Skip to main content

Advertisement

Log in

Examining Autistic Traits in Children with ADHD: Does the Autism Spectrum Extend to ADHD?

  • Original Paper
  • Published:
Journal of Autism and Developmental Disorders Aims and scope Submit manuscript

Abstract

We examined to what extent increased parent reports of autistic traits in some children with Attention Deficit Hyperactivity Disorder (ADHD) are the result of ADHD-related symptoms or qualitatively similar to the core characteristics of autism spectrum disorders (ASD). Results confirm the presence of a subgroup of children with ADHD and elevated ratings of core ASD traits (ADHD+) not accounted for by ADHD or behavioral symptoms. Further, analyses revealed greater oppositional behaviors, but not greater ADHD severity or anxiety, in the ADHD+ subgroup compared to those with ADHD only. These results highlight the importance of specifically examining autistic traits in children with ADHD for better characterization in studies of the underlying physiopathology and treatment.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  • Abikoff, H. B., Jensen, P. S., Arnold, L. L., Hoza, B., Hechtman, L., Pollack, S., et al. (2002). Observed classroom behavior of children with ADHD: Relationship to gender and comorbidity. Journal of Abnormal Child Psychology, 30, 349–359.

    Article  PubMed  Google Scholar 

  • Achenbach, T., & Edelbrock, C. (1983). Manual for the Child Behavior Checklist and Revised Child Behavior Profile. University of Vermont, Department of Psychiatry: Burlington, VT.

    Google Scholar 

  • American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: American Psychiatric Association.

    Google Scholar 

  • Bagwell, C. L., Molina, B. S., Pelham, W. E., Jr., & Hoza, B. (2001). Attention-deficit hyperactivity disorder and problems in peer relations: Predictions from childhood to adolescence. Journal of the American Academy of Child and Adolescent Psychiatry, 40, 1285–1292.

    Article  PubMed  Google Scholar 

  • Biederman, J., Faraone, S. V., Mick, E., Williamson, S., Wilens, T. E., Spencer, T. J., et al. (1999). Clinical correlates of ADHD in females: Findings from a large group of girls ascertained from pediatric and psychiatric referral sources. Journal of the American Academy of Child and Adolescent Psychiatry, 38, 966–975.

    Article  PubMed  Google Scholar 

  • Bishop, D. V. (1998). Development of the Children’s Communication Checklist (CCC): A method for assessing qualitative aspects of communicative impairment in children. Journal of Child Psychology and Psychiatry and Allied Disciplines, 39, 879–891.

    Article  Google Scholar 

  • Bishop, D. V. (2003). The Children’s Communication Checklist- CCC-2 Manual.

  • Bishop, D. V., & Baird, G. (2001). Parent and teacher report of pragmatic aspects of communication: Use of the children’s communication checklist in a clinical setting. Developmental Medicine and Child Neurology, 43, 809–818.

    Article  PubMed  Google Scholar 

  • Bradley, E. A., & Isaacs, B. J. (2006). Inattention, hyperactivity, and impulsivity in teenagers with intellectual disabilities, with and without autism. Canadian Journal of Psychiatry-Revue Canadienne de Psychiatrie, 51, 598–606.

    PubMed  Google Scholar 

  • Brieber, S., Neufang, S., Bruning, N., Kamp-Becker, I., Remschmidt, H., Herpertz-Dahlmann, B., et al. (2007). Structural brain abnormalities in adolescents with autism spectrum disorder and patients with attention deficit/hyperactivity disorder. Journal of Child Psychology & Psychiatry, 48, 1251–1258.

    Article  Google Scholar 

  • Buitelaar, J. K., Van der Wees, M., Swaab-Barneveld, H., & van der Gaag, R. J. (1999). Theory of mind and emotion-recognition functioning in autistic spectrum disorders and in psychiatric control and normal children. Development and Psychopathology, 11, 39–58.

    Article  PubMed  Google Scholar 

  • Carpenter, R. E., Loo, S. K., Yang, M., Dang, J., & Smalley, S. L. (2009). Social functioning difficulties in ADHD: Association with PDD risk. Clinical Child Psychology & Psychiatry, 14, 329–344.

