ArticlePublisher preview available

Assessing the Contribution of Measures of Attention and Executive Function to Diagnosis of ADHD or Autism

March 2024
Journal of Autism and Developmental Disorders

Authors:

The University of Calgary

Attention and executive function (EF) dysregulation are common in a number of disorders including autism and attention-deficit/hyperactivity disorder (ADHD). Better understanding of the relationship between indirect and direct measures of attention and EF and common neurodevelopmental diagnoses may contribute to more efficient and effective diagnostic assessment in childhood. We obtained cognitive (NIH Toolbox, Little Man Task, Matrix Reasoning Task, and Rey Delayed Recall) and symptom (CBCL, and BPMT) assessment data from the Adolescent Brain and Cognitive Development (ABCD) database for three groups, autistic (N = 110), ADHD (N = 878), and control without autism or ADHD diagnoses (N = 9130) and used ridge regression to determine which attention and EF assessments were most strongly associated with autism or ADHD. More variance was accounted for in the model for the ADHD group (31%) compared to the autism group (2.7%). Finally, we ran odds ratios (using clinical cutoffs where available and 2 standard deviations below the mean when not) for each assessment measure, which generally demonstrated a greater significance within the indirect measures when compared to the direct measures. These results add to the growing literature of symptom variably across diagnostic groups allowing for better understanding of presentations in autism and ADHD and how best to assess diagnosis. It also highlights the increased difficulty in differentiating autism and controls when compared to ADHD and controls and the importance of indirect measures of attention and EF in this differentiation.

A preview of this full-text is provided by Springer Nature.

Learn more

Content available from Journal of Autism and Developmental Disorders

This content is subject to copyright. Terms and conditions apply.

Vol.:(0123456789)

Journal of Autism and Developmental Disorders

https://doi.org/10.1007/s10803-024-06275-9

ORIGINAL ARTICLE

Assessing theContribution ofMeasures ofAttention andExecutive

Function toDiagnosis ofADHD orAutism

KelseyHarkness1,2,3 · SigneBray2,3,5· ChelseaM.Durber4· DeborahDewey2,3,5· KaraMurias2,3,5

Accepted: 29 January 2024

Abstract

Attention and executive function (EF) dysregulation are common in a number of disorders including autism and attention-

deﬁcit/hyperactivity disorder (ADHD). Better understanding of the relationship between indirect and direct measures of

attention and EF and common neurodevelopmental diagnoses may contribute to more eﬃcient and eﬀective diagnostic

assessment in childhood. We obtained cognitive (NIH Toolbox, Little Man Task, Matrix Reasoning Task, and Rey Delayed

Recall) and symptom (CBCL, and BPMT) assessment data from the Adolescent Brain and Cognitive Development (ABCD)

database for three groups, autistic (N = 110), ADHD (N = 878), and control without autism or ADHD diagnoses (N = 9130)

and used ridge regression to determine which attention and EF assessments were most strongly associated with autism or

ADHD. More variance was accounted for in the model for the ADHD group (31%) compared to the autism group (2.7%).

Finally, we ran odds ratios (using clinical cutoﬀs where available and 2 standard deviations below the mean when not) for

each assessment measure, which generally demonstrated a greater signiﬁcance within the indirect measures when compared

to the direct measures. These results add to the growing literature of symptom variably across diagnostic groups allowing for

better understanding of presentations in autism and ADHD and how best to assess diagnosis. It also highlights the increased

diﬃculty in diﬀerentiating autism and controls when compared to ADHD and controls and the importance of indirect meas-

ures of attention and EF in this diﬀerentiation.

