantly below the HFA- group and the ADHD group on the verbal working memory and delayed recall measures. The results support the proposition that children with HFA+, HFA-, and ADHD differ not only on a clinical level but also on a neurocognitive level which may have implications for treatment.

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Written from the paper’s full text.

TL;DR

Children with high-functioning autism (HFA) and children with ADHD both showed impaired verbal working memory, verbal acquisition, and delayed recall compared with typically developing children, with no overall HFA–ADHD difference. Dividing HFA by parent-reported attention problems revealed that HFA+ children were more impaired than HFA− and ADHD children on verbal working memory and delayed recall.

Key findings

  • In the undivided groups, HFA and ADHD scored significantly below TDC on all three measures: Letter-Number Sequencing (LNS) means 15.0 (3.4) for HFA, 15.5 (3.3) for ADHD, 18.2 (1.9) for TDC, F(2,164)=17.0, p<.001; HVLT-R acquisition 21.4 (6.5), 21.1 (5.9), 26.3 (4.7), F=14.1, p<.001; HVLT-R delayed recall 7.5 (2.4), 7.5 (2.3), 9.1 (2.1), F=8.7, p<.001. There were no significant HFA vs ADHD differences.
  • After splitting HFA by CBCL attention T-score >65, HFA+ (n=16) was significantly more impaired than HFA− (n=22), ADHD, and TDC on verbal working memory: LNS 13.4 (3.6) vs 16.0 (2.7), 15.5 (3.3), and 18.2 (1.9), F(3,163)=14.3, p<.001.
  • On delayed recall, HFA+ and ADHD were impaired compared with TDC, and HFA+ was more impaired than HFA−: HVLT-R recall 6.6 (2.4) for HFA+, 8.1 (2.2) for HFA−, 7.5 (2.3) for ADHD, 9.1 (2.1) for TDC, F(3,163)=7.5, p<.001.
  • On acquisition, HFA+, HFA−, and ADHD all scored below TDC: 20.6 (7.7), 22.0 (5.6), 21.1 (5.9), and 26.3 (4.7), respectively, F(3,163)=9.6, p<.001.

Methods

  • Cross-sectional comparison of 38 children with HFA, 79 with ADHD, and 50 typically developing children (TDC), ages 8–17, recruited from Norwegian child and adolescent mental health centres and local schools.
  • Diagnoses used K-SADS-PL interviews, DSM-IV criteria, and parent-rated ADHD Rating Scale IV, ASSQ, and CBCL; HFA was subdivided by CBCL attention problems T-score >65 (HFA+) vs ≤65 (HFA−).
  • Neurocognitive measures were the WISC-IV Letter-Number Sequencing task for verbal working memory and the Hopkins Verbal Learning Test–Revised for acquisition and 20-minute delayed recall; analyses used ANOVA with Fisher’s LSD post-hoc tests, plus MANCOVA controlling for IQ and gender and sensitivity analyses excluding medicated participants.

Limitations

  • Stated by the authors: groups were not matched on gender ratio; no measures for specific learning disabilities; no children with Autistic Disorder in the HFA group; ADI-R or ADOS criteria were not applied; the sample came from a clinical population willing to seek help, with no information on those who refused participation.
  • Evident from the text: the HFA+ and HFA− subgroups were small (n=16 and n=22), and attention problems were defined by parent-report CBCL rather than a separate ADHD diagnostic assessment.
  • Evident from the text: the study is cross-sectional, so it cannot establish whether attention problems precede or cause the observed memory and working-memory differences.

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Crossref · 10.1371/journal.pone.0064842

Cites

58 of 58 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

0 of 37 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    The CBCL measure of attention was moderately correlated to ASD symptoms on the ASSQ.

    “The CBCL measure of attention was moderately (r = .33, p<.05) correlated to ASD symptoms on the ASSQ.”
    Quote in the paperNot a substantial claim
  • Findingown data

    Children with ADHD and HFA- were significantly impaired compared to TDC on verbal working memory (p<.05).

    “In addition, children with ADHD and HFA- were significantly (p<.05) impaired compared to the TDC on verbal working memory.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The CBCL attention T-score >65 is a valid indicator of clinically significant ADHD symptoms in children with HFA.
  • Findingown data

    The ADHD group scored significantly impaired compared to TDC on the three measures.

