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AuDHD

From EverybodyWiki Bios & Wiki









AuDHD (also spelled AuDHD) is an informal but increasingly clinical term for the co-occurrence of autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) in the same person. This is a well-established pattern of comorbidity, not a separate diagnostic category in DSM-5 or ICD-11, and only since 2013 has it been formally diagnosable concurrently.[1]

Diagnostic history

The Diagnostic and Statistical Manual of Mental Disorders from 1994, also known as DSM-IV, had a rule that said a person could not be diagnosed with attention-deficit/hyperactivity disorder (ADHD) if they also had a pervasive developmental disorder. The new version of the Diagnostic and Statistical Manual of Mental Disorders that came out in 2013 changed this rule, so now it is possible for someone to be diagnosed with ADHD and another condition at the same time as long as they meet the criteria for both conditions on their own. The World Health Organization also made a change in their book called the ICD-11, which started being used in 2022, and this allows doctors to say that someone has both ADHD and a pervasive developmental disorder at the same time.[1] The World Health Organization's ICD-11, in effect since 2022, similarly permits concurrent coding of both conditions.[2]

Prevalence

ADHD and autism often co-occur, though their prevalence varies greatly based on the type of test and sample used. According to the results of a meta-analysis of 96 articles done by Lai et al. in 2019, the prevalence of ADHD among individuals with autism is approximately 28%, rising to 33% in clinical samples.[3] Another study done in 2021 by Rong et al. analyzed 63 papers and concluded that the pooled prevalence rate of ADHD among individuals with autism was 38.5%, with the lifetime prevalence at 40.2%.[4] Earlier reviews report a wider range, from 30% to over 80%, in clinic-referred samples.[5][6]

Genetics and heritability

Both conditions are highly heritable. Twin studies meta-analysis estimated the heritability of autism at 64–91%.[7] ADHD heritability from twin studies is approximately 74%, summarised in the World Federation of ADHD International Consensus Statement.[8][9]

Genetic correlation between autism and ADHD is measurable. Common variant risk is shared among 25 brain disorders: a genome-wide analysis of psychiatric disorders.[10] Some copy number variants, such as those in 16p11.2 and 22q11.2, increase risk for multiple neurodevelopmental disorders, not just a single disorder.[11][12]

Sex, gender and demographic differences

Autism is a disorder that is diagnosed more commonly in males, with a meta-analysis of 54 prevalence studies finding that the ratio between males and females in the population was approximately 3:1, which is lower than the commonly cited ratio of 4:1, implying that girls are underdiagnosed.[13] In the USA, Black, Hispanic, and Asian children are less frequently diagnosed with autism than white children.

Neurobiology

Task-related fMRI meta-analysis of 55 studies in patients with ADHD found abnormalities in fronto-striatal, fronto-parietal, and default mode networks.[14] Atypical resting state functional connectivity was reported in autism using data from the Autism Brain Imaging Data Exchange (ABIDE).[15] Neuroimaging studies on AuDHD have not been conducted yet.

Clinical features

Executive function

Both these disorders exhibit differential executive functioning, with autism being associated with impaired planning, cognitive flexibility, and inhibitory control, while ADHD primarily affects response inhibition, working memory, and attentional control.[16][14]

Sensory processing

Atypical sensory processing is a recognised feature of autism with documented neurophysiological correlates.[17]

Emotion regulation

Emotion dysregulation is recognized as a transdiagnostic feature of ADHD,[18] while in autism much of the difficulty in identifying and recognising emotions is explained by co-occurring alexithymia rather than autism per se.[19]

Camouflaging and late diagnosis

Many people diagnosed with autism as adults have described engaging in strategies to mask their autistic characteristics to fit into social norms. This phenomenon is known as camouflaging.[20] The Camouflaging Autistic Traits Questionnaire is a validated self-report measure of this construct.[21] Camouflaging is associated with poorer mental health outcomes, including anxiety and depression.[22]