Keywords Autism· Attention Deﬁcit Hyperactivity Disorder (ADHD)· Attention· Executive Function (EF)

Abbreviations

ADHD Attention-Deﬁcit Hyperactivity Disorder

ABCD Adolescent Brain and Cognitive Development

EF Executive Function

CBCL Childhood Behavioral Checklist

BPMT Brief Problem Monitoring Teacher Report

KSAD Kiddie Score for Aﬀective Disorders and

Schizophrenia

RAVLT Rey Auditory Verbal Learning Test

Introduction

Attention and executive function (EF) dysregulation are

common features of neurodevelopmental, mental health,

and neurologic disorders, such as Attention Deﬁcit Hyper-

activity Disorder (ADHD), Autism (Boxhoorn etal., 2018),

traumatic brain injury (Bonnelle etal., 2011), and obses-

sive compulsive behavior (Koch and Exner, 2015), as either

primary (part of diagnosis) or secondary (common in the

population) symptoms. Attention and EF dysregulation have

been associated with poor long-term educational, occupa-

tional, and social outcomes including low academic and

professional achievement, poorer lifelong earning poten-

tial, and worse physical health (Shaw etal., 2012). Given

the importance of early intervention in mediating the long-

term impacts of attention and EF dysregulation, determin-

ing measures that can assist with diagnosis of neurodevel-

opmental disorders and their associated attention and EF

dysregulations, is imperative (Harpin etal., 2016; Shaw

etal., 2012). There has been a lack of consistency in the

literature regarding the assessment measures that are more

* Kelsey Harkness

kelsey.harkness@ucalgary.ca

1 Faculty ofGraduate Studies, University ofCalgary, Calgary,

AB, Canada

2 Alberta Children’s Hospital Research Institute, Calgary, AB,

Canada

3 Hotchkiss Brain Institute, Calgary, AB, Canada

4 Alberta Health Services, Calgary, AB, Canada

5 Cumming School ofMedicine, University ofCalgary,

Calgary, AB, Canada

Content courtesy of Springer Nature, terms of use apply. Rights reserved.

ResearchGate has not been able to resolve any citations for this publication.

ADHD and autism symptoms in youth: a network analysis

Article

Full-text available

May 2021
J CHILD PSYCHOL PSYC

Background Previous research investigating the overlap between attention‐deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (henceforth, autism) symptoms in population samples have relied on latent variable modeling in which averaged scores representing dimensions were derived from observed symptoms. There are no studies evaluating how ADHD and autism symptoms interact at the level of individual symptom items. Methods We aimed to address this gap by performing a network analysis on data from a school survey of children aged 6–17 years old (N = 7,405). ADHD and autism symptoms were measured via parent‐report on the Swanson, Nolan, Pelham‐IV questionnaire and the Childhood Autism Spectrum test, respectively. Results A relatively low interconnectivity between ADHD and autism symptoms was found with only 10.06% of possible connections (edges) between one ADHD and one autism symptoms different than zero. Associations between ADHD and autism symptoms were significantly weaker than those between two symptoms pertaining to the same construct. Select ADHD symptoms, particularly those presenting in social contexts (e.g. ‘talks excessively’, ‘does not wait turn’), showed moderate‐to‐strong associations with autism symptoms, but some were considered redundant to autism symptoms. Conclusions The present findings indicate that individual ADHD and autism symptoms are largely segregated in accordance with diagnostic boundaries corresponding to these conditions in children and adolescents from the community. These findings could improve our clinical conceptualization of ADHD and autism and guide advancements in diagnosis and treatment.

Inattention and hyperactive/impulsive component scores do not differentiate between autism spectrum disorder and attention-deficit/hyperactivity disorder in a clinical sample