    “Fisher's LSD post hoc analysis showed that both the HFA group and the ADHD group scored significantly (p<.001) impaired compared to the TDC.”
    Quote in the paperSubstantial claim
  • Findingown data

    The HFA+ group scored significantly below the ADHD group on the verbal working memory and delayed recall measures.

    “In addition, the HFA+ group scored significantly below the HFA− group and the ADHD group on the verbal working memory and delayed recall measures.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: A deficit in a subgroup of patients may account for diagnostic group differences when heterogeneity is large.
  • Findingown data

    The children with HFA− were significantly impaired compared to TDC only on the working memory and acquisition measures.

    “The children with HFA+ displayed significant impairment compared to TDC on all three neurocognitive measures, while the children with HFA− were significantly impaired compared to TDC only on the working memory and acquisition measures.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: A deficit in a subgroup of patients may account for diagnostic group differences when heterogeneity is large.
  • May combine two claims. 23
  • Classified as probably not a substantial claim. 46

  • May combine two claims.

    Findingown data

    When comparing the ADHD and TDC groups with FSIQ as covariate, the results from the ANOVA persisted, with significant main effects for verbal working memory, acquisition, and delayed recall.

    “When comparing the ADHD and TDC groups with FSIQ as covariate, the results from the ANOVA persisted. The main effects of diagnosis were as follows: verbal working memory (F (1,127) = 16.4, p<.001), HVLT-R acquisition (F (1,127) = 17.3, p<.001), and HVLT-R delayed recall (F (1,127) = 10.3, p = .002).”
    Quote in the paperSubstantial claim

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

    Findingown data

    The ADHD group had significantly lower PIQ and FSIQ than the TDC group.

    “Post-hoc analysis showed that the ADHD group had significantly lower PIQ and FSIQ than the TDC group.”
    Quote in the paperNot a substantial claim

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

    Findingown data

    There were significantly fewer girls in the HFA group compared to the two other groups.

    “There were significantly (p = .024) fewer girls in the HFA group compared to the two other groups.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The HFA group did not differ significantly from the TDC group or from the ADHD group with regard to the IQ measures.

    “The HFA group did not differ significantly from the TDC group or from the ADHD group with regard to the IQ measures.”
    Quote in the paperNot a substantial claim

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

    Findingown data

    There was a significant difference between the groups with regard to PIQ and FSIQ.

    “There was a significant difference between the groups with regard to PIQ (F = 5.1, p = .007) and FSIQ (F = 4.8, p = .010).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Both clinical groups (HFA and ADHD) were impaired on all three neurocognitive test measures compared to TDC.

    “Both clinical groups were, however, impaired on all three neurocognitive test measures compared to the TDC group.”
    Quote in the paperSubstantial claim

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

    Findingown data

    Mothers of TDC had significantly longer education than the clinical groups.

    “Mothers of TDC had significantly longer education than the clinical groups.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Both clinical groups performed impaired compared to TDC on both CBCL school and total problems measures.

    “Both clinical groups performed impaired compared to TDC on both measures (F = 89.2, p <.001 and F = 139.3, p<.001), and there were no differences between the ADHD and the HFA groups.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    There were no significant differences between the HFA subgroups with regard to IQ or total symptom load.

    “Although numerically lower IQ in the HFA+ group, there were no significant differences between the HFA subgroups with regard to IQ or total symptom load.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Only children with HFA+, and not HFA-, were impaired compared to TDC on delayed recall.

    “Only the children with HFA+, and not the children with HFA-, were impaired compared to TDC on delayed recall.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The CBCL attention T-score >65 is a valid indicator of clinically significant ADHD symptoms in children with HFA.

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

    Premisecitation

    Children with ASD typically have difficulties with planning and cognitive flexibility.

    “Children with ASD typically have difficulties with planning and cognitive flexibility, while children with ADHD more commonly struggle with inhibition and sustained attention [13].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [13] BA Gargaro, 2011, Autism and ADHD: How far have we come in the comorbidity debate, Neuroscience & Biobehavioral Reviews source

      Not checked in the free run.

