Journal
JOURNAL OF THE AMERICAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY
Volume 58, Issue 5, Pages 525-+Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/j.jaac.2018.08.017
Keywords
autism; ADHD; comorbidity; adaptive behavior; outcomes
Categories
Funding
- National Institute of Mental Health (NIMH) [K23MH086111, R21MH092615, RC1MH088791]
- New Program Development Award through the Intellectual and Developmental Disabilities Research Center - National Institute of Child and Human Development (NICHD) [P30HD026979]
- Philadelphia Foundation
- Pennsylvania Department of Health [SAP 4100042728, SAP 41(30047863)]
- Pfizer
- Robert Wood Johnson Foundation [6672]
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Objective: To investigate the predictive power of comorbid attention-deficit/hyperactivity disorder (ADHD) symptoms on adaptive behavior skills in children who have an autism specrum disorder (ASD) diagnosis. Method: This case-control study recruited 347 children from specialty clinics, primary care, and the community. Linear regression was used to test whether ADHD Rating Scale, Fourth Edition, scores of autistic children associated with poorer adaptive behavior scores, after controlling for the effects of age, intelligence, sex, and ASD symptom severity. Adaptive behaviors were measured with the Vineland Adaptive Behavior Scales, Second Edition. Subsequent analyses tested this relation in a subset of the ASD sample with subclinical ADHD symptoms (n = 179) and another with teacher ratings (n = 153). Prior relations between age with adaptive behaviors and ADHD symptoms were replicated and age was explored as a moderator. Results: ADHD symptoms predicted poor adaptive behavior scores in the full ASD sample (caregiver ratings, Delta R-2 = 0.033-0.119; teacher ratings, Delta R-2 = 0.113-0.163) and in the subset with subclinical ADHD symptoms (caregiver ratings, Delta R-2 = 0.023-0.030; teacher ratings, Delta R-2 = 0.097-0.159) after controlling for confounds. Age correlated negatively with ADHD symptoms (r = -0.21) and adaptive behaviors (-0.17 < r < -0.39) in the full ASD sample. Age did not moderate the effect of ADHD symptoms on adaptive behaviors. Conclusion: ADHD symptoms predict poorer adaptive behavior for autistic children across settings, even for children with subclinical co-occurring ADHD symptoms. Findings support a Research Domain Criteria framework that behavioral impairments and functional outcome measures exist along a continuum.
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