Article

Full-text available

Apr 2020

Background: Although there is high co-occurrence between ASD and ADHD, the nature of this co-occurrence remains unclear. Our study aimed to examine the underlying relationship between ASD and ADHD symptoms in a combined sample of children with a primary clinical diagnosis of ASD or ADHD. Methods: Participants included children and youth (aged 3-20 years) with a clinical diagnosis of ASD (n = 303) or ADHD (n = 319) for a total of 622 participants. Parents of these children completed the social communication questionnaire (SCQ), a measure of autism symptoms, and the strengths and weaknesses of ADHD and normal behavior (SWAN) questionnaire, a measure of ADHD symptoms. A principal component analysis (PCA) was performed on combined SCQ and SWAN items, followed by a profile analysis comparing normalized component scores between diagnostic groups and gender. Results: PCA revealed a four-component solution (inattention, hyperactivity/impulsivity, social-communication, and restricted, repetitive, behaviors, and interests (RRBI)), with no overlap between SCQ and SWAN items in the components. Children with ASD had higher component scores in social-communication and RRBI than children with ADHD, while there was no difference in inattentive and hyperactive/impulsive scores between diagnostic groups. Males had higher scores than females in social-communication, RRBI, and hyperactivity/impulsivity components in each diagnostic group. Limitations: We did not formally assess children with ASD for ADHD using our research-criteria for ADHD, and vice versa. High rates of co-occurring ADHD in ASD, for example, may have inflated component scores in inattention and hyperactivity/impulsivity. A disadvantage with using single informant-based reports (i.e., parent-rated questionnaires) is that ASD and ADHD symptoms may be difficult to distinguish by parents, and may be interpreted differently between parents and clinicians. Conclusions: ASD and ADHD items loaded on separate components in our sample, suggesting that the measurement structure cannot explain the covariation between the two disorders in clinical samples. High levels of inattention and hyperactivity/impulsivity were seen in both ASD and ADHD in our clinical sample. This supports the need for a dimensional framework that examines neurodevelopmental domains across traditional diagnostic boundaries. Females also had lower component scores across social-communication, RRBI, and hyperactivity/impulsivity than males, suggesting that there may be gender-specific phenotypes related to the two conditions.

Examining overlap and homogeneity in ASD, ADHD, and OCD: a data-driven, diagnosis-agnostic approach

Article

Full-text available

Nov 2019

The validity of diagnostic labels of autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (ADHD), and obsessive compulsive disorder (OCD) is an open question given the mounting evidence that these categories may not correspond to conditions with distinct etiologies, biologies, or phenotypes. The objective of this study was to determine the agreement between existing diagnostic labels and groups discovered based on a data-driven, diagnosis-agnostic approach integrating cortical neuroanatomy and core-domain phenotype features. A machine learning pipeline, called bagged-multiview clustering, was designed to discover homogeneous subgroups by integrating cortical thickness data and measures of core-domain phenotypic features of ASD, ADHD, and OCD. This study was conducted using data from the Province of Ontario Neurodevelopmental Disorders (POND) Network, a multi-center study in Ontario, Canada. Participants (n = 226) included children between the ages of 6 and 18 with a diagnosis of ASD (n = 112, median [IQR] age = 11.7[4.8], 21% female), ADHD (n = 58, median [IQR] age = 10.2[3.3], 14% female), or OCD (n = 34, median [IQR] age = 12.1[4.2], 38% female), as well as typically developing controls (n = 22, median [IQR] age = 11.0[3.8], 55% female). The diagnosis-agnostic groups were significantly different than each other in phenotypic characteristics (SCQ: χ2(9) = 111.21, p < 0.0001; SWAN: χ2(9) = 142.44, p < 0.0001) as well as cortical thickness in 75 regions of the brain. The analyses revealed disagreement between existing diagnostic labels and the diagnosis-agnostic homogeneous groups (normalized mutual information < 0.20). Our results did not support the validity of existing diagnostic labels of ASD, ADHD, and OCD as distinct entities with respect to phenotype and cortical morphology.

Attention profiles in autism spectrum disorder and subtypes of attention-deficit/hyperactivity disorder