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

    Premisecitation

    Children with ADHD have been found to perform significantly more impaired than children with ASD on both verbal and visual working memory.

    “Children with ADHD have been found to perform significantly more impaired than children with ASD on both verbal and visual working memory [19].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [19] TP Alloway, 2009, Working memory in children with developmental disorders, Journal of Learning Disabilities source

      Not checked in the free run.

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

    Premisecitation

    Research has shown different patterns of deficits in executive functioning in children with ASD and ADHD.

    “Research has shown different patterns of deficits in executive functioning in children with ASD and ADHD [13].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [13] BA Gargaro, 2011, Autism and ADHD: How far have we come in the comorbidity debate, Neuroscience & Biobehavioral Reviews source

      Not checked in the free run.

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

    Premisecitation

    In another study only children with ADHD, and not children with ASD, displayed impairments in visual working memory when compared to typically developing children (TDC).

    “In another study only children with ADHD, and not children with ASD, displayed impairments in visual working memory when compared to typically developing children (TDC) [20].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [20] F Happe, 2006, Executive function deficits in autism spectrum disorders and attention-deficit/hyperactivity disorder: examining profiles across domains and ages, Brain and Cognition source

      Not checked in the free run.

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

    Premisecitation

    Children with ADHD more commonly struggle with inhibition and sustained attention.

    “Children with ASD typically have difficulties with planning and cognitive flexibility, while children with ADHD more commonly struggle with inhibition and sustained attention [13].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [13] BA Gargaro, 2011, Autism and ADHD: How far have we come in the comorbidity debate, Neuroscience & Biobehavioral Reviews source

      Not checked in the free run.

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

    Premisecitation

    Children with ASD and ADHD-like symptoms seem to display deficits in inhibition similar to that found in children with ADHD.

    “However, children with ASD and ADHD-like symptoms seem to display deficits in inhibition similar to that found in children with ADHD [17], [18].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [17], [18]

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    ADHD symptoms (attention problems and hyperactivity) often occur in subjects with ASD and vice versa.

    “Symptoms similar to those found in Attention-Deficit/Hyperactivity Disorder (ADHD) often occur in children with Autism Spectrum Disorders (ASD).”
    • Also stated in: § Introduction · plain
      “Although ASD is an exclusion criteria for Attention-Deficit/Hyperactivity Disorder (ADHD) in both DSM-IV-TR [1] and ICD-10 [2] several studies have reported that ADHD symptoms (attention problems and hyperactivity) often occur in subjects with ASD and vice versa [3]–[7].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [3]–[7]

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

    Premisecitation

    Psychopathological, neurocognitive, brain imaging and genetic studies suggest possible pathophysiological links between ASD and ADHD.

    “Psychopathological, neurocognitive, brain imaging and genetic studies suggest possible pathophysiological links between ASD and ADHD [13]–[16].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [13]–[16]

      Not checked in the free run.

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

    Premisecitation

    Comorbidity between ASD and ADHD has been reported to be within the range of 14-78%.

    “Comorbidity between ASD and ADHD has been reported to be within the range of 14–78% [4], [5], [8]–[12].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [4], [5], [8]–[12]

      Not checked in the free run.

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

    Premisecitation

    Other studies have found no significant differences between children with ASD, ADHD and TDC on visual working memory.

    “Other studies have found no significant differences between children with ASD, ADHD and TDC on visual working memory [21].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [21] HM Geurts, 2004, How specific are executive functioning deficits in attention deficit hyperactivity disorder and autism, Journal of Child Psychology and Psychiatry source

      Not checked in the free run.

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

    Study design and conductown data

    A MANCOVA controlling for gender showed no significant effect of gender on the test results.

    “A MANCOVA controlling for the overall effect of gender showed no significant effect of gender on the test results.”
    Quote in the paperNot a substantial claim

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

    Premisecitation

    Other studies have found impairments in delayed recall but not in acquisition in children with ADHD.

    “In ADHD research some studies have found more impairments in acquisition than in delayed recall in children with ADHD [24]–[26], while others have found impairments in delayed recall but not in acquisition [27], [28].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [27], [28]

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

    Premisecitation

    The ratio of males to females in the HFA group is similar to that found in prevalence studies.

