1. 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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