    Article  Google Scholar 

  • Charman, T., Baird, G., Simonoff, E., Loucas, T., Chandler, S., Meldrum, D., et al. (2007). Efficacy of three screening instruments in the identification of autistic-spectrum disorders. British Journal of Psychiatry, 191, 554–559.

    Article  PubMed  Google Scholar 

  • Clark, T., Feehan, C., Tinline, C., & Vostanis, P. (1999). Autistic symptoms in children with attention deficit-hyperactivity disorder. European Child and Adolescent Psychiatry, 8, 50–55.

    Article  PubMed  Google Scholar 

  • Conners, C. K. (1997). Conners’ rating scales-revised user’s manual. North Tonawanda, NY: Multi-Health Systems, Inc.

    Google Scholar 

  • Conners, C. K. (1998). Rating scales in attention-deficit/hyperactivity disorder: Use in assessment and treatment monitoring. Journal of Clinical Psychiatry, 59, 24–30.

    Article  PubMed  Google Scholar 

  • Conners, C. K., Sitarenios, G., Parker, J. D., & Epstein, J. N. (1998). The revised Conners’ Parent Rating Scale (CPRS-R): Factor structure, reliability, and criterion validity. Journal of Abnormal Child Psychology, 26, 257–268.

    Article  PubMed  Google Scholar 

  • Constantino, J. N., Davis, S. A., Todd, R. D., Schindler, M. K., Gross, M. M., Brophy, S. L., et al. (2003). Validation of a brief quantitative measure of autistic traits: Comparison of the social responsiveness scale with the autism diagnostic interview-revised. Journal of Autism and Developmental Disorders, 33, 427–433.

    Article  PubMed  Google Scholar 

  • Constantino, J. N., & Gruber, C. P. (2005). Social responsiveness scale (SRS): Manual. Los Angeles, CA: Western Psychological Services.

    Google Scholar 

  • Constantino, J. N., Gruber, C. P., Davis, S., Hayes, S., Passanante, N., & Przybeck, T. (2004). The factor structure of autistic traits. Journal of Child Psychology and Psychiatry and Allied Disciplines, 45, 719–726.

    Article  Google Scholar 

  • Constantino, J. N., Przybeck, T., Friesen, D., & Todd, R. D. (2000). Reciprocal social behavior in children with and without pervasive developmental disorders. Journal of Developmental and Behavioral Pediatrics, 21, 2–11.

    Article  PubMed  Google Scholar 

  • Constantino, J. N., & Todd, R. D. (2000). Genetic structure of reciprocal social behavior. American Journal of Psychiatry, 157, 2043–2045.

    Article  PubMed  Google Scholar 

  • Constantino, J. N., & Todd, R. D. (2003). Autistic traits in the general population: A twin study. Archives of General Psychiatry, 60, 524–530.

    Article  PubMed  Google Scholar 

  • Corbett, B. A., & Constantine, L. J. (2006). Autism and attention deficit hyperactivity disorder: Assessing attention and response control with the integrated visual and auditory continuous performance test. Child Neuropsychology, 12, 335–348.

    Article  PubMed  Google Scholar 

  • de Bruin, E. I., Ferdinand, R. F., Meester, S., de Nijs, P. F., & Verheij, F. (2007). High rates of psychiatric co-morbidity in PDD-NOS. Journal of Autism and Developmental Disorders, 37, 877–886.

    Article  PubMed  Google Scholar 

  • Di Martino, A., Shehzad, Z., Kelly, C., Roy, A. K., Gee, D. G., Uddin, L. Q., et al. (2009). Relationship between cingulo-insular functional connectivity and autistic traits in neurotypical adults. American Journal of Psychiatry, 166, 891–899.

    Article  PubMed  Google Scholar 

  • Fine, J. G., Semrud-Clikeman, M., Butcher, B., & Walkowiak, J. (2008). Brief report: Attention effect on a measure of social perception. Journal of Autism and Developmental Disorders, 38, 1797–1802.

