Both disorders can lead to social challenges, such as difficulty understanding social cues, engaging in reciprocal interactions, and maintaining friendships.
Key Points
Rationale
Previous research has demonstrated that children with autism spectrum disorder (ASD) and attention deficit/hyperactivity disorder (ADHD) experience significant social difficulties (Barkley, 1998; Cervantes et al., 2013).
When these disorders co-occur, an additive effect on symptom expression has been observed (Ames & White, 2011; Factor et al., 2017). However, limited research has focused on the specific impact of ASD+ADHD comorbidity on social functioning, and existing studies have reported inconsistent findings (Factor et al., 2017; Rao & Landa, 2014; Salley et al., 2015).
These inconsistencies may be attributed to differences in sample characteristics and assessment tools used to measure social impairment.
Understanding the social profiles of these diagnostic groups is essential for developing targeted interventions and improving outcomes for affected individuals.
Method
The study utilized data from a previously completed study comparing DSM-IV and DSM-5 criteria for ASD. Participants were 282 children (ages 2-17) diagnosed with ASD (n= 151), ADHD (n= 82), or ASD+ADHD (n= 49) who underwent a comprehensive diagnostic evaluation at one of six autism centers.
Procedure
Participants were recruited before their evaluation and underwent a standard diagnostic process, including record review, standardized observation using the ADOS-2, cognitive assessment, and additional measures as needed.
Sample
The sample consisted of 282 children (82.27% male) with a mean age of 93.12 months (SD=50.46). Participants were predominantly White (80.85%) and non-Hispanic (85.46%).
Measures
Statistical Measures
Data were transformed due to skewed distributions and missing data were replaced using multiple imputation. MANCOVA was used to compare diagnostic groups on measures of social impairment, with age and IQ as covariates.
Results
MANCOVA results revealed significant differences between diagnostic groups on the ADOS-2 SA-CSS, with the ASD and ASD+ADHD groups scoring significantly higher than the ADHD group (p<.001).
However, no significant differences were found between the ASD and ASD+ADHD groups on the ADOS-2 SA-CSS. Additionally, no significant group differences were observed on the ABC Lethargy/Social Withdrawal subscale.
Age was a significant covariate (p<.001), while IQ was not (p=.227). These findings suggest that children with ASD and ASD+ADHD display similar levels of social impairment when assessed using the ADOS-2 SA-CSS, and that the ABC Lethargy/Social Withdrawal subscale may capture convergent social symptoms attributed to either ASD or ADHD.
The results highlight the importance of using multiple assessment methods to evaluate social functioning in these diagnostic groups.
Insight
This study provides valuable insights into the social profiles of children with ASD, ADHD, and ASD+ADHD.
However, the lack of significant group differences on the ABC Lethargy/Social Withdrawal subscale indicates that this parent-report measure may be capturing convergent social symptoms attributed to either disorder.
These findings underscore the importance of using multiple assessment methods, including both clinician observation and parent report, to comprehensively evaluate social functioning in these populations.
The results contribute to the understanding of the ASD+ADHD phenotype and have implications for diagnostic assessment and intervention planning.
Future research should investigate potential age-related differences in symptom presentation and explore the role of executive functioning in the social difficulties observed in these diagnostic groups.
Strengths
Below are some of the methodological strengths of this study:
Limitations
Below are some of the methodological limitations of this study:
The limitations of this study highlight the need for future research with more balanced sample sizes, participants matched on age and ADOS-2 module, and more representative samples of children with ADHD.
Additionally, comprehensive assessment data on co-occurring conditions and cognitive functioning should be included to better understand the factors influencing social impairment in these diagnostic groups.
Implications
The results of this study have significant implications for the assessment and treatment of social impairment in children with ASD, ADHD, and ASD+ADHD.
The finding that children with ASD and ASD+ADHD display similar levels of social impairment on the ADOS-2 SA-CSS suggests that social interventions targeting core deficits in ASD may be similarly effective for children with ASD+ADHD.
However, the lack of significant group differences on the ABC Lethargy/Social Withdrawal subscale highlights the importance of using multiple assessment methods to comprehensively evaluate social functioning and tailor interventions accordingly.
The study’s findings also underscore the need for clinicians to consider the potential impact of ADHD symptoms on social functioning of autistic children and to screen for co-occurring ADHD in this population.
Early identification and intervention for both disorders may be crucial for improving social outcomes and overall quality of life.
Furthermore, the study’s limitations, such as the wide age range of participants and potential differences in social demands across ADOS-2 modules, emphasize the need for future research to investigate age-related differences in symptom presentation and to control for potential confounding variables.
Longitudinal studies examining the developmental trajectories of social impairment in these diagnostic groups could provide valuable insights into the factors influencing social outcomes over time.
References
Primary reference
Harkins, C. M., Handen, B. L., & Mazurek, M. O. (2022). The impact of the comorbidity of ASD and ADHD on social impairment.Journal of Autism and Developmental Disorders,52(6), 2512-2522.https://doi.org/10.1007/s10803-021-05150-1
Other references
Ames, C. S., & White, S. J. (2011). Brief report: Are ADHD traits dissociable from the autistic profile? Links between cognition and behaviour.Journal of Autism and Developmental Disorders,41(3), 357–363.https://doi.org/10.1007/s10803-010-1049-0
Barkley, R. A. (1998). Attention-deficit hyperactivity disorder.Scientific American,279(3), 66–71.https://doi.org/10.3928/0048-5713-19891101-08
Cervantes, P. E., Matson, J. L., Adams, H. L., Williams, L. W., Goldin, R. L., & Jang, J. (2013). Comparing social skill profiles of children with autism spectrum disorders versus children with attention deficit hyperactivity disorder: Where the deficits lie.Research in Autism Spectrum Disorders,7(9), 1104–1110.https://doi.org/10.1016/j.rasd.2013.05.008
Factor, R. S., Ryan, S. M., Farley, J. P., Ollendick, T. H., & Scarpa, A. (2017). Does the presence of anxiety and ADHD symptoms add to social impairment in children with autism spectrum disorder?Journal of Autism and Developmental Disorders,47(4), 1122–1134.https://doi.org/10.1007/s10803-016-3025-9
Rao, P. A., & Landa, R. J. (2014). Association between severity of behavioral phenotype and comorbid attention deficit hyperactivity disorder symptoms in children with autism spectrum disorders.Autism,18(3), 272–280.https://doi.org/10.1177/1362361312470494
Salley, B., Gabrielli, J., Smith, C. M., & Braun, M. (2015). Do communication and social interaction skills differ across youth diagnosed with autism spectrum disorder, attention-deficit/hyperactivity disorder, or dual diagnosis?Research in Autism Spectrum Disorders,20, 58–66.https://doi.org/10.1016/j.rasd.2015.08.006
Keep Learning
Here are some reflective questions related to this study that could prompt further discussion:
Saul McLeod, PhD
BSc (Hons) Psychology, MRes, PhD, University of Manchester
Saul McLeod, PhD., is a qualified psychology teacher with over 18 years of experience in further and higher education. He has been published in peer-reviewed journals, including the Journal of Clinical Psychology.
Olivia Guy-Evans, MSc
BSc (Hons) Psychology, MSc Psychology of Education
Olivia Guy-Evans is a writer and associate editor for Simply Psychology. She has previously worked in healthcare and educational sectors.
