Factor Structure of Repetitive Behaviors Across Autism Spectrum Disorder and Attention-Deficit/Hyperactivity Disorder

Background: Autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) show high rates of comorbidity. Restricted interests and repetitive behaviors (RRBs) are a core symptom of ASD and commonly occur in ADHD. However, little is known about how RRBs manifest in ADHD, nor how they relate to cognitive abilities and sex across these disorders. Methods: This study investigated the joint factor structure of RRBs in a large sample of children with ASD and ADHD using (1) exploratory factor analysis, and (2) analysis of factorial invariance across diagnostic status (ASD versus ADHD). Subsequently, relations for these factors with sex and IQ were evaluated. Children (N=1,082; 78% male) were identified with primary diagnoses of ASD (n=634) or ADHD (n=448). RRBs were measured using the Repetitive Behavior Scale-Revised (RBS-R). Results: A 4-factor solution provided the best fit to the data and yielded four psychologically meaningful factors, including (1) Stereotypy, (2) Self-Injury, (3) Compulsions, and (4) Ritualistic/Sameness. The four-factor solution was equivalent across diagnostic status, as imposition of weak (△RMSEA=.001) and strong (△RMSEA=.003) invariance did not significantly diminish model fit. IQ was negatively associated with Stereotypy, Self-Injury and Compulsions in ASD, and negatively associated with Compulsions and Ritualistic/Sameness behaviors in ADHD. A main effect of sex on Self-Injury was observed, whereby females displayed higher levels of Self-Injury in ASD but not ADHD. Conclusions: Our results underscore a common 4-factor structure across ASD and ADHD, which simplifies prior models of the RBS-R and indicates a similar pattern of occurrence of RRBs across these disorders.

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Catecholaminergic and Cholinergic Neuromodulation in Autism Spectrum Disorder: A Comparison to Attention-Deficit Hyperactivity Disorder

10.31234/osf.io/nb5j8 ◽

2021 ◽

Author(s):

Damian Koevoet ◽

Peter Deschamps ◽

Leon Kenemans

Keyword(s):

Autism Spectrum Disorder ◽

Attention Deficit Hyperactivity Disorder ◽

Attention Deficit ◽

Autism Spectrum ◽

Repetitive Behaviors ◽

Spectrum Disorder ◽

Blink Rate ◽

Stimulant Treatment ◽

Targeted Interventions ◽

Hyperactivity Disorder

Autism spectrum disorder (ASD) is a heterogeneous neurodevelopmental disorder characterized by social impairments and restricted, repetitive behaviors. Treatment of ASD is notoriously difficult and might benefit from identification of underlying mechanisms that overlap with those disturbed in other developmental disorders, for which treatment options are more obvious. One example of the latter is attention-deficit hyperactivity disorder (ADHD), given the efficacy of especially stimulants in treatment of ADHD. Deficiencies in catecholaminergic systems (dopamine (DA)), norepinephrine (NE)) in ADHD are obvious targets for stimulant treatment. Recent findings suggest that abnormalities in catecholaminergic systems may also be a factor in at least a subgroup of ASD. In this review we scrutinize the evidence for catecholaminergic mechanisms underlying ASD symptoms, and also include in this analysis a third classic ascending arousing system, the acetylcholinergic (ACh) network. We complement this with a comprehensive review of DA-, NE-, and ACh-targeted interventions in ASD, and an exploratory search for potential treatment-response predictors (biomarkers) in ASD, genetically or otherwise. Based on this review and analysis we propose that 1) stimulant treatment may be a viable option for an ASD subcategory, possibly defined by genetic subtyping; 2) cerebellar dysfunction is pronounced for a relatively small ADHD subgroup but much more common in ASD and in both cases may point towards NE- or ACh-directed intervention; 3) deficiency of the cortical salience network is sizable in subgroups of both disorders, and biomarkers such as eye blink rate and pupillometric data may predict the efficacy of targeting this underlying deficiency via DA, NE, or ACh in both ASD and ADHD.

