A Causal and Mediation Analysis of the Comorbidity Between Attention Deficit Hyperactivity Disorder (ADHD) and Autism Spectrum Disorder (ASD).
Elena Sokolova, Anoek M Oerlemans, Nanda N Rommelse and 6 others
PMID 28255761WHAT IT FOUND
In children and young people with ASD or ADHD, social communication difficulties linked directly to inattention and impulsivity, while repetitive behaviour linked to hyperactivity.
These are exploratory associations, not evidence that treating one symptom will improve the other.
Key findings
01In the causal model, social ineptness had direct links to inattention and impulsivity, each with reliability over 99%.
02Hyperactivity had a direct link to stereotyped, repetitive behaviour, with reliability over 99%, while repetitive behaviour had no direct links to inattention or impulsivity.
03The model gave preliminary causal directions from hyperactivity to repetitive behaviour and from impulsivity to social ineptness, but these need independent testing.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
The causal model used cross-sectional data and the same data generated and tested the hypotheses, so the mediation p-values need caution. The sample excluded people with IQ below 70, epilepsy, brain disorders, genetic syndromes and non-European Caucasian descent, so it may not represent all children with ASD. ASD symptoms came only from parent report, while ADHD symptoms combined parent and teacher reports. The sample included siblings and family members, which can create hidden links, although a singleton sensitivity analysis gave a similar network. The causal directions are preliminary and need independent longitudinal or experimental testing.
Declared interests
No funding or conflict of interest declaration appears in the supplied text.
The easy way to misread this
Do not conclude that reducing hyperactivity will reduce repetitive behaviour or that reducing impulsivity will improve social communication. These causal directions were preliminary, came from one cross-sectional sample, and were not tested by intervention.