Report Claims Kids with Autism, Over-diagnosed with ADHD Comorbidity

PHILADELPHIA: Research reported in 2016 suggests that one of the tools commonly used to screen for ADHD may need an update.

The concern is that a common ADHD screening tool may not work well for autistic children, which could lead to a wrong ADHD diagnosis and support that doesn’t fit the child. It is an important question for autism and ADHD comorbidity, because the two often do occur together.

The researchers analyzed results from the ADHD Rating Scale, Fourth Edition for 386 children aged 7 to 11.

All of these children had already been diagnosed with autism. The results raised a red flag: some children who did not have ADHD were scoring as if they did.

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Benjamin Yerys, a researcher from Philadelphia, commented:

The best of the current screening measures that were being carried out for ADHD might be having children with autism over diagnosed.

He stressed that this needs careful study and a thorough look at the evidence.

If there is a need an overhaul of the existing system should be carried out.

He said this matters because medications that work well for other children may be less helpful, or less well tolerated, for autistic children.

How the ADHD Screening Tool Works

The tool that is designed to screen ADHD symptoms asks parents and teachers to rate how a child responds in different situations.

Traits such as the child’s level of attention are measured. The results are often used to decide whether a child needs school-based support or other services.

This technique raises many questions

Yerys explained that some screening questions can point in two directions at once.

For example, one question asks parents or carers whether the child responds when spoken to directly.

If the answer is “no”, it could mean the child finds it hard to pay attention, which points to ADHD.

But it could also reflect a different way of communicating and responding socially, which is a possible sign of autism.

Autism and ADHD Comorbidity: Why This Matters for Autistic Children

In the US, around 11 percent of children have been diagnosed with attention deficit hyperactivity disorder, according to the data available at the time.

The overlap is much higher among children with autism: around 1 in 3 autistic children are also thought to have ADHD.

This is a key reason the researchers called for the ADHD tool to be updated, to lower the risk of an inaccurate diagnosis.

A better tool should lead to the right support, and fewer unnecessary medications and services that a child may not need.

Yerys said that until a new tool is developed that takes autism symptoms into account, families should see a clinician experienced in both conditions.

These trained specialists carry out ADHD evaluations while also taking Autism Symptoms into account.

Is There an ADHD and Autism Comorbidity Test?

No single test can show both. Clinicians usually combine an autism assessment (often including the ADOS-2) with ADHD rating scales completed by parents and teachers, plus a detailed history. What matters most is an assessor who knows both conditions and can tell whether a trait comes from attention differences, autism or both.

What Parents Can Do

Autism and ADHD can genuinely co-occur, and many autistic children benefit from ADHD support. The point is to get the picture right. If ADHD is being considered for your autistic child:

• Ask whether the assessor has experience with both autism and ADHD.
• Share examples from home, school and other settings, including when your child focuses well (often on things they love).
• Ask how the assessor will tell apart attention differences from communication or sensory differences, such as not responding because the room is too loud.
• If medication is suggested, ask what to watch for and when it will be reviewed.