Adolescents with Autism Spectrum Disorders and ADHD

Autism spectrum disorder (ASD) is a complex lifelong neurodevelopmental disorder that affects communication and behavior, generally diagnosed within the early stages of life. No two individuals living with Autism experience the same symptoms, as the type and severity varies with each case (Holland, 2018.). Autism has been around for hundreds of years, but the definition has evolved immensely. In 1943, scientists Leo Kanner and Hans Asperger conducted research on individuals with social and emotional deficits to better refine the definition of autism. They observed the cognitive behavioral changes which initially lead to the discovery of Aspergers, separate from Autism (Ames, 2018) .

Aspergers and Autism have similar symptoms, but in order to have Autism, the patient must have social and or emotional interaction deficits, severe problems in regards to maintaining relationships, and nonverbal communication problems (Hyman, 2013).

Attention Deficit Hyperactivity Disorder (ADHD) is a fairly new chronic neurodevelopmental condition that has been discovered within the past two decades. Attention Deficit Hyperactivity Disorder is a chronic neurodevelopmental condition of the brain that affects 7.1% of the population according to Bink and his research team (Bink, 2014). ADHD hinders the ability of an individual to sit still and pay attention to detail, which results in difficulty on focusing on one thing at a time. Though there is no cure for ADHD, there have been many medical advancements and therapies created to help individuals with ADHD suppress their symptoms. Methylphenidate and Amphetamines are two of the most common stimulants used to help treat ADHD. These help reduce the hyperactivity in the brain and can improve the ability to focus. These medications have been found to be extremely helpful for neurotypicals, but they can have a different effect on individuals with Autism (Hyche, 2014). ADHD is often diagnosed with adolescents living with Autism Spectrum Disorder. The most common form of treatment for ADHD is through medication, but it is statistically proven that the medication response rates between neurotypicals and individuals living with Autism are significantly different.

In one case study, Bink and his team used an electroencephalogram to determine if there was a physiological overlap in neuropticals with ADHD and comorbid ASD and ADHD in regards to the effectiveness of stimulant medication. EEG's are often used to measure the theta and beta power levels in different parts of the brain. With ADHD, the most common finding through research is the increased theta activity and decreased beta activity in the frontocentral areas of the brain. Theta powers have shown to be negatively correlated with how alert the individual is, while beta powers have been shown to be positively correlated with attention. Therefore, a decrease in beta power may result in lack of attention, or an unfocused state. It was shown that when neurotypicals were given a stimulant medication, there was a 77% response rate with their ADHD. When the same medication was prescribed with individuals with ASD and ADHD, there was only a 49% stimulant medication response. In comparing these two statistics, the results indicated a 28% discrepancy due to their bodies reacting differently to the medication. Thus, results suggested that there was a clear behavioral overlap due to the chemical makeup of a neurtotypical's brain versus an individual with Autism's brain. Throughout this case study, researchers not only tested individuals with ADHD versus individuals with ADHD and ASD and their reaction to stimulant medication, but also how their brain is compared using tests without medication. When they subjects were given a task, their brains were compared to see how they would react and the results were recorded. The results from completing tasks to observe the differences in brain function showed that the theta powers levels were elevated in adolescents with ADHD in comparison to adolescents with ADHD and ASD. This can be due to the psychophysiological differences of each brain and how the medication reacts with the differences (Bink, 2014).

Executive functions are cognitive processes in the brain that subconsciously help determine a set of rules or guidelines in hopes of accomplishing a goal. This function occurs naturally in neurotypicals, but is often hindered with those who have ADHD. Executive functions are performed in order to help successfully accomplish a goal. Examples of executive functions can range from event planning and organizing to cognitive skills of determining whether or not to eat a piece of cake. In one study, children and adolescents with ADHD and ASD were observed by researchers to see if their responses would differ given that both have a deficit in executive functions. The study observed the reaction when two types of monetary rewards were given to the adolescents. One of the monetary award options was a small immediate reward. The other option was a larger monetary reward, but received over a longer period of time. There were 46 participants in this study, 38 with ADHD and 34 with ASD between the ages of 8-16. The computerized temporal reward discounting (TD) test lead to the results of the study showing that children and adolescents with ADHD chose the smaller but immediate reward rather than the larger monetary reward, but dispersed over a period of time. A TD test is responsible for determining whether or not real tasks coincide with hypothetical ones, in this case measuring the difference in monetary rewards. Results found that participants with ADHD chose the smaller and immediate reward, unlike the participants with Autism (Lawson, 2015). By the participants with ADHD choosing the immediate reward option, showed that there may be a correlation between delay-related processes in the brain.

A limitation within this study may have been the age range of the participants. By having children and adolescents participate in a study regarding monetary value could have lead to inaccurate data for the results. This can be due to the fact that the children and adolescents may not have the intellectual capacity to understand and answer the question correctly and understand the meaning behind it. A simpler task and a more intellectually developed audience of those with ADHD and ASD may have resulted in more accurate results. In conclusion of this study, research showed that both children and adolescents with ADHD and ASD have cognitive disturbances in the psychological processes (Demurie, 2012).