Co-occurring conditions

People on the autism spectrum tend to suffer from high rates of comorbid disorders, such as ADHD, anxiety, depression, and OCD.[23][3] There are indications of hypermobile joints, dysautonomia, and chronic pain in neurodiverse individuals.[24] In addition, gender dysphoria and gender diversity occur at higher frequencies in autistic populations compared to the general population.[25] Demand avoidance has also been investigated as a dimensional aspect in autism.[26]

Treatment

Pharmacotherapy

A systematic review and meta-analysis published in 2021 of randomized trials among children and adolescents with ASD and ADHD revealed that both methylphenidate and atomoxetine effectively treat ADHD symptoms, albeit with reduced efficacy and greater adverse effects compared to ADHD patients without autism.[27] The use of atomoxetine has received support from a randomised placebo-controlled trial involving autistic children with ADHD,[28] along with studies conducted in combination with parent management training.[29] The extended-release form of guanfacine is an effective treatment option for hyperactivity in autistic children.[30]

Psychological interventions

Adaptations to cognitive behavioral therapy may help in treating co-occurring anxiety and depression in autistic adults.[31] Sensory integration therapy for autistic children has shown promise in small pilot tests.[32]

References

  1. ↑ 1.0 1.1 American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA: American Psychiatric Publishing. doi:10.1176/appi.books.9780890425596. ISBN 978-0-89042-555-8. Search this book on
  2. ↑ World Health Organization (2022). "International Classification of Diseases, 11th Revision (ICD-11)". Retrieved 2026-05-11.
  3. ↑ 3.0 3.1 Lai, MC; Kassee, C; Besney, R; Bonato, S; Hull, L; Mandy, W; Szatmari, P; Ameis, SH (2019). "Prevalence of co-occurring mental health diagnoses in the autism population: a systematic review and meta-analysis". Lancet Psychiatry. 6 (10): 819–829. doi:10.1016/S2215-0366(19)30289-5. PMID 31447415.
  4. ↑ Rong, Y; Yang, CJ; Jin, Y; Wang, Y (2021). "Prevalence of attention-deficit/hyperactivity disorder in individuals with autism spectrum disorder: a meta-analysis". Research in Autism Spectrum Disorders. 83. doi:10.1016/j.rasd.2021.101759. Unknown parameter |article-number= ignored (help)
  5. ↑ Leitner, Y (2014). "The co-occurrence of autism and attention deficit hyperactivity disorder in children — what do we know?". Frontiers in Human Neuroscience. 8: 268. doi:10.3389/fnhum.2014.00268. PMC 4010758. PMID 24808851.
  6. ↑ Antshel, KM; Zhang-James, Y; Faraone, SV (2013). "The comorbidity of ADHD and autism spectrum disorder". Expert Review of Neurotherapeutics. 13 (10): 1117–1128. doi:10.1586/14737175.2013.840417. PMID 24117274.
  7. ↑ Tick, B; Bolton, P; Happé, F; Rutter, M; Rijsdijk, F (2016). "Heritability of autism spectrum disorders: a meta-analysis of twin studies". Journal of Child Psychology and Psychiatry. 57 (5): 585–595. doi:10.1111/jcpp.12499. PMC 4996332. PMID 26709141.
  8. ↑ Faraone, SV; Banaschewski, T; Coghill, D; Zheng, Y; Biederman, J; Bellgrove, MA (2021). "The World Federation of ADHD International Consensus Statement: 208 evidence-based conclusions about the disorder". Neuroscience and Biobehavioral Reviews. 128: 789–818. Bibcode:2021NBRev.128..789F. doi:10.1016/j.neubiorev.2021.01.022. PMC 8328933 Check |pmc= value (help). PMID 33549739 Check |pmid= value (help).