    “The ratio of males to females is similar to that found in prevalence studies [33], [34].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [33], [34]

      Not checked in the free run.

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

    Study design and conductcitation

    The CBCL is widely used internationally and has demonstrated good discriminant validity.

    “It is widely used internationally and has demonstrated good discriminant validity with mean factor loadings across societies at.62 [46].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [46] MY Ivanova, 2007, Testing the 8-syndrome structure of the child behavior checklist in 30 societies, Journal of Clinical Child and Adolescent Psychology source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    Leffard et al. state that the LNS task requires high processing demands.

    “This is coinciding with Leffard et al. [40] who state that the LNS task requires high processing demands.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [40] SA Leffard, 2006, Substantive validity of working memory measures in major cognitive functioning test batteries for children, Applied Neuropsychology source

      Not checked in the free run.

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

    Premisecitation

    Russo et al. review found deficits in verbal working memory in children with ASD compared to TDC.

    “This finding is in line with a review study by Russo et al. [48], finding deficits in verbal working memory in children with ASD compared to TDC.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [48] N Russo, 2007, Deconstructing executive deficits among persons with autism: implications for cognitive neuroscience, Brain and Cognition source

      Not checked in the free run.

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

    Premisecitation

    The education level of the mothers of TDC was nearly equal to that of mothers of TDC in comparable studies in Norway.

    “However, the education level of the mothers of TDC was nearly equal to that of mothers of TDC in comparable studies in Norway [36].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [36] KS Heiervang, 2010, The Chernobyl accident and cognitive functioning: a study of Norwegian adolescents exposed in utero, Developmental Neuropsychology source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    If the delayed recall deficit was not secondary to the deficit in acquisition, there should have been an additional impairment in delayed recall, reflected in a larger effect size.

    “If the delayed recall deficit was not secondary to the deficit in acquisition there should have been an additional impairment in delayed recall, reflected in a larger effect size that could account for both the impairment in acquisition plus the additional impairment in recall.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    A review of memory functions in ASD found that memory deficits were related to retrieval problems and not to acquisition problems.

    “A review of memory functions in ASD found that memory deficits were related to retrieval problems and not to acquisition problems [22].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [22] A Gras-Vincendon, 2008, Functioning of memory in subjects with autism, Encephale

      Not checked in the free run.

  • May combine two claims.

    Study design and conductown data

    The HFA+ and HFA- group did not differ significantly with regard to IQ, CBCL composite score, sex distribution or age.

    “The HFA+ and HFA- group did not differ significantly with regard to IQ, CBCL composite score (the mean of T-scores from the CBCL syndrome scales), sex distribution or age.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Steele et al. found that working memory deficits in HFA were load-dependent, and that only a complex task revealed difficulties.

    “Steele et al. [47] found that working memory deficits in HFA were load-dependent, and that only a complex task revealed difficulties.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [47] S Steele, 2007, Spatial working memory deficits in autism, Journal of Autism and Developmental Disorders source

      Not checked in the free run.

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

    Study design and conductcitation

    Factor loading and test-retest reliability are reported as good for the LNS.

    “Factor loading (.62) and test–retest reliability (.70–.80) are reported as good for the LNS [41].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [41] Groth-Marnat G (2003) Handbook of psychological assessment. Hoboken, NJ: John Wiley &amp; Sons.

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Interpretationnone given

    These studies differ from the current study in the working memory task used.

    “However, these studies differ from the current study in the working memory task used.”
    Quote in the paperSubstantial claim

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

    Study design and conductcitation

    Research using HVLT-R has shown good discriminant validity and test-retest reliability.

    “Research using HVLT-R has shown good discriminant validity (canonical correlations up to.83) and test-retest reliability ranging from.47 to.59 [43]–[45].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [43]–[45]

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  • Classified as probably not a substantial claim.

    Premisecitation

    Free delayed recall, cued memory and recognition have been found to be intact in ASD.

    “In contrast to this, free delayed recall, cued memory and recognition have been found to be intact in ASD [23].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [23] H Phelan, 2011, Brief Report: Memory performance on the California verbal learning test – Children&apos;s version in autism spectrum disorder, Journal of Autism and Developmental Disorders source

      Not checked in the free run.

