Rosello Rocio, Martinez-Raga Jose, Tomas Jose Manuel, Mira Alvaro, Cortese Samuele
Division of Psychiatry, Hospital Universitario Dr Peset, Valencia, Spain.
Doctor Peset Hospital of Valencia, Valencia, Spain.
Child Adolesc Ment Health. 2023 May;28(2):269-276. doi: 10.1111/camh.12562. Epub 2022 Apr 19.
Understanding the developmental trajectories of children with autism spectrum disorder (ASD) with and without comorbid ADHD is relevant to tailor care plans. This prospective study assessed, for the first time, cognitive, emotional, behavioral, and learning outcomes in adolescence of children with ASD-ADHD and in those with ASD+ADHD in childhood. Possible predictors of severity of ASD core symptoms in adolescence were also evaluated.
Forty-five adolescents without intellectual disability, 26 diagnosed in childhood with ASD-ADHD and 19 with ASD+ADHD, were evaluated at baseline (mean age: 8.6 ± 1.3) and at 5-year follow-up (mean age: 12.9 ± 0.9). Parents and teachers completed questionnaires on executive functions, theory of mind (ToM), emotional/behavioral difficulties (EBD), and learning style at both time points..
Overall different developmental trajectories for the two groups were found. In general, deficits in metacognition processes, ToM skills, EBD, and learning abilities were more pronounced in the ASD+ group. Over time, the ASD+ADHD group, but not the ASD-ADHD, tended to improve in EBD and metacognition but their level of development continued to be lower compared with ASD+ADHD. EBD in childhood were significant predictors of autism core symptoms of adolescents.
Our findings highlight the importance of an early identification of comorbid ADHD symptoms in ASD to offer treatment strategies based on specific developmental trajectories.
了解患有和未患有共病注意力缺陷多动障碍（ADHD）的自闭症谱系障碍（ASD）儿童的发育轨迹，对于制定个性化护理计划具有重要意义。这项前瞻性研究首次评估了患有ASD-ADHD的儿童以及童年期患有ASD+ADHD的儿童在青春期的认知、情感、行为和学习成果。同时还评估了青春期ASD核心症状严重程度的可能预测因素。
45名无智力残疾的青少年，其中26名在童年期被诊断为患有ASD-ADHD，19名患有ASD+ADHD，在基线时（平均年龄：8.6±1.3岁）和5年随访时（平均年龄：12.9±0.9岁）接受评估。家长和教师在两个时间点均完成了关于执行功能、心理理论（ToM）、情绪/行为困难（EBD）和学习风格的问卷调查。
发现两组总体发育轨迹不同。一般来说，元认知过程、ToM技能、EBD和学习能力方面的缺陷在ASD+组中更为明显。随着时间的推移，ASD+ADHD组而非ASD-ADHD组在EBD和元认知方面有改善趋势，但与ASD+ADHD组相比，其发育水平仍较低。童年期的EBD是青少年自闭症核心症状的重要预测因素。
我们的研究结果强调了早期识别ASD中共病ADHD症状的重要性，以便根据特定的发育轨迹提供治疗策略。
