Comorbitidies: ADHD autism PDD

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Findings summarized herein are consistent with CDC-Verstraeten et al

1999, wherein a range of pathologies were associated with thimerosal

injections with which infants had been assaulted. The findings

herein are also consistent with AD, ADHD, and autism associations with

environmental pollutants such as mercury and arsenic. A bell curve

could be created, with the horizontal axis being severity/comorbidity of

disorder - from normal to adhd to PDD to autism, with the vertical axis

being a combination of pollutant levels, nutritional impairments, and

weak alleles.

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Co-occurrence of motor problems and autistic symptoms in

attention-deficit/hyperactivity disorder

Reiersen AM, Constantino JN, Todd RD.

J Am Acad Child Adolesc Psychiatry. 2008 Jun;47(6):662-72.

OBJECTIVE: To investigate the relation between parent reports of motor

problems and clinically significant autistic symptoms in children with

and without attention-deficit/hyperactivity disorder (ADHD). METHOD:

Subjects were male (n = 521) and female (n = 330) twins from an

epidemiological study of ADHD, ages 7 to 19 years at assessment using the

Child Behavior Checklist and semistructured psychiatric diagnostic

interviews. Parent-rated Social Responsiveness Scale questionnaires were

returned for 62% of 1,647 individuals who participated in interviews.

After exclusion of subjects with incomplete data or evidence of mental

retardation, 851 subjects (52%) were available for the present study

analysis. Each subject was classified by DSM-IV ADHD subtype and assigned

to one of seven population-defined ADHD subtypes based on latent class

analysis of DSM-IV ADHD symptoms. Within each ADHD subtype, we examined

the relation between Child Behavior Checklist motor problem endorsement

and elevated autistic symptoms on the Social Responsiveness Scale.

RESULTS: Motor problems and high levels of autistic traits were most

common in individuals with combined-type ADHD. Within each of the

clinically relevant DSM-IV and latent class ADHD subtypes, individuals

with the combination of motor problems and ADHD were more likely to have

high levels of autistic traits than those with ADHD alone. CONCLUSIONS:

Children with the combination of ADHD and parent-reported motor

coordination deficits have elevated levels of autistic symptoms. Targeted

treatment and prevention interventions may be warranted. The exclusion

criteria for DSM-IV ADHD should be revised to reflect these

population-based findings.

PMID: 18434922

Autistic traits in a population-based ADHD twin sample

Reiersen AM, Constantino JN, Volk HE, Todd RD.

J Child Psychol Psychiatry. 2007 May;48(5):464-72.

BACKGROUND: Most diagnostic nomenclatures do not allow for the concurrent

diagnosis of autism and attention-deficit/hyperactivity disorder (ADHD).

Clinic-based studies suggest autistic symptoms are common in children

with ADHD, but such studies are prone to referral bias. This study

assesses whether children with ADHD selected from the general twin

population have elevated levels of autistic traits. METHODS: Nine hundred

forty-six twins identified by Missouri birth records were assigned to

DSM-IV ADHD diagnoses and seven population-derived ADHD subtypes defined

through latent class analysis of DSM-IV ADHD symptoms. The Social

Responsiveness Scale (SRS) was used as a quantitative measure of autistic

traits. Linear regression was used to evaluate whether mean SRS scores

differed between ADHD diagnostic groups. RESULTS: Mean SRS scores for

DSM-IV predominantly inattentive subtype and combined subtype ADHD groups

were significantly higher than for subjects without DSM-IV ADHD (p <

..001, both comparisons). Five of the population-derived ADHD subtypes

(talkative-impulsive, mild and severe inattentive, mild and severe

combined) had significantly higher mean SRS scores compared to the latent

class subtype with few ADHD symptoms (p < .001, all comparisons).

DSM-IV combined subtype and the population-derived severe combined

subtype had the highest mean total SRS scores and the highest mean scores

for each of the three autism symptom domains, with a substantial

proportion of individuals scoring in the clinically significant range.

CONCLUSIONS: This study provides population-based evidence for clinically

significant elevations of autistic traits in children meeting diagnostic

criteria for ADHD. These results have implications for the design and

interpretation of studies of both disorders.

PMID: 17501727

The comorbidity of Pervasive Developmental Disorder and Attention

Deficit Hyperactivity Disorder: results of a retrospective chart

review

Goldstein S, Schwebach AJ.

J Autism Dev Disord. 2004 Jun;34(3):329-39.

OBJECTIVE: To determine if a sample of children meeting diagnostic

criteria for a Pervasive Developmental Disorder (PDD) display symptoms

and impairment related to Attention Deficit Hyperactivity Disorder (ADHD)

sufficient to warrant a comorbid diagnosis of ADHD. Further, do children

with PDD displaying such symptoms demonstrate more impairment in daily

life activities than those children only having PDD? METHOD: A

retrospective chart review was conducted on children (N = 57) diagnosed

with the PDD's of Autism or PDD-Not Otherwise Specified (PDD-NOS), or

ADHD. Comparative analysis of questionnaire and neuropsychological test

data was completed to determine the severity of ADHD-like symptoms

presenting among children with PDD. RESULTS: From the pool of subjects

having PDD with sufficient data (N = 27), 7 or 26% met DSM-IV criteria

for the combined type of ADHD. Nine or 33% met diagnostic criteria for

the Inattentive Type of ADHD and 11 or 41% did not demonstrate a

significant number of ADHD symptoms to warrant a comorbid diagnosis of

ADHD. Results indicate that a subgroup of children with PDD displaying

significant ADHD-like symptoms may in fact have ADHD thus warranting a

comorbid diagnosis of ADHD. Current data did not suggest children with

PDD and the combined type of ADHD demonstrated significantly more

impairment in daily life functioning than those children only having PDD.

However, this appeared likely the result of small sample size. The data,

however, does indicate such children experience more difficulties in

daily situations as rated by parents and teachers. CONCLUSION: These

findings reinforce clinical observations indicating that some children

with PDD may also experience an independent comorbid condition of ADHD,

suggesting that a comorbid diagnosis of ADHD with PDD be considered in

such cases. If further findings are replicated, the current exclusionary

DSM-IV-TR criteria of making such a comorbid diagnosis should be

re-considered.

PMID: 15264500

Autism and attention deficit hyperactivity disorder: assessing

attention and response control with the integrated visual and auditory

continuous performance test

Corbett BA, Constantine LJ.

Child Neuropsychol. 2006 Aug;12(4-5):335-48.Click here to read

Links

Symptoms of attention deficit hyperactivity disorder (ADHD) have been

widely reported in children with autism spectrum disorder (ASD). The

current study investigated attention and response control in children

with ASD, ADHD, and typical development using the Integrated Visual and

Auditory Continuous Performance Test. Results indicate that many children

with ASD show significant deficits in visual and auditory attention and

greater deficits in impulsivity than children with ADHD or typical

development. These findings suggest that many of the children with ASD

demonstrate significant ADHD-like deficits. These findings are discussed

in the context of symptoms, subtypes, and comorbidity.

PMID: 16911977

Impact of comorbid autism spectrum disorders on stimulant response in

children with attention deficit hyperactivity disorder: a retrospective

and prospective effectiveness study

Santosh PJ, Baird G, Pityaratstian N, Tavare E, Gringras P.

Child Care Health Dev. 2006 Sep;32(5):575-83.

BACKGROUND: In the recent past, psychiatrists and paediatricians have

avoided prescribing stimulant medication, such as methylphenidate and