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

    Study design and conductown data

    There were no significant differences between the groups with regard to age.

    “There were no significant differences between the groups with regard to age.”
    Quote in the paperNot a substantial claim

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

    Interpretationcitation

    The results from this study on verbal working memory are comparable with the results from Geurts et al., who found no significant differences between children with ASD, ADHD and TDC on visual working memory.

    “The results from our study on verbal working memory seems to be comparable with the results from Geurts et al. [21] who found no significant differences between children with ASD, ADHD and TDC on visual working memory.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [21] HM Geurts, 2004, How specific are executive functioning deficits in attention deficit hyperactivity disorder and autism, Journal of Child Psychology and Psychiatry source

      Not checked in the free run.

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

    Premisecitation

    Some studies have found more impairments in acquisition than in delayed recall in children with ADHD.

    “In ADHD research some studies have found more impairments in acquisition than in delayed recall in children with ADHD [24]–[26], while others have found impairments in delayed recall but not in acquisition [27], [28].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [24]–[26]

      Not checked in the free run.

  • May combine two claims.

    Study design and conductown data

    When controlling for FSIQ in pair-wise MANCOVAs, FSIQ was significantly related to all measures, but all group differences from the ANOVAs still remained significant.

    “When controlling for FSIQ in pair-wise MANCOVAs, FSIQ was significantly related to all measures, but all group differences from the ANOVAs still remained significant.”
    Quote in the paperSubstantial claim

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

    Premisecitation

    Other studies have found that children with ADHD are more impaired than those with HFA on working memory.

    “Regarding working memory, other studies have found that children with ADHD are more impaired than those with HFA on working memory [17], [19]–[20].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [17] J Sinzig, 2008, Inhibition, flexibility, working memory and planning in autism spectrum disorders with and without comorbid ADHD-symptoms, Child and Adolescent Psychiatry and Mental Health source

      Not checked in the free run.

    • cites [19]–[20]

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

    Study design and conductown data

    Excluding children on medication did not impact any of the results.

    “ANOVAs excluding children on medication did not have an impact on any of the results.”
    Quote in the paperNot a substantial claim

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

    Interpretationcitation

    Difficulties with working memory, acquisition and delayed recall along with different subtypes of ASD may complicate social skills interventions because it will take longer to learn new social skills.

    “It is possible that difficulties with working memory, acquisition and delayed recall along with different subtypes of ASD (HFA+ and HFA-) may complicate such interventions [53], [54] because it will take longer time to learn new social skills.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [53] KM Antshel, 2011, Comorbid ADHD and anxiety affect social skills group intervention treatment efficacy in children with autism spectrum disorders, Journal of Developmental and Behavioral Pediatrics source

      Not checked in the free run.

    • cites [54] Thomson K, Walters K, Martin GL, Yu CT (2011) Teaching adaptive and social skills to individuals with autism. In: Matson JL, Sturmey P, editors. International handbook of autism and pervasive developmental disorders. London: Springer. 339–354. source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    A strength of the study is the inclusion of groups of children with HFA, ADHD and TDC in the same study.

    “Strengths of the present study are inclusion of groups of children with HFA, ADHD and TDC in the same study.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Social skills training strategies are a widely used therapeutic approach in treating children with ASD, but such training has been found to have a limited effect on children and adolescents with ADHD.

    “Social skills training strategies are a widely used therapeutic approach in treating children with ASD, but such training has been found to have a limited effect on children and adolescents with ADHD [53].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [53] KM Antshel, 2011, Comorbid ADHD and anxiety affect social skills group intervention treatment efficacy in children with autism spectrum disorders, Journal of Developmental and Behavioral Pediatrics source

      Not checked in the free run.

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

    Study design and conductnone given

    There are no children diagnosed with Autistic Disorder in the HFA group.

    “Further, there are no children diagnosed with Autistic Disorder in the HFA group.”
    Quote in the paperNot a substantial claim

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

    Premisecitation

    Recent research shows that working memory can be trained using specifically designed computer programs.

