Supporting adults with autism — don’t forget comorbid ADHD

Laurence Leaver; Sally Cubbin; Allyson Parry

doi:10.3399/bjgp23X735633

O’Nions et al’s recent analysis of autism¹ helpfully highlights how primary care can help and the problem of under-diagnosis of autism. However, we were disappointed that the article does not mention the importance of screening autistic patients for attention deficit hyperactivity disorder (ADHD). They mention that the presence of ADHD should be one factor that may trigger the clinician to consider the presence of autism but not vice versa. Indeed, Ronald et al² found that 22% of those with suspected ADHD met the criteria for autistic spectrum disorders (ASD), but, more relevantly, they also found that 41% of individuals with ASD had suspected ADHD. A recent systematic review³ found that, for studies at low risk of bias, 26.7% to 95.5% of those with ASD had ADHD. The DSM-5 recognised in 2013 that ADHD symptoms are common in people with ASD, with estimated prevalence of 30%–50%.⁴ Ghirardi et al⁵ in 2018 also found that individuals with ASD were more likely to have ADHD (odds ratio 22.33).

We already know that difficulties with attention are common in people with ASD.⁶ Difficulties with listening and concentrating are also common features of ADHD, and could exacerbate social problems experienced by autistic patients, and further add to social anxiety. Difficulties with executive function can also reinforce low self-esteem and low mood. ADHD benefits from highly effective pharmacological treatments recommended by the National Institute for Health and Care Excellence.⁷ Diagnosing and treating ADHD could make a dramatic difference to many patients with ASD. Given the lack of treatments for ASD, we believe that early identification and intervention for ADHD should be a priority. It is easy to screen for ADHD using a simple six-question scoring tool, available free of charge, as recommended by the World Health Organization: the ASRS.⁸

Notes

Competing interests

Laurence Leaver, Allyson Parry, and Sally Cubbin are affiliated with the UK Adult ADHD Network (UKAAN). Sally Cubbin works in private practice in an ADHD clinic.

REFERENCES

1.↵
1. O’Nions E,
2. McKechnie DGJ,
3. Long C,
4. et al.
(2023) How can autistic adults be supported in primary care? Br J Gen Pract, DOI: https://doi.org/10.3399/bjgp23X735525.
2.↵
1. Ronald A,
2. Simonoff E,
3. Kuntsi J,
4. et al.
(2008) Evidence for overlapping genetic influences on autistic and ADHD behaviours in a community twin sample. J Child Psychol Psychiatry 49, 5, 535–542.
OpenUrl CrossRef PubMed
3.↵
1. Eaton C,
2. Roarty K,
3. Doval N,
4. et al.
(2023) The prevalence of attention deficit/hyperactivity disorder symptoms in children and adolescents with autism spectrum disorder without intellectual disability: a systematic review. J Atten Disord 27, 12, 1360–1376.
OpenUrl
4.↵
1. Leitner Y
(2014) The co-occurrence of autism and attention deficit hyperactivity disorder in children — what do we know? Front Hum Neurosci 8, 268.
OpenUrl CrossRef PubMed
5.↵
1. Ghirardi L,
2. Brikell I,
3. Kuja-Halkola R,
4. et al.
(2018) The familial co-aggregation of ASD and ADHD: a register-based cohort study. Mol Psychiatry 23, 2, 257–262.
OpenUrl PubMed
6.↵
1. Corbett BA,
2. Constantine LJ,
3. Hendren R,
4. et al.
(2009) Examining executive functioning in children with autism spectrum disorder, attention deficit hyperactivity disorder and typical development. Psychiatry Res 166, 2–3, 210–222.
OpenUrl CrossRef PubMed
7.↵
1. National Institute for Health and Care Excellence
(2019) Attention deficit hyperactivity disorder: diagnosis and management NG87 (NICE, London) https://www.nice.org.uk/guidance/ng87 (accessed 9 Nov 2023).
8.↵
1. Kessler RC,
2. Adler L,
3. Ames M,
4. et al.
(2005) The World Health Organization Adult ADHD Self-Report Scale (ASRS): a short screening scale for use in the general population. Psychol Med 35, 2, 245–256.
OpenUrl CrossRef PubMed

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[1] 1.↵
O’Nions E,
McKechnie DGJ,
Long C,
et al.
(2023) How can autistic adults be supported in primary care? Br J Gen Pract, DOI: https://doi.org/10.3399/bjgp23X735525.

[2] O’Nions E,

[3] McKechnie DGJ,

[4] Long C,

[5] et al.

[6] 2.↵
Ronald A,
Simonoff E,
Kuntsi J,
et al.
(2008) Evidence for overlapping genetic influences on autistic and ADHD behaviours in a community twin sample. J Child Psychol Psychiatry 49, 5, 535–542.
OpenUrl CrossRef PubMed

[7] Ronald A,

[8] Simonoff E,

[9] Kuntsi J,

[10] et al.

[11] 3.↵
Eaton C,
Roarty K,
Doval N,
et al.
(2023) The prevalence of attention deficit/hyperactivity disorder symptoms in children and adolescents with autism spectrum disorder without intellectual disability: a systematic review. J Atten Disord 27, 12, 1360–1376.
OpenUrl

[12] Eaton C,

[13] Roarty K,

[14] Doval N,

[15] et al.

[16] 4.↵
Leitner Y
(2014) The co-occurrence of autism and attention deficit hyperactivity disorder in children — what do we know? Front Hum Neurosci 8, 268.
OpenUrl CrossRef PubMed

[17] Leitner Y

[18] 5.↵
Ghirardi L,
Brikell I,
Kuja-Halkola R,
et al.
(2018) The familial co-aggregation of ASD and ADHD: a register-based cohort study. Mol Psychiatry 23, 2, 257–262.
OpenUrl PubMed

[19] Ghirardi L,

[20] Brikell I,

[21] Kuja-Halkola R,

[22] et al.

[23] 6.↵
Corbett BA,
Constantine LJ,
Hendren R,
et al.
(2009) Examining executive functioning in children with autism spectrum disorder, attention deficit hyperactivity disorder and typical development. Psychiatry Res 166, 2–3, 210–222.
OpenUrl CrossRef PubMed

[24] Corbett BA,

[25] Constantine LJ,

[26] Hendren R,

[27] et al.

[28] 7.↵
National Institute for Health and Care Excellence
(2019) Attention deficit hyperactivity disorder: diagnosis and management NG87 (NICE, London) https://www.nice.org.uk/guidance/ng87 (accessed 9 Nov 2023).

[29] National Institute for Health and Care Excellence

[30] 8.↵
Kessler RC,
Adler L,
Ames M,
et al.
(2005) The World Health Organization Adult ADHD Self-Report Scale (ASRS): a short screening scale for use in the general population. Psychol Med 35, 2, 245–256.
OpenUrl CrossRef PubMed

[31] Kessler RC,

[32] Adler L,

[33] Ames M,

[34] et al.

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