Junior resident, Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry - 605 006, India.
Senior Resident, Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry - 605 006, India.
Asian J Psychiatr. 2018 Mar;33:68-73. doi: 10.1016/j.ajp.2018.03.009. Epub 2018 Mar 2.
Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder commonly associated with Attention Deficit Hyperactivity Disorder (ADHD), the prevalence ranging from 14-70%. The current study attempted to assess the impact of comorbid ADHD in children with ASD, in terms of challenges in diagnosis, treatment, intervention outcomes and parental stress and coping through a naturalistic design.
Fifty children aged 2-6 years with ASD were recruited, assessed and followed up for six months. Twenty children were found to have comorbid ADHD. Severity of ASD and ADHD was assessed by Childhood Autism rating scale and Connor's abbreviated rating scale respectively. Parental stress and coping was assessed by Family Interview for stress and coping.
The diagnosis of ASD was apparently obscured by ADHD symptoms in about 22% of cases, as only diagnosis of ADHD was made at the time of referral to our centre. ADHD was the most common comorbidity followed by intellectual disability and seizure disorder. About 66% of children received combination of pharmacological and behavioral interventions. Clonidine was the most common medication to be used and was well tolerated. The improvement in ADHD symptomatology showed positive correlation with improvement with ASD-specific interventions as reflected by change in severity scores. Severity of ADHD significantly also predicted parental stress and coping, and thereby engagement in ASD-specific interventions.
The current study highlights the need for screening and early diagnosis of comorbid ADHD in children with ASD and vice versa considering the management challenges. In case of multiple comorbid neurodevelopmental disorders, early interventions for one disorder can improve the outcome of the other.
自闭症谱系障碍（ASD）是一种常见的神经发育障碍，通常与注意力缺陷多动障碍（ADHD）相关，患病率为 14-70%。本研究试图通过自然设计评估 ASD 儿童共患 ADHD 的影响，包括诊断、治疗、干预结果以及父母压力和应对方面的挑战。
招募了 50 名 2-6 岁的 ASD 儿童，对他们进行评估并随访六个月。发现 20 名儿童共患 ADHD。ASD 和 ADHD 的严重程度分别通过儿童自闭症评定量表和 Connor 简短评定量表进行评估。父母压力和应对通过家庭访谈进行评估。
大约 22%的病例中，ADHD 症状明显掩盖了 ASD 的诊断，因为只有 ADHD 的诊断是在转诊到我们中心时做出的。最常见的共病是智力障碍和癫痫，其次是 ADHD。大约 66%的儿童接受了药物治疗和行为干预的联合治疗。可乐定是最常用的药物，且耐受性良好。ADHD 症状的改善与 ASD 特异性干预的改善呈正相关，反映在严重程度评分的变化上。ADHD 的严重程度也显著预测了父母的压力和应对方式，从而影响了 ASD 特异性干预的参与。
本研究强调了在 ASD 儿童中筛查和早期诊断共患 ADHD 的必要性，反之亦然，因为这会带来管理上的挑战。在存在多种共患神经发育障碍的情况下，早期干预一种障碍可以改善另一种障碍的预后。
