Experts in Autism and ADHD Join Forces to Address the Unique Needs of Neurodiverse Children

At the Duke Autism Clinic, clinicians are frequently asked by parents, “Does my child have autism, attention deficit hyperactivity disorder (ADHD), or both?” The question is common because of the remarkably high degree of overlap between the two conditions; approximately 50% of people on the autism spectrum also have ADHD. Knowing whether a child has one or both will shape the clinician’s recommendations with respect to the type of educational program and intervention approach that will be most helpful.

Tackling Three Big Questions that Have Real-world Impacts

Autistic children primarily have challenges navigating the social world, whereas children with ADHD often have difficulty focusing their attention, which in turn can affect their social relationships. It is not surprising that distinguishing between the two conditions can be challenging, especially when the child is young. In fact, when autistic children also have ADHD, they tend to receive their autism diagnosis much later in life, missing out on years of benefits that early interventions are proven to provide. With a $12.5 million grant from the National Institutes of Health (NIH) Autism Centers of Excellence (ACE) program, scientists at the Duke Center for Autism and Brain Development are developing innovative screening tools, diagnostic methods, and intervention approaches to ensure autistic children with ADHD are recognized early and have access to the interventions they may need.

The first question: Why are autistic children who have ADHD missed during their routine, early screening for autism?

For four years, a research team comprised of Drs. Geraldine Dawson, Scott Kollins, Naomi Davis, Eliana Perrin, and several other Duke University faculty members, has followed more than 3,000 toddlers from their first autism screening at their 18-month well-child visit in four Duke Pediatric Primary Care Clinics. Working in close partnership with the primary care providers, the center diagnostic team offered all those who did not “pass” the autism screening (considered more likely to be diagnosed with autism) a diagnostic evaluation. Once evaluated, the children were followed and seen again at three years of age when a reliable diagnosis of ADHD can be made. The researchers are then looking backwards to evaluate how current autism screening tools could be improved to better detect toddlers with both autism and ADHD. Discoveries are helping to illuminate a number of novel approaches to early screening, such as the use of a digital app that may help improve early identification of children with both conditions.

The second question: How can we adjust our current diagnostic methods so they can better discern whether a young child has both autism

As part of the NIH ACE research program, Drs. Naomi Davis, Rachel Aiello, Julia Schechter, Saritha Vermeer, and other center clinicians have evaluated hundreds of preschoolers for autism and ADHD, using evidence-based, frequently used clinical evaluation methods. Data gathered is helping to inform new diagnostic guidelines to help child development experts worldwide adjust their practices to accurately diagnose children with both autism and ADHD.

The third question: How can we address the unique needs of autistic children who also have ADHD?

A research team led by Drs. Lauren Franz, Jill Howard, Linmarie Sikich, and Tara Chandrasekhar is evaluating a new early intervention model that could address the distinctive needs of these children with autism and ADHD. To date, there have been well-validated treatment approaches that address the needs of each individual diagnosis, but none that address the full range of needs of children with both. To meet the unique needs of these children, the research team has adapted and is testing the effectiveness of a naturalistic developmental behavioral intervention, the Early Start Denver Model, developed by Dawson and Sally Rogers, Ph.D., professor emeritus at the University of California Davis MIND Institute. “This work is crucial because autistic children with ADHD tend to have more difficulties in school and in developing peer relationships than autistic children or those who have ADHD only,” said Jill Howard, Ph.D., an investigator on the NIH ACE study. “We need to find specialized ways to intervene for those families who are asking for our help.”