Autism and ADHD are often correlated with each other because they are neurodevelopmental disorders and ADHD is commonly another symptom in children and adolescents with ASD (Bink, 2014). Since ADHD is such a common symptom in ASD, there has been countless studies observing the correlation and how ADHD is diagnosed with children and adolescents who already have been diagnosed with Autism. Most recently, in 2017, Benjamin E. Yerys and his team of researchers evaluated the ADHD rating scale based on youth and Autism. The purpose of this study was to distinguish whether both ASD and ADHD symptoms have an impact on each other. The study consisted of 386 adolescents with ASD who were eligible to complete the 18 question ADHD-Rating Scale-IV (ADHD-RS-IV). 203 of the participants had caregiver reports as well as teacher reports, with the same demographics in such as age, sex and IQ. The ADHD-RS-IV rating scale was created to observe the child's home and school life by their teacher and caregiver. This test measures how prevalent ADHD is in the child and how symptomatic they are. If the child results ensured in a higher quiz score, it meant that the symptoms of ADHD were more severe than other cases. When ranking the participants, if they had six or more symptoms in the inattention and hyperactivity category then it can be further determined that the participant has ADHD (Yerys, 2017). This testing method was a beneficial way to help diagnose children and adolescents with ADHD because they can be observed through different lens which leads to a more accurate and appropriate diagnosis. Though it was beneficial to observe the participants from different perspectives, the results came in inconclusive due to the fact that the scale did not accurately analyze both inattention and hyperactivity in ASD alone. This became a major limitation for the study.

Children with ASD often struggle with social and emotional impairments, more frequently than neurotypicals. In 2017, Reina Factor and her research team performed a study observing children with Autism and if the presence of anxiety and ADHD affect the social impairment of the individuals. Social anxiety is one of the most common problems children and adolescents with ASD face on a daily basis. The main focus of this study was to research and unpack the severity of ASD and social impairment with the presence of ADHD. ADHD was measured via a parent report on the Attention Deficit Hyperactivity Problems scale. This helped greater analyze the symptoms and whether ADHD had negative social effects to children with ASD from a different lens, also like the study using the ADHD-RS-IV rating scale. The results concluded that there were significant differences in the participants with ASD versus participants with ASD and anxiety, and ASD and ADHD in regards to having symptoms of clinical anxiety. There was a greater difference in social anxiety with the participants who have ASD and ADHD, which can conclude that ADHD does have a major impact on children who have both ASD and ADHD. It was also found that children with the comorbid disorder had more social deficits than those with ASD alone. This confirmed that symptoms ADHD directly impact social and communication skills of individuals with ASD (Factor, 2017).

A limitation within this study consisted of observing too many different comorbid diseases, instead of just one. Breaking this study into two different cases might have lead to more specific results. This could also lead to two complete studies without having to conduct a follow up. Since anxiety symptoms worsened those who have ASD, a follow up study is required to conclude if children with ASD are negatively affected on a social scale.

In conclusion, there is a clear association of ADHD affecting children and adolescents with ASD. Both ADHD and ASD are neurodevelopmental disorders affecting different parts of the brain. Adolescents on the spectrum have social impairments, and deficits in communication and reasoning affecting their whole brain; neurotypical adolescents with ADHD have deficit disorders in the frontal lobe. When these disorders become comorbid, there have been evident cases that there are clear differences in symptoms with those who have ASD alone versus ASD and ADHD.

References

1. Ames, C. (2018, March 30). What is the History of Autism Spectrum Disorder? Retrieved December 2, 2018, from https://harkla.co/blogs/special-needs/history-of-autism
2. Demurie, E., Roeyers, H., Baeyens, D., & Sonuga, B. E. (2012). Temporal discounting of monetary rewards in children and adolescents with ADHD and autism spectrum disorders. Developmental Science, 15(6), 791800. Retrieved December 10, 2018, from https://doi.org/10.1111/j.1467-7687.2012.01178.x
3. Factor, R. S., Ryan, S. M., Farley, J. P., Ollendick, T. H., & Scarpa, A. (2017). Does the Presence of Anxiety and ADHD Symptoms Add to Social Impairment in Children with Autism Spectrum Disorder? Journal of Autism and Developmental Disorders, 47(4), 11221134. Retrieved December 4, 2018, from https://ezproxy.sju.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=eric&AN=EJ1134155&site=eds-live
4. Holland, K. (2018, April 25). The Relationship Between ADHD and Autism. Retrieved December 10, 2018, from https://www.healthline.com/health/adhd/autism-and-adhd
5. Hyche, K., & Maertz, V. (2014).Classroom Strategies for Children with ADHD, Autism & Sensory Processing Disorders??: Solutions for Behavior, Attention and Emotional Regulation. Eau Claire WI: PESI Publishing & Media. Retrieved December 2, 2018 from https://ezproxy.sju.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=nlebk&AN=772128&site=eds-live
6. Hyman, S. L. (2013, June 04). New DSM-5 includes changes to autism criteria. Retrieved December 2, 2018, from http://www.aappublications.org/content/early/2013/06/04/aapnews.20130604-1
7. Lawson, R. A., Papadakis, A. A., Higginson, C. I., Barnett, J. E., Wills, M. C., Strang, J. F., Kenworthy, L. (2015). Everyday executive function impairments predict comorbid psychopathology in autism spectrum and attention deficit hyperactivity disorders. Neuropsychology,29(3), 445453. Retrieved December 2, 2018, from https://doi.org/10.1037/neu0000145

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