  9. ↑ Lundström, S; Reichenberg, A; Melke, J; Råstam, M; Kerekes, N; Lichtenstein, P; Gillberg, C; Anckarsäter, H (2015). "Autism spectrum disorders and coexisting disorders in a nationwide Swedish twin study". Journal of Child Psychology and Psychiatry. 56 (6): 702–710. doi:10.1111/jcpp.12329. PMID 25279993.
  10. ↑ Anttila, V; Bulik-Sullivan, B; Finucane, HK; Walters, RK; Bras, J; Duncan, L; et al. (Brainstorm Consortium) (2018). "Analysis of shared heritability in common disorders of the brain". Science. 360 (6395): eaap8757. doi:10.1126/science.aap8757. PMC 6097237. PMID 29930110.
  11. ↑ Stessman, HA; Xiong, B; Coe, BP; Wang, T; Hoekzema, K; Fenckova, M (2017). "Targeted sequencing identifies 91 neurodevelopmental-disorder risk genes with autism and developmental-disability biases". Nature Genetics. 49 (4): 515–526. doi:10.1038/ng.3792. PMC 5374041. PMID 28191889.
  12. ↑ Lionel, AC; Crosbie, J; Barbosa, N; Goodale, T; Thiruvahindrapuram, B; Rickaby, J (2011). "Rare copy number variation discovery and cross-disorder comparisons identify risk genes for ADHD". Science Translational Medicine. 3 (95): 95ra75. doi:10.1126/scitranslmed.3002464. PMID 21832240.
  13. ↑ Loomes, R; Hull, L; Mandy, WPL (2017). "What is the male-to-female ratio in autism spectrum disorder? A systematic review and meta-analysis". Journal of the American Academy of Child and Adolescent Psychiatry. 56 (6): 466–474. doi:10.1016/j.jaac.2017.03.013. PMID 28545751.
  14. ↑ 14.0 14.1 Cortese, S; Kelly, C; Chabernaud, C; Proal, E; Di Martino, A; Milham, MP; Castellanos, FX (2012). "Toward systems neuroscience of ADHD: a meta-analysis of 55 fMRI studies". American Journal of Psychiatry. 169 (10): 1038–1055. doi:10.1176/appi.ajp.2012.11101521. PMC 3879048. PMID 22983386.
  15. ↑ Di Martino, A; Yan, CG; Li, Q; Denio, E; Castellanos, FX; Alaerts, K (2014). "The autism brain imaging data exchange: towards a large-scale evaluation of the intrinsic brain architecture in autism". Molecular Psychiatry. 19 (6): 659–667. doi:10.1038/mp.2013.78. PMC 4162310. PMID 23774715.
  16. ↑ Hill, EL (2004). "Executive dysfunction in autism". Trends in Cognitive Sciences. 8 (1): 26–32. doi:10.1016/j.tics.2003.11.003. PMID 14697400.
  17. ↑ Marco, EJ; Hinkley, LB; Hill, SS; Nagarajan, SS (2011). "Sensory processing in autism: a review of neurophysiologic findings". Pediatric Research. 69 (5 Pt 2): 48R–54R. doi:10.1203/PDR.0b013e3182130c54. PMC 3086654. PMID 21289533.
  18. ↑ Shaw, P; Stringaris, A; Nigg, J; Leibenluft, E (2014). "Emotion dysregulation in attention deficit hyperactivity disorder". American Journal of Psychiatry. 171 (3): 276–293. doi:10.1176/appi.ajp.2013.13070966. PMC 4282137. PMID 24480930.
  19. ↑ Bird, G; Cook, R (2013). "Mixed emotions: the contribution of alexithymia to the emotional symptoms of autism". Translational Psychiatry. 3 (7): e285. doi:10.1038/tp.2013.61. PMC 3731793. PMID 23880881.
  20. ↑ Hull, L; Petrides, KV; Allison, C; Smith, P; Baron-Cohen, S; Lai, MC; Mandy, W (2017). ""Putting on my best normal": social camouflaging in adults with autism spectrum conditions". Journal of Autism and Developmental Disorders. 47 (8): 2519–2534. doi:10.1007/s10803-017-3166-5. PMC 5509825. PMID 28527095.
  21. ↑ Hull, L; Mandy, W; Lai, MC; Baron-Cohen, S; Allison, C; Smith, P; Petrides, KV (2019). "Development and validation of the Camouflaging Autistic Traits Questionnaire (CAT-Q)". Journal of Autism and Developmental Disorders. 49 (3): 819–833. doi:10.1007/s10803-018-3792-6. PMC 6394586. PMID 30361940.