Article

Full-text available

Nov 2018
EUR CHILD ADOLES PSY

Attention problems are observed in attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD). Most neuropsychological studies that compared both disorders focused on complex executive functions (EF), but missed to contrast basic attention functions, as well as ASD- and ADHD subtypes. The present study compared EF as well as basic attention functioning of children with the combined subtype (ADHD-C), the predominantly inattentive subtype (ADHD-I), and autism spectrum disorder without ADHD (ASD-) with typically developing controls (TD). Basic attention functions and EF profiles were analysed by testing the comprehensive attention function model of van Zomeren and Brouwer using profile analysis. Additionally, neurocognitive impairments in ASD- and ADHD were regressed on dimensional measures of attention- and hyperactive-impulsive symptoms across and within groups. ADHD-C revealed a strong impairment across measures of EF compared to ASD- and TD. The ADHD-C profile furthermore showed disorder specific impairments in interference control, whereas the ASD- profile showed a disorder specific impairment in basic attention component divided attention. Attention- and hyperactive-impulsive symptom severity did not predict neurocognitive impairments across- or within groups. Study findings thus support disorder and subtype specific attention/EF profiles, which refute the idea of a continuum of ADHD-I, ADHD-C, and ASD with increasing neurocognitive impairments.

Parent and Teacher Concordance of Child Outcomes for Youth with Autism Spectrum Disorder

Article

Full-text available

May 2018
J AUTISM DEV DISORD

Cross-informant ratings of are considered gold standard for child behavioral assessment. To date, little work has examined informant ratings of adaptive functioning for youth with autism spectrum disorder (ASD). In a large, diverse sample of youth with ASD, this study evaluated parent–teacher concordance of ratings of adaptive functioning and ASD-specific symptomatology across time. The impact of child clinical characteristics on concordance was also examined. Participants included 246 children, their caregivers and teachers. Parent–teacher concordance was variable but generally consistent across time. Concordance was significantly impacted by autism severity and child cognitive abilities. Findings inform the broader concordance literature and support the need to consider child clinical factors when assessing child functioning in samples of children with ASD.

Clinical characteristics of children with ASD and comorbid ADHD: Association with social impairment and externalizing and internalizing behaviours

Article

Jun 2021
RES DEV DISABIL

Background Autism spectrum disorder (ASD) and attention-deficit hyperactivity disorder (ADHD) are frequently occurring conditions that are often associated (ASD + ADHD). However, there are few comparative studies concerning the clinical presentation in patients formally diagnosed with both ASD and ADHD. Here, we aimed to 1) compare social impairment and externalizing/internalizing behavioural problems across four groups of children: ASD + ADHD, ASD alone, ADHD alone, and typical development and 2) examine their bidirectional relationship with ASD and/or ADHD symptoms. Methods This study included 186 participants from 6 to 12 years of age: single ASD (n = 98), ASD + ADHD (n = 29), single ADHD (n = 28), and TD (n = 31). Results The results showed that children in the ASD + ADHD and single ASD groups had a higher level of social impairment than those in the single ADHD group. In addition, children in the single ADHD group presented a greater attention deficit than those in the single ASD group. Externalizing /internalizing behaviours were more frequent in all groups with neuro-developmental disorders than in typical development. In addition, externalizing behavioural problems were related to ADHD severity in the ASD + ADHD and single ADHD groups, whereas internalizing behaviours were related to ASD severity. Conclusions These findings highlight the specific needs of children who have both ASD and ADHD and underscore the necessity of individualizing their interventions.

The ABCD study: understanding the development of risk for mental and physical health outcomes

Article

Jun 2020

Following in the footsteps of other large “population neuroscience” studies, the Adolescent Brain Cognitive Development (ABCD) study is the largest in the U.S. assessing brain development. The study is examining approximately 11,875 youth from 21 sites from age 9 to 10 for approximately ten years into young adulthood. The ABCD Study® has completed recruitment for the baseline sample generally using a multi-stage probability sample including a stratified random sample of schools. The dataset has a wealth of measured attributes of youths and their environment, including neuroimaging, cognitive, biospecimen, behavioral, youth self-report and parent self-report metrics, and environmental measures. The initial goal of the ABCD Study was to examine risk and resiliency factors associated with the development of substance use, but the project has expanded far beyond this initial set of questions and will also greatly inform our understanding of the contributions of biospecimens (e.g., pubertal hormones), neural alterations, and environmental factors to the development of both healthy behavior and brain function as well as risk for poor mental and physical outcomes. This review outlines how the ABCD Study was designed to elucidate factors associated with the development of negative mental and physical health outcomes and will provide a selective overview of results emerging from the ABCD Study. Such emerging data includes initial validation of new instruments, important new information about the prevalence and correlates of mental health challenges in middle childhood, and promising data regarding neural correlates of both healthy and disordered behavior. In addition, we will discuss the challenges and opportunities to understand both the healthy development and the emergence of risk from ABCD Study data. Finally, we will overview the future directions of this large undertaking and the ways in which it will shape our understanding of the development of healthy function and the risk for poor outcomes in adolescence.