    “Recent research shows that working memory can be trained using specifically designed computer programs [51], [52].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [51] SV Loosli, 2011, Working memory training improves reading processes in typically developing children, Child Neuropsychology source

      Not checked in the free run.

    • cites [52] PJM Prins, 2011, Does computerized working memory training with game elements enhance motivation and training efficacy in children with ADHD, Cyberpsychology, Behavior and Social Networking source

      Not checked in the free run.

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

    Study design and conductnone given

    The groups are not matched on gender ratio.

    “The limitations are that the groups are not matched on gender ratio and the lack of measures for specific learning disabilities.”
    Quote in the paperNot a substantial claim

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

    Study design and conductnone given

    There is a lack of measures for specific learning disabilities.

    “The limitations are that the groups are not matched on gender ratio and the lack of measures for specific learning disabilities.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based). May combine two claims.

    Interpretationnone given

    A successful social interaction often requires the ability to maintain focus and the ability to take-turns which may rely on intact working memory functions.

    “Further, a successful social interaction often requires the ability to maintain focus and the ability to take-turns which may rely on intact working memory functions.”
    Quote in the paperNot a substantial claim

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

    Study design and conductnone given

    Not applying ADI-R or ADOS criteria is a possible limitation of the study.

    “Not applying ADI-R or ADOS criteria is a possible limitation of the study.”
    Quote in the paperNot a substantial claim

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

    Study design and conductnone given

    Another strength is the division of the HFA group according to attention problems and the subsequent comparison between the clinical subgroups.

    “Another strength is the division of the HFA group according to attention problems and the subsequent comparison between the clinical subgroups.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    Neurocognitive impairments seem to be more a core deficit in children with HFA-, while the impaired delayed recall deficit in children with HFA+ is related to elevated attention problems.

    “These neurocognitive impairments seems to be more a core deficit in children with HFA-, while the impaired delayed recall deficit in children with HFA+ is related to elevated attention problems.”
    Quote in the paperSubstantial claim

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

    Premisecitation

    An additive effect has also been found for inhibition.

    “Such an additive effect has also been found for inhibition [17].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [17] J Sinzig, 2008, Inhibition, flexibility, working memory and planning in autism spectrum disorders with and without comorbid ADHD-symptoms, Child and Adolescent Psychiatry and Mental Health source

      Not checked in the free run.

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

    Study design and conductnone given

    We do not have information regarding those who refused to participate.

    “Other potential limitations are that the sample was drawn from a clinical population, and represents those who are willing to seek help, and that we do not have information regarding those who refused to participate.”
    Quote in the paperNot a substantial claim

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

    Interpretationreasoning

    This may support the need for a more dimensional way of looking at diagnoses, symptoms and everyday functioning in children with HFA, and have implications for treatment.

    “This may support the need for a more dimensional way of looking at diagnoses, symptoms and everyday functioning in children with HFA, and have implications for treatment.”
    Quote in the paperNot a substantial claim

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

    Interpretationnone given

    Group comparisons between children with ADHD and children with HFA may be misleading since the HFA group is heterogeneous with regard to comorbid attention deficits.

    “However, as earlier stated, group comparisons between children with ADHD and children with HFA may be misleading since the HFA group is heterogeneous with regard to comorbid attention deficits.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based). May combine two claims.

    Interpretationnone given

    Neurocognitive deficits may have a negative effect on both general functioning and academic achievement and make everyday life and school facilitation necessary.

    “Further, neurocognitive deficits may have a negative effect on both general functioning and academic achievement and make everyday life and school facilitation necessary.”
    Quote in the paperNot a substantial claim

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

    Study design and conductnone given

    The sample was drawn from a clinical population and represents those who are willing to seek help.

    “Other potential limitations are that the sample was drawn from a clinical population, and represents those who are willing to seek help, and that we do not have information regarding those who refused to participate.”
    Quote in the paperNot a substantial claim
58 of 58

  • The paper relies on this without support.

    No studies have investigated acquisition (learning) and delayed recall in children with ASD compared to children with ADHD.

    “To our knowledge, no studies have investigated acquisition (learning) and delayed recall in children with ASD compared to children with ADHD.”

  • The paper relies on this without support.

    A deficit in a subgroup of patients may account for diagnostic group differences when heterogeneity is large.