    Article  PubMed  Google Scholar 

  • Gadow, K. D., DeVincent, C. J., & Drabick, D. A. (2008). Oppositional defiant disorder as a clinical phenotype in children with autism spectrum disorder. Journal of Autism and Developmental Disorders, 38, 1302–1310.

    Article  PubMed  Google Scholar 

  • Gadow, K. D., DeVincent, C. J., & Pomeroy, J. (2006). ADHD symptom subtypes in children with pervasive developmental disorder. Journal of Autism and Developmental Disorders, 36, 271–283.

    Article  PubMed  Google Scholar 

  • Geurts, H. M., & Embrechts, M. (2008). Language Profiles in ASD, SLI, and ADHD. Journal of Autism and Developmental Disorders, 38, 1931–1943.

    Article  PubMed  Google Scholar 

  • Geurts, H. M., Verte, S., Oosterlaan, J., Roeyers, H., Hartman, C. A., Mulder, E. J., et al. (2004a). Can the children’s communication checklist differentiate between children with autism, children with ADHD, and normal controls? Journal of Child Psychology and Psychiatry, 45, 1437–1453.

    Article  PubMed  Google Scholar 

  • Geurts, H. M., Verte, S., Oosterlaan, J., Roeyers, H., & Sergeant, J. A. (2004b). How specific are executive functioning deficits in attention deficit hyperactivity disorder and autism? Journal of Child Psychology and Psychiatry and Allied Disciplines, 45, 836–854.

    Article  Google Scholar 

  • Gillberg, C. (1989). Asperger syndrome in 23 Swedish children. Developmental Medicine and Child Neurology, 31, 520–531.

    Article  PubMed  Google Scholar 

  • Goldstein, S., & Schwebach, A. J. (2004). The comorbidity of pervasive developmental disorder and attention deficit hyperactivity disorder: Results of a retrospective chart review. Journal of Autism and Developmental Disorders, 34, 329–339.

    Article  PubMed  Google Scholar 

  • Greene, R. W., Biederman, J., Faraone, S. V., Ouellette, C. A., Penn, C., & Griffin, S. M. (1996). Toward a new psychometric definition of social disability in children with attention-deficit hyperactivity disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 35, 571–578.

    Article  PubMed  Google Scholar 

  • Guttmann-Steinmetz, S., Gadow, K. D., & DeVincent, C. J. (2009). Oppositional defiant and conduct disorder behaviors in boys with Autism spectrum disorder with and without attention-deficit hyperactivity disorder versus several comparison samples. Journal of Autism and Developmental Disorders, 39, 976–985.

    Article  PubMed  Google Scholar 

  • Hattori, J., Ogino, T., Abiru, K., Nakano, K., Oka, M., & Ohtsuka, Y. (2006). Are pervasive developmental disorders and attention-deficit/hyperactivity disorder distinct disorders? Brain and Development, 28, 371–374.

    Article  PubMed  Google Scholar 

  • Hollingshead, A. B. (1975). Four factor index of social status. New Haven.

  • Holtmann, M., Bolte, S., & Poustka, F. (2005). ADHD, Asperger syndrome, and high-functioning autism. Journal of the American Academy of Child and Adolescent Psychiatry, 44, 1101.

    Article  PubMed  Google Scholar 

  • Holtmann, M., Bolte, S., & Poustka, F. (2007). Attention deficit hyperactivity disorder symptoms in pervasive developmental disorders: Association with autistic behavior domains and coexisting psychopathology. Psychopathology, 40, 172–177.

    Article  PubMed  Google Scholar 

  • Hoza, B., Mrug, S., Gerdes, A. C., Hinshaw, S. P., Bukowski, W. M., Gold, J. A., et al. (2005). What aspects of peer relationships are impaired in children with attention-deficit/hyperactivity disorder? Journal of Consulting and Clinical Psychology, 73, 411–423.

    Article  PubMed  Google Scholar 

  • Icasiano, F., Hewson, P., Machet, P., Cooper, C., & Marshall, A. (2004). Childhood autism spectrum disorder in the Barwon region: A community based study. Journal of Paediatrics and Child Health, 40, 696–701.

