Autism, Attention Deficit Hyperactivity Disorder, and Cognitive Enhancement

Author(s):  
Iulia Dud ◽  
Louise Brennan ◽  
Dene Robertson

Attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) are common neurodevelopmental disorders. Impairments in attention and executive functions are core characteristics of ADHD. ASD is primarily characterized by severe deficits in social communication, but cognitive impairments are common, including in attention and executive functions. Currently, there is only limited evidence for efficacy of either pharmacological or behavioral interventions for the treatment of the cognitive deficits associated with the disorders. This chapter presents the current evidence base for cognitive enhancements for ADHD and ASD. It summarizes evidence from available and experimental pharmacological interventions, as well as behavioral, cognitive, and psychosocial interventions. The chapter also discusses the limitations of current tools and future directions.

2018 ◽  
Vol 24 (4) ◽  
pp. 279-284 ◽  
Author(s):  
Tobias Banaschewski ◽  
Brendan Belsham ◽  
Michael H Bloch ◽  
Maite Ferrin ◽  
Mats Johnson ◽  
...  

While pharmacotherapy and psychosocial interventions are recommended as the primary frontline treatment for attention deficit hyperactivity disorder (ADHD), alternative approaches to managing ADHD are becoming increasingly popular among patients and their families. Supplementation with polyunsaturated fatty acids (PUFAs) is an example of this. PUFA supplementation is not recommended by guidelines for managing ADHD; however, patients may still decide to use it. To provide direction to healthcare professionals (HCPs) managing ADHD, eight international experts in the field of adult and child ADHD came together for the Continuum Education Board: Omega Supplements in ADHD meeting. This commentary summarises the panel's consensus that current evidence suggests PUFA supplementation has a small beneficial effect on behaviour in children with ADHD, and that further high-quality research is needed to clearly evaluate and define its role in the management of ADHD of children, adolescents and adults. The panel concluded that in cases where patients use PUFA supplementation, HCPs should be comfortable explaining the potential gains that they may have and their possible side effects. The panel also concluded HCPs should not reinforce the idea that PUFA supplementation should replace treatment approaches with a more robust evidence base for managing ADHD.


Author(s):  
Steve Pearce ◽  
Gail Critchlow

This chapter reviews research and expert guidelines on inpatient management of personality disorder, autism spectrum disorder, and adult attention deficit hyperactivity disorder. It covers use of medication, milieu approaches, other psychosocial interventions, the impact of the ward environment, quality assurance mechanisms, and the impact of institutionalization. Ways in which formal therapeutic approaches can be implemented on inpatient wards are also addressed. The effect of risky and challenging behaviours on defensive practice and staff burnout is covered, and detailed advice on managing suicidal and high-risk patients who are difficult to discharge safely is included. The chapter details specific approaches to milieu management, use of observations, personalized care plans, and communication styles in borderline personality disorder, autism spectrum disorder, and attention deficit hyperactivity disorder. Patients with these diagnoses constitute an important group of inpatients, and with careful management, iatrogenic harms can be avoided.


2020 ◽  
Vol 9 (12) ◽  
pp. 3839
Author(s):  
Gianluca Sesso ◽  
Chiara Cristofani ◽  
Stefano Berloffa ◽  
Paola Cristofani ◽  
Pamela Fantozzi ◽  
...  

Although childhood-onset psychiatric disorders are often considered as distinct and separate from each other, they frequently co-occur, with partial overlapping symptomatology. Autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) commonly co-occur with each other and with other mental disorders, particularly disruptive behavior disorders, oppositional defiant disorder/conduct disorder (ODD/CD). Whether these associated comorbidities represent a spectrum of distinct clinical phenotypes is matter of research. The aim of our study was to describe the clinical phenotypes of youths with ADHD with and without ASD and/or ODD/CD, based on neuropsychological and psychopathological variables. One-hundred fifty-one participants with ADHD were prospectively recruited and assigned to four clinical groups, and assessed by means of parent-reported questionnaires, the child behavior checklist and the behavior rating inventory of executive functions. The ADHD alone group presented a greater impairment in metacognitive executive functions, ADHD+ASD patients presented higher internalizing problems and deficits in Shifting tasks, and ADHD+ODD/CD subjects presented emotional-behavioral dysregulation. Moreover, ADHD+ASD+ODD/CD individuals exhibited greater internalizing and externalizing problems, and specific neuropsychological impairments in the domains of emotional regulation. Our study supports the need to implement the evaluation of the psychopathological and neuropsychological functioning profiles, and to characterize specific endophenotypes for a finely customized establishment of treatment strategies.


2018 ◽  
Vol 8 (2) ◽  
pp. 107
Author(s):  
Carmen Berenguer ◽  
Belen Rosello ◽  
Geraldine Leader

Autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD) are two of the most common childhood-onset neurodevelopmental disorders. Literature has shown different patterns of deficits in executive functioning in children with ASD and ADHD. To date few studies have examined executive functions in both ASD and ADHD and with mixed results.The current study provides the first systematic review to explore distinct executive function components (attention problems, response inhibition, working memory, planning and flexibility) that underlie the specific deficits seen in children and adolescents with both ASD and ADHD disorders. Findings provide evidence for executive dysfunctions across different key components such as attention, response inhibition and verbal working memory in children and adolescents with ASD and comorbid ADHD clinical symptoms. This research explores the neurocognitive profile of the comorbid condition, which is also critical for designing appropriate interventions.


Author(s):  
Karen Bearss ◽  
Aaron J. Kaat

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.


2020 ◽  
Vol 12 (1) ◽  
Author(s):  
Viktoria Johansson ◽  
Sven Sandin ◽  
Zheng Chang ◽  
Mark J. Taylor ◽  
Paul Lichtenstein ◽  
...  

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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