When screening children for attention-deficit hyperactivity disorder (ADHD) there are established rating scales, diagnostic criteria and information on clinical interpretation for health care providers. While the most commonly used tool to screen for ADHD, the
ADHD-RS-IV has lots of information on the disorder it turns out it might not be the best screening tool for children who are also on the autism spectrum.
Children who have an autism spectrum disorder (ASD) have social integration impairments and other characteristics of the disease that can be mistaken for the problems children who have ADHD suffer with. In both cases, ADHD and autism, early intervention is crucial and misidentification can delay this.
A new study from researchers at the Children’s Hospital of Philadelphia, the Perelman School of Medicine at the University of Pennsylvania, and Baylor University, appeared online Oct. 13 in the Journal of Autism and Developmental Disorders and their results suggest that ADHD-RS-IV screening tool could be responsible for some children with an ASD being incorrectly diagnosed with an attention deficit issue.
Study leader Benjamin E. Yerys, PhD, a researcher in the Center for Autism Research at Children’s Hospital of Philadelphia (CHOP) said in a press release, “One of our best current screening measures for ADHD may be over-diagnosing ADHD in children with autism. This is important because medications that work for ADHD may be less effective for a child on the autism spectrum.”
It’s not that the screening tool currently used by most practitioners is wrong, it’s the issue of comorbidity. Autism experts report that about 30% of children on the autism spectrum also have ADHD as a co-morbid condition. It’s not uncommon to see the two disorders in the same child. While the ADHD-RS-IV is very efficient when it comes to screening children with attention problems and hyperactivity, in children on the spectrum it can result in an overestimate of ADHD diagnoses.
The study at CHOP analyzed ratings of 386 children, between the ages of 7 to 17, who had been diagnosed with an ASD without intellectual disability. They noted that some of the questions on the rating scale resulted in a higher ADHD rating in children with autism than they did in children with ADHD.
Dr. Yerys explained that it might be how the questions are formed. “One underlying problem,” he said, “may be in how we ask these questions.” As an example he pointed to one question on the scale that parents and teachers are asked, “Does the child respond when spoken to directly?” A child who has ADHD and a child on the autism spectrum are both likely to have issues responding directly to questions, however in one situation it could be a result of inattention and in another it could be the difficulty an autistic child has in reading social cues that is responsible for how they behave when asked a direct question. A simple yes or no answer does nothing to indicate ADHD or autism in the case of that question. Staying on task is another issue that presents in both children with an ASD and those with ADHD. The reasons for it are different however. ASD children have difficulty with social play, and children who have ADHD have trouble focusing for longer periods.
The study team suggested that the scale be modified to reflect possible ASDs in children being screened as well as clinicians following up with parents and teachers to get more specific information. Thomas J. Power, PhD, director of CHOP’s Center for Management of ADHD, helped develop the ADHD-RS-IV in the 1990s and was a co-author on the study. He stated, “I’m excited to be involved in this study, and in efforts to refine our screening tools especially since few researchers have previously investigated using this scale in children with ASD. Our research raises questions not only about this rating tool, but all such measures that rely on parent and teacher ratings to assess ADHD in children with ASD.” Check out the video below for more information.
Sources
Journal of Autism and Developmental Disorders,
UPI Health,
ADHD Institute,
Children’s Hospital of Philadelphia