    Article  PubMed  Google Scholar 

  • Jensen, P. S., Arnold, L. E., Richters, J. E., Severe, J. B., Vereen, D., & Vitiello, B. (1999). Moderators and mediators of treatment response for children with attention-deficit/hyperactivity disorder: The Multimodal Treatment Study of children with Attention-deficit/hyperactivity disorder. Archives of General Psychiatry, 56, 1088–1096.

    Article  Google Scholar 

  • Kaufman, J., Birmaher, B., Brent, D., Rao, U., Flynn, C., Moreci, P., et al. (1997). Schedule for affective disorders and schizophrenia for school-age children present and lifetime version (K-SADS-PL): Initial reliability and validity data. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 980–988.

    Article  PubMed  Google Scholar 

  • Keen, D., & Ward, S. (2004). Autistic spectrum disorder: A child population profile. Autism : The International Journal of Research and Practice, 8, 39–48.

    Google Scholar 

  • Lee, D. O., & Ousley, O. Y. (2006). Attention-deficit hyperactivity disorder symptoms in a clinic sample of children and adolescents with pervasive developmental disorders. Journal of Child and Adolescent Psychopharmacology, 16, 737–746.

    Article  PubMed  Google Scholar 

  • Luteijn, E. F., Serra, M., Jackson, S., Steenhuis, M. P., Althaus, M., Volkmar, F., et al. (2000). How unspecified are disorders of children with a pervasive developmental disorder not otherwise specified? A study of social problems in children with PDD-NOS and ADHD. European Child and Adolescent Psychiatry, 9, 168–179.

    Article  PubMed  Google Scholar 

  • Marton, I., Wiener, J., Rogers, M., Moore, C., & Tannock, R. (2009). Empathy and social perspective taking in children with Attention-Deficit/Hyperactivity Disorder. Journal of Abnormal Child Psychology, 37, 107–118.

    Article  PubMed  Google Scholar 

  • Matthys, W., Cuperus, J. M., & van Engeland, H. (1999). Deficient social problem-solving in boys with ODD/CD, with ADHD, and with both disorders. Journal of the American Academy of Child and Adolescent Psychiatry, 38, 311–321.

    Article  PubMed  Google Scholar 

  • McQuade, J. D., & Hoza, B. (2008). Peer problems in attention deficit hyperactivity disorder: Current status and future directions. Developmental Disabilities and Research Reviews, 14, 320–324.

    Article  Google Scholar 

  • Montes, G., & Halterman, J. S. (2006). Characteristics of school-age children with autism. Journal of Developmental and Behavioral Pediatrics, 27, 379–385.

    Article  PubMed  Google Scholar 

  • Mulligan, A., Anney, R. J. L., O’Regan, M., Chen, W., Butler, L., Fitzgerald, M., et al. (2009). Autism symptoms in attention-deficit/hyperactivity disorder: A familial trait which correlates with conduct, oppositional defiant, language and motor disorders. Journal of Autism and Developmental Disorders, 39, 197–209.

    Article  PubMed  Google Scholar 

  • Nijmeijer, J. S., Hoekstra, P. J., Minderaa, R. B., Buitelaar, J. K., Altink, M. E., Buschgens, C. J., et al. (2009). PDD symptoms in ADHD, an independent familial trait? Journal of Abnormal Child Psychology, 37, 443–453.

    Article  PubMed  Google Scholar 

  • Nijmeijer, J. S., Minderaa, R. B., Buitelaar, J. K., Mulligan, A., Hartman, C. A., & Hoekstra, P. J. (2008). Attention-deficit/hyperactivity disorder and social dysfunctioning. Clinical Psychology Review, 28, 692–708.

    Article  PubMed  Google Scholar 

  • Norbury, C. F., Nash, M., Baird, G., & Bishop, D. (2004). Using a parental checklist to identify diagnostic groups in children with communication impairment: A validation of the Children’s Communication Checklist–2. International Journal of Language & Communication Disorders, 39, 345–364.

