IMFAR, Atlanta, May 2014 International Meeting for Autism Research

Conflict of Interest: None

A Review of Attention-Deficit/Hyperactivity Disorder Measures

for Children with Autism Spectrum Disorder

Shawna A. Scott, Marcia N. Gragg, & Sophie A. Rutter

University of Windsor, The Summit Centre for Preschool Children with Autism, Windsor, ON, Canada

BACKGROUND

• The new DSM-5 diagnostic criteria for Autism Spectrum Disorder (ASD)

permit diagnosis of Attention-Deficit/Hyperactivity Disorder (ADHD) in

individuals with ASD.

• Both disorders are more prevalent in boys than girls.

• Considerable phenotypic overlap exists between ASD and ADHD.

OBJECTIVE

• It is essential that clinicians distinguish and identify commonalities between

symptoms of ASD and ADHD.

• There is a need to delineate which ADHD measures are valid for ASD

assessment.

• Purpose: To review the literature on measures assessing ADHD symptoms in

children with autism.

METHODS

CONCLUSIONS

• Peer-reviewed articles on ADHD assessment in children with ASD were

retrieved using PsycInfo, PsycCritiques, PsycArticles, and PsycTests

databases.

• Additional articles were identified from references in search-retrieved papers.

• Articles included in this review (a) utilized a sample of children with ASD; (b)

used ADHD measures or interviews; and (c) reported psychometric properties

of the instruments.

RESULTS

Measures to Assess Comorbid ADHD in Children with ASD

• Clinicians need to address the phenotypic overlap between ASD and ADHD.

• A comprehensive assessment of ADHD when ASD is suspected is crucial, as treatment implications differ considerably between the two.

• Many common measures of ADHD have not yet been used to assess comorbid ASD (e.g., Brown ADD Rating Scales; Conners Parent Rating Scale).

• Future research should examine treatment methods for individuals with co-occurring ASD and ADHD.

Distinguishing ASD from ADHD: Examples

• Social difficulties in children with ASD may be related to social disengagement and communication deficits;

social difficulties in children with ADHD may be related to peer rejection.

• Tantrums in children with ASD may be related to intolerance to changes in routine;

tantrums in children with ADHD may be related to poor self-control or impulsivity.

Children with ASD tend to have:

• Highly restricted and

fixated interests

• Interests that are unusual in

their intensity or focus

• Analogy: narrow flashlight beam

Children with ADHD tend to have:

• Difficulty sustaining attention

• Difficulty remaining focused

• Analogy: wide spotlight beam

ACI-PL ASD-CC A-TAC BASC-2 BISCUIT

Age Range ● 5 – 17 years ● 2 – 16 years ● 7 – 18 years ● 2 – 21 years

● Preschool, child, and adolescent

forms

● 16 – 37 months

Type Of

Measure

● Semi-structured parent

interview

● Assesses for disorders

comorbid with ASD,

including ADHD

● Screening and follow-up

questions

● Informant-based rating scale

● 7 subscales that assess for

disorders comorbid with ASD,

including ADHD

● Rating from 0 (not a problem)

to 2 (severe problem)

● Structured telephone

interview

● Screens for disorders

comorbid with ASD, including

ADHD

● Responses: yes, previously,

to some extent, no

● 14 behaviour subscales on

parent rating scales (PRS); 15

on teacher rating scales (TRS)

● Has Attention Problems and

Hyperactivity scales

● Rating from 1 (never) to 4

(almost always)

● Informant-based rating scale

● Part Two assesses for disorders

comorbid with ASD, including

ADHD (Inattention/Impulsivity)

● 5 factors

● Rating from 0 (no impairment) to

2 (severe impairment)

Length ● Unknown ● 49 items ● 96 screening items; 163 items

for specific symptoms; 72

items for psychosocial

impairment

● Up to 35 minutes

● Up to 148 items on TRS; up to

160 items on PRS

● 84 items

Psychometric

Properties

● Moderate test-retest

reliability

● Strong criterion validity

● Strong inter-rater reliability

● Strong internal consistency

and sensitivity

● Moderate inter-rater reliability,

test-retest reliability, and

validity

● High inter-rater reliability,

specificity, and sensitivity

● Good predictive validity

● Moderate test-retest reliability

● High internal consistency, test-

retest reliability, and inter-rater

reliability

● Moderate to high concurrent

validity

For Part Two:

● Strong internal consistency and

individual item correlations

● Norms established using

samples with and without ASD

Approx. #

Studies with

ASD Sample

● 2 ● 15 ● 7 ● 12 ● 35 for entire BISCUIT

● 2 for Part Two, specifically

Advantages ● Considers presentation of

symptoms in children with

ASD

● Differentiates between

symptoms within/not within

the normal range

● High sensitivity and specificity

for ADHD

● Easy to administer

● Normative data and clinical

profiles for children with ASD

● Strong psychometric properties

● Aids in early detection

Disadvantages ● Normed on a sample of

mainly high-functioning

children with ASD

● Does not assess symptom

presentation in children with

ASD

● Factors do not correspond to

DSM diagnoses

● Highly structured

● Forced choice

● Does not assess symptom

presentation in children with

ASD

● Cross-informant comparison

difficult (different items)

● Items do not assess symptom

presentation in children with

ASD

Note: ACI-PL = Autism Comorbidity Interview - Present and Lifetime Version; ASD-CC = Autism Spectrum Disorders - Comorbidity for Children; A-TAC = Autism -- Tics, AD/HD and other Comorbidities; BASC-2 =

Behavioural Assessment System for Children - Second Edition; and BISCUIT = Baby and Infant Screen for Children with Autism Traits

Note. Prevalence of ASD is from Centers for Disease Control and

Prevention (CDC, 2008). Prevalence of ADHD is from CDC (2011).

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