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ANTI-PCA/YO AND ANTI-GAD LEVELS IN AUTISM SPECTRUM DISORDER AND ATTENTION DEFICIT HYPERACTIVITY DISORDER

10.21506/j.ponte.2018.4.4 ◽

2018 ◽

Vol 74 (4) ◽

Author(s):

Cagatay Ugur ◽

Ozden Sukran Uneri ◽

Esra Yurumez

Keyword(s):

Autism Spectrum Disorder ◽

Attention Deficit Hyperactivity Disorder ◽

Attention Deficit ◽

Autism Spectrum ◽

Spectrum Disorder ◽

Hyperactivity Disorder

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Attention Deficit Hyperactivity Disorder in Autism Spectrum Disorder

The Oxford Handbook of Autism and Co-Occurring Psychiatric Conditions ◽

10.1093/oxfordhb/9780190910761.013.9 ◽

2020 ◽

pp. 158-176

Author(s):

Karen Bearss ◽

Aaron J. Kaat

Keyword(s):

Autism Spectrum Disorder ◽

Attention Deficit Hyperactivity Disorder ◽

Attention Deficit ◽

Autism Spectrum ◽

Developmental Trajectory ◽

Spectrum Disorder ◽

Adhd Symptoms ◽

Functional Impairments ◽

Hyperactivity Disorder ◽

Delayed Recognition

This chapter will review the available evidence on individuals with co-occurring diagnoses of autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD). This chapter contends that children diagnosed with both disorders (ASD+ADHD) are a subset of the ASD population that is at risk for delayed recognition of their ASD diagnosis, poor treatment response, and poorer functional outcomes compared to those with ASD without ADHD. Specifically, the chapter highlights the best estimates of the prevalence of the comorbidity, the developmental trajectory of people with co-occurring ASD and ADHD, how ADHD symptoms change across development, overlapping genetic and neurobiological risk factors, psychometrics of ADHD diagnostic instruments in an ASD population, neuropsychological and functional impairments associated with co-occurring ASD and ADHD, and the current state of evidence-based treatment for both ASD and ADHD symptoms. Finally, the chapter discusses fruitful avenues of research for improving understanding of this high-risk comorbidity so that mechanism-to-treatment pathways for ADHD in children with ASD can be better developed.

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Medications for attention-deficit/hyperactivity disorder in individuals with or without coexisting autism spectrum disorder: analysis of data from the Swedish prescribed drug register

Journal of Neurodevelopmental Disorders ◽

10.1186/s11689-020-09352-z ◽

2020 ◽

Vol 12 (1) ◽

Author(s):

Viktoria Johansson ◽

Sven Sandin ◽

Zheng Chang ◽

Mark J. Taylor ◽

Paul Lichtenstein ◽

...

Keyword(s):

Autism Spectrum Disorder ◽

Attention Deficit Hyperactivity Disorder ◽

Attention Deficit ◽

Clinical Studies ◽

Autism Spectrum ◽

Spectrum Disorder ◽

Prescribing Patterns ◽

Adhd Medication ◽

Hyperactivity Disorder ◽

Drug Register

Abstract Background Clinical studies found that medication for attention-deficit/hyperactivity disorder (ADHD) is effective in coexisting autism spectrum disorder (ASD), but current research is based on small clinical studies mainly performed on children or adolescents. We here use register data to examine if individuals with ADHD and coexisting ASD present differences in the prescribing patterns of ADHD medication when compared to individuals with pure ADHD. Methods Data with information on filled prescriptions and diagnoses was retrieved from the Swedish Prescribed Drug Register and the National Patient Register. We identified 34,374 individuals with pure ADHD and 5012 individuals with ADHD and coexisting ASD, aged between 3 and 80 years. The first treatment episode with ADHD medications (≥ 2 filled prescriptions within 90 days) and daily doses of methylphenidate during a 3-year period was measured. Odds ratios (ORs) were calculated for the likelihood of being prescribed ADHD medication in individuals with and without ASD and Wilcoxon rank-sum test was used to compare group differences in dose per day. Results Individuals with ADHD and coexisting ASD were less likely to start continuous treatment with ADHD medication (ADHD 80.5%; ADHD with ASD 76.2%; OR, 0.80; 95% confidence interval, 0.75-0.86), were less likely to be prescribed methylphenidate, and were more commonly prescribed second line treatments such as dexamphetamine, amphetamine, or modafinil. No group difference was observed for atomoxetine. In adults with ADHD and coexisting ASD, methylphenidate was prescribed in lower daily doses over three years as compared to individuals with pure ADHD. Conclusions The findings indicate that there are differences in the medical treatment of individuals with or without ASD. If these differences are due to different medication responses in ASD or due to other factors such as clinicians’ perceptions of medication effects in patients with ASD, needs to be further studied.

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