    Article  Google Scholar 

  • Ogino, T., Hattori, J., Abiru, K., Nakano, K., Oka, E., & Ohtsuka, Y. (2005). Symptoms related to ADHD observed in patients with pervasive developmental disorder. Brain and Development, 27, 345–348.

    Article  PubMed  Google Scholar 

  • Orvaschel, H., & Walsh, G. (1984). The assessment of adaptive functioning in children: A review of existing measures suitable for epidemiological and clinical services research. Washington, DC: U.S. Department of Health and Human Services, NIMH, Division of Biometry and Epidemiology.

    Google Scholar 

  • Reiersen, A. M., Constantino, J. N., Grimmer, M., Martin, N. G., & Todd, R. D. (2008a). Evidence for shared genetic influences on self-reported ADHD and autistic symptoms in young adult Australian twins. Twin Research and Human Genetics, 11, 579–585.

    Article  PubMed  Google Scholar 

  • Reiersen, A. M., Constantino, J. N., & Todd, R. D. (2008b). Co-occurrence of motor problems and autistic symptoms in attention-deficit/hyperactivity disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 47, 662–672.

    Article  PubMed  Google Scholar 

  • Reiersen, A. M., Constantino, J. N., Volk, H. E., & Todd, R. D. (2007). Autistic traits in a population-based ADHD twin sample. Journal of Child Psychology and Psychiatry and Allied Disciplines, 48, 464–472.

    Article  Google Scholar 

  • Reiersen, A. M., & Todd, R. D. (2008). Co-occurrence of ADHD and autism spectrum disorders: Phenomenology and treatment. Expert Review of Neurotherapeutics, 8, 657–669.

    Article  PubMed  Google Scholar 

  • Rommelse, N. N. J., Altink, M. E., Fliers, E. A., Martin, N. C., Buschgens, C. J. M., Hartman, C. A., et al. (2009). Comorbid problems in ADHD: Degree of association, shared endophenotypes, and formation of distinct subtypes. Implications for a future DSM. Journal of Abnormal Child Psychology, 37, 793–804.

    Article  PubMed  Google Scholar 

  • Rommelse, N. N., Franke, B., Geurts, H. M., Hartman, C. A., & Buitelaar, J. K. (2010). Shared heritability of attention-deficit/hyperactivity disorder and autism spectrum disorder. European Child and Adolescent Psychiatry, 19, 281–295.

    Article  PubMed  Google Scholar 

  • Ronald, A., Simonoff, E., Kuntsi, J., Asherson, P., & Plomin, R. (2008). Evidence for overlapping genetic influences on autistic and ADHD behaviours in a community twin sample. Journal of Child Psychology and Psychiatry and Allied Disciplines, 49, 535–542.

    Article  Google Scholar 

  • Santosh, P. J., Baird, G., Pityaratstian, N., Tavare, E., & Gringras, P. (2006). Impact of comorbid autism spectrum disorders on stimulant response in children with attention deficit hyperactivity disorder: A retrospective and prospective effectiveness study. Child: Care, Health and Development, 32, 575–583.

    Article  Google Scholar 

  • Schatz, A. M., Weimer, A. K., & Trauner, D. A. (2002). Brief report attention differences in asperger syndrome. Journal of Autism and Developmental Disorders, 32, 333–336.

    Article  PubMed  Google Scholar 

  • Simonoff, E., Pickles, A., Charman, T., Chandler, S., Loucas, T., & Baird, G. (2008). Psychiatric disorders in children with autism spectrum disorders: Prevalence, comorbidity, and associated factors in a population-derived sample. Journal of the American Academy of Child and Adolescent Psychiatry, 47, 921–929.

    Article  PubMed  Google Scholar 

  • Sinzig, J., Morsch, D., Bruning, N., Schmidt, M. H., & Lehmkuhl, G. (2008a). Inhibition, flexibility, working memory and planning in autism spectrum disorders with and without comorbid ADHD-symptoms. Child and Adolescent Psychiatry and Mental Health, 2, 4.

    Article  PubMed  Google Scholar 

  • Sinzig, J., Morsch, D., & Lehmkuhl, G. (2008b). Do hyperactivity, impulsivity and inattention have an impact on the ability of facial affect recognition in children with autism and ADHD? European Child and Adolescent Psychiatry, 17, 63–72.