    “Group comparisons can be misleading when heterogeneity is large. A deficit in a subgroup of patients may account for diagnostic group differences.”

  • The paper relies on this without support.

    The CBCL attention T-score >65 is a valid indicator of clinically significant ADHD symptoms in children with HFA.

    “a) CBCL attention T-score>65”
    “children with HFA whose parents report co-occurring ADHD symptoms”
3 of 3

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?

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(2, 164) = 17reported p < .001 · recomputed p < .001

    “F (2,164) = 17.0, p < .001”

  • ConsistentF(2, 164) = 14.1reported p < .001 · recomputed p < .001

    “F (2,164) = 14.1, p < .001”

  • ConsistentF(2, 164) = 8.7reported p < .001 · recomputed p < .001

    “F (2,164) = 8.7, p < .001”

  • ConsistentF(1, 85) = 30.2reported p < .001 · recomputed p < .001

    “F (1, 85) = 30.2, p < .001”

  • ConsistentF(1, 85) = 13.5reported p < .001 · recomputed p < .001

    “F (1, 85) = 13.5, p < .001”

  • ConsistentF(1, 85) = 7.5reported p = .007 · recomputed p = .008

    “F (1, 85) = 7.5, p = .007”

  • ConsistentF(1, 127) = 16.4reported p < .001 · recomputed p < .001

    “F (1,127) = 16.4, p < .001”

  • ConsistentF(1, 127) = 17.3reported p < .001 · recomputed p < .001

    “F (1,127) = 17.3, p < .001”

  • ConsistentF(1, 127) = 10.3reported p = .002 · recomputed p = .002

    “F (1,127) = 10.3, p = .002”

  • ConsistentF(3, 163) = 14.3reported p < .001 · recomputed p < .001

    “F (3,163) = 14.3, p < .001”

  • ConsistentF(3, 163) = 9.6reported p < .001 · recomputed p < .001

    “F (3,163) = 9.6, p < .001”

  • ConsistentF(3, 163) = 7.5reported p < .001 · recomputed p < .001

    “F (3,163) = 7.5, p < .001”

12 of 12

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.

  • Abstract claims a delayed-recall difference not reported in the results

    Major

    The abstract says HFA+ scored significantly below ADHD on delayed recall. The delayed-recall post-hoc results report HFA+ and ADHD as below TDC, and HFA+ as below HFA−, but do not report a significant HFA+-ADHD difference.

1 of 1

Cites

Flagged first, then by citations

Research works printed but not linked: 1

  1. A Gras-Vincendon, 2008, Functioning of memory in subjects with autism, Encephale, 34, 550

Cited by

Sorted by citations

Related

Authors
Andersen, P. N., Hovik, K. T., Skogli, E. W., Egeland, J., & Øie, M.
Affiliations
University of Oslo (NO)
Corresponding author
Andersen, Per Normann
ORCID
Venue
PLoS ONE
Publisher
Public Library of Science (PLoS)
Published
2013-05-22
Volume
8
Issue
5
Pages
e64842
ISSN
1932-6203 (ISSN-L)
DOI
10.1371/journal.pone.0064842
PMC
PMC3661504
OpenAlex
W2069301108
Semantic Scholar
a796a6e24dee3a32e34b5cdc1d42d848616e2864
Cited by
82
References
57
Citations by year
2026: 4 · 2025: 4 · 2024: 6 · 2023: 8 · 2022: 5 · 2021: 3 · 2020: 4 · 2019: 6 · 2018: 7 · 2017: 9 · 2016: 12 · 2015: 8 · 2014: 6
FWCI
4.75
Type
journal article
Language
en
Open access
Licence
Locations
  • PLoS ONE (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, other-oa)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • RePEc: Research Papers in Economics (submittedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
Funders
Sykehuset Innlandet HF
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
high-functioning autism, attention deficit hyperactivity disorder, verbal working memory, verbal learning, letter-number sequencing, attention deficits, neurocognitive impairment, children
MeSH terms
Adolescent, Attention Deficit Disorder with Hyperactivity, Autistic Disorder, Child, Female, Humans, Male, Memory, Short-Term, Mental Recall, Verbal Learning

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-06.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-06.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

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