Evaluation of the ADHD Rating Scale in Youth with Autism.
Benjamin E Yerys, Jenelle Nissley-Tsiopinis, Ashley de Marchena and 4 others
PMID 27738853WHAT IT FOUND
In 386 youth with ASD, ADHD-RS-IV ratings did not separate inattention from hyperactivity/impulsivity as intended.
Elevated scores, especially social items such as not listening when spoken to directly, may reflect ASD difficulties, so use follow-up interview before treating as ADHD.
Key findings
01The ADHD-RS-IV did not show an acceptable factor structure in youth with ASD.
02In exploratory analyses, several items did not fit the expected ADHD domains: caregiver inattention items 3, 5, and 15 cross-loaded, and teacher hyperactivity/impulsivity item 2 cross-loaded.
03Caregiver ADHD-RS-IV scores still tracked expected ADHD-related patterns: they correlated with executive function and externalizing behavior problems, not internalizing problems, and hyperactivity/impulsivity decreased with age.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
The study used a convenience sample of families who could travel and take part in testing, so it may not represent all autistic youth. No gold-standard diagnostic interview for ADHD was done, so the scale could not be compared directly with best-practice diagnosis in the same participants. ADHD symptoms were counted without confirming how much impairment they caused, which may inflate apparent ADHD rates. Youth with IQ below 60 were excluded, so findings do not cover autistic youth with significant intellectual disability. Age effects came from a cross-sectional comparison, not the same children followed over time. Many participants were taking psychoactive medications, including ADHD medications, which can affect ratings. The version tested was ADHD-RS-IV, not the newer ADHD-RS-5.
The easy way to misread this
Do not treat a high ADHD-RS-IV score as a confirmed ADHD diagnosis in an autistic youth. The scale did not cleanly separate inattention and hyperactivity/impulsivity, and some items may be endorsed because of social communication difficulties rather than attention problems.