  22. ↑ Cage, E; Troxell-Whitman, Z (2019). "Understanding the reasons, contexts and costs of camouflaging for autistic adults". Journal of Autism and Developmental Disorders. 49 (5): 1899–1911. doi:10.1007/s10803-018-03878-x. PMC 6483965. PMID 30627892.
  23. ↑ 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 (8): 921–929. doi:10.1097/CHI.0b013e318179964f. PMID 18645422.
  24. ↑ Csecs, JLL; Iodice, V; Rae, CL; Brooke, A; Simmons, R; Quadt, L (2022). "Joint hypermobility links neurodivergence to dysautonomia and pain". Frontiers in Psychiatry. 12. doi:10.3389/fpsyt.2021.786916. PMC 8847158 Check |pmc= value (help). PMID 35185638 Check |pmid= value (help). Unknown parameter |article-number= ignored (help)
  25. ↑ van der Miesen, AIR; de Vries, ALC; Steensma, TD; Hartman, CA (2018). "Autistic symptoms in children and adolescents with gender dysphoria". Journal of Autism and Developmental Disorders. 48 (5): 1537–1548. doi:10.1007/s10803-017-3417-5. PMC 5889781. PMID 29189919.
  26. ↑ O'Nions, E; Viding, E; Floyd, C; Quinlan, E; Pidgeon, C; Gould, J; Happé, F (2018). "Dimensions of difficulty in children reported to have an autism spectrum diagnosis and features of extreme/'pathological' demand avoidance". Child and Adolescent Mental Health. 23 (3): 220–227. doi:10.1111/camh.12242. PMID 32677301 Check |pmid= value (help).
  27. ↑ Rodrigues, R; Lai, MC; Beswick, A; Gorman, DA; Anagnostou, E; Szatmari, P; Anderson, KK; Ameis, SH (2021). "Practitioner Review: Pharmacological treatment of attention-deficit/hyperactivity disorder symptoms in children and youth with autism spectrum disorder: a systematic review and meta-analysis". Journal of Child Psychology and Psychiatry. 62 (6): 680–700. doi:10.1111/jcpp.13305. PMID 32845025 Check |pmid= value (help).
  28. ↑ Harfterkamp, M; van de Loo-Neus, G; Minderaa, RB; van der Gaag, RJ; Escobar, R; Schacht, A (2012). "A randomized double-blind study of atomoxetine versus placebo for attention-deficit/hyperactivity disorder symptoms in children with autism spectrum disorder". Journal of the American Academy of Child and Adolescent Psychiatry. 51 (7): 733–741. doi:10.1016/j.jaac.2012.04.011. PMID 22721596.
  29. ↑ Handen, BL; Aman, MG; Arnold, LE; Hyman, SL; Tumuluru, RV; Lecavalier, L (2015). "Atomoxetine, parent training, and their combination in children with autism spectrum disorder and attention-deficit/hyperactivity disorder". Journal of the American Academy of Child and Adolescent Psychiatry. 54 (11): 905–915. doi:10.1016/j.jaac.2015.08.013. PMC 4630823. PMID 26506581.
  30. ↑ Scahill, L; McCracken, JT; King, BH; Rockhill, C; Shah, B; Politte, L (2015). "Extended-release guanfacine for hyperactivity in children with autism spectrum disorder". American Journal of Psychiatry. 172 (12): 1197–1206. doi:10.1176/appi.ajp.2015.15010055. PMID 26315981.
  31. ↑ Spain, D; Sin, J; Chalder, T; Murphy, D; Happé, F (2015). "Cognitive behavior therapy for adults with autism spectrum disorders and psychiatric co-morbidity: a review". Research in Autism Spectrum Disorders. 9: 151–162. doi:10.1016/j.rasd.2014.10.019.
  32. ↑ Pfeiffer, BA; Koenig, K; Kinnealey, M; Sheppard, M; Henderson, L (2011). "Effectiveness of sensory integration interventions in children with autism spectrum disorders: a pilot study". American Journal of Occupational Therapy. 65 (1): 76–85. doi:10.5014/ajot.2011.09205. PMC 3708964. PMID 21309374.


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