    Article  PubMed  Google Scholar 

  • Skuse, D. H., Mandy, W., Steer, C., Miller, L. L., Goodman, R., Lawrence, K., et al. (2009). Social communication competence and functional adaptation in a general population of children: Preliminary evidence for sex-by-verbal IQ differential risk. Journal of the American Academy of Child and Adolescent Psychiatry, 48, 128–137.

    Article  PubMed  Google Scholar 

  • Smalley, S. L., Kustanovich, V., Minassian, S. L., Stone, J. L., Ogdie, M. N., McGough, J. J., et al. (2002). Genetic linkage of attention-deficit/hyperactivity disorder on chromosome 16p13, in a region implicated in autism. American Journal of Human Genetics, 71, 959–963.

    Article  PubMed  Google Scholar 

  • Song, P. S. K. (2007). Correlated data analysis: Modeling, analytics, and applications. New York: Springer.

    Google Scholar 

  • Sturm, H., Fernell, E., & Gillberg, C. (2004). Autism spectrum disorders in children with normal intellectual levels: Associated impairments and subgroup. Developmental Medicine and Child Neurology, 46, 444–447.

    Article  PubMed  Google Scholar 

  • Virkud, Y. V., Todd, R. D., Abbacchi, A. M., Zhang, Y., & Constantino, J. N. (2009). Familial aggregation of quantitative autistic traits in multiplex versus simplex autism. American Journal of Medical Genetics. Part B, Neuropsychiatric Genetics, 150B, 328–334.

    Article  Google Scholar 

  • Wechsler, D. (1999). Wechsler abbreviated scale of intelligence (WASI). San Antonio, TX: The Psychological Corporation.

    Google Scholar 

  • Williams, N. M., Zaharieva, I., Martin, A., Langley, K., Mantripragada, K., Fossdal, R., et al. (2010). Rare chromosomal deletions and duplications in attention-deficit hyperactivity disorder: A genome-wide analysis. Lancet, 376, 1401–1408.

    Article  Google Scholar 

  • Wozniak, J., Biederman, J., Faraone, S. V., Frazier, J., Kim, J., Millstein, R., et al. (1997). Mania in children with pervasive developmental disorder revisited. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 1552–1559.

    PubMed  Google Scholar 

  • Yuill, N., & Lyon, J. (2007). Selective difficulty in recognising facial expressions of emotion in boys with ADHD. General performance impairments or specific problems in social cognition? European Child and Adolescent Psychiatry, 16, 398–404.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This work was partly supported by grants from NARSAD and NIMH (K23MH087770) awarded to Adriana Di Martino and to F. Xavier Castellanos by NICHD (R01HD065282), Autism Speaks, the Stavros Niarchos Foundation, the Leon Levy Foundation, and the Alicia Koplowitz Foundation. The authors wish to thank three anonymous clinicians at the University of Michigan Autism and Communication Disorders Center for graciously providing their SRS item classification, Dylan Gee, B.A., for helping in data collection, Sherine Khalil, M.P.A., for her dedicated work on research administration, and Amy Krain Roy, Ph.D., for helpful suggestions on an earlier version of this manuscript. Most of all the authors want to express their sincere gratitude to the parents and their children who have dedicated their time and commitment to this research.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Adriana Di Martino.

Appendix

Appendix

See Tables 3, 4, 5.

Table 3 SRS item-by-item consensus coding
Table 4 ADHD vs. ADHD+ comparisons in parent ratings of psychopathology (based on CCC-2)
Table 5 SRS consensus categories in ADHD+ and ADHD (based on CCC-2)

Rights and permissions

Reprints and permissions

About this article

Cite this article

Grzadzinski, R., Di Martino, A., Brady, E. et al. Examining Autistic Traits in Children with ADHD: Does the Autism Spectrum Extend to ADHD?. J Autism Dev Disord 41, 1178–1191 (2011). https://doi.org/10.1007/s10803-010-1135-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10803-010-1135-3

Keywords

Navigation