Autistic spectrum disorder symptoms in children and adolescents with attention-deficit/hyperactivity disorder: A meta-analytical review

Article

Sep 2019

Background Research identifies highly variable prevalence estimates for autism spectrum disorder (ASD) in children and adolescents with attention deficit hyperactivity disorder (ADHD), particularly between community and clinical samples, warranting quantitative meta-analyses to investigate the true prevalence of ASD in children and adolescents with ADHD. Methods Studies were identified through a systematic literature search of PsycINFO, MEDLINE and Web of Science through January 2018. Twenty-two publications met inclusion criteria (total N = 61 985). Two random effects meta-analyses were conducted: (1) to identify the proportion of children and adolescents with ADHD that met criteria for ASD; and (2) to compare the severity of dimensionally-measured ASD symptomology in children and adolescents with and without ADHD. Results The overall pooled effect for children and adolescents with ADHD who met threshold for ASD was 21%. There was no significant difference between community samples (19%) and clinical samples (24%) or between US studies v. those from other countries. Children and adolescents with ADHD had substantially more dimensionally-measured ASD traits compared with those who did not have ADHD (d = 1.23). Conclusion The findings provide further evidence that ADHD and ASD are associated in nature. Clinical and research implications are discussed.

ADHD in children and youth: Part 3—Assessment and treatment with comorbid ASD, ID, or prematurity

Article

Oct 2018

Attention-deficit hyperactivity disorder (ADHD) is a chronic neurodevelopmental disorder. Three position statements have been developed by the Canadian Paediatric Society, following systematic literature reviews. Statement objectives are to: • 1) Summarize the current clinical evidence regarding ADHD, • 2) Establish a standard for ADHD care, and • 3) Assist Canadian clinicians in making well-informed, evidence-based decisions to enhance care of children and youth with this condition. Specific topics reviewed in Part 3, which focuses on associated autism spectrum disorder, intellectual disability, and prematurity, include the challenges of diagnostic assessment, common presentations, the role of genetics, and treatment, including the benefits of physical activity. Recommendations are based on current guidelines, evidence from the literature, and expert consensus.

Adolescent Neurocognitive Development and Impacts of Substance Use: Overview of the Adolescent Brain Cognitive Development (ABCD) Baseline Neurocognition Battery

Article

Feb 2018

Adolescence is characterized by numerous social, hormonal and physical changes, as well as a marked increase in risk-taking behaviors. Dual systems models attribute adolescent risk-taking to tensions between developing capacities for cognitive control and motivational strivings, which may peak at this time. A comprehensive understanding of neurocognitive development during the adolescent period is necessary to permit the distinction between premorbid vulnerabilities and consequences of behaviors such as substance use. Thus, the prospective assessment of cognitive development is fundamental to the aims of the newly launched Adolescent Brain and Cognitive Development (ABCD) Consortium. This paper details the rationale for ABC’lected measures of neurocognition, presents preliminary descriptive data on an initial sample of 2299 participants, and provides a context for how this large-scale project can inform our understanding of adolescent neurodevelopment.

Assessing the Contribution of Measures of Attention and Executive Function to Diagnosis of ADHD or Autism

Abstract

Recommended publications

The role of stimulant washout status in functional connectivity of default mode and fronto-parietal...

The Relationship Between Cortical Thickness and Executive Function Measures in Children With and Wit...

The Role of Stimulant Washout Status in Functional Connectivity of Default Mode and Fronto-Parietal...

Caffeine intake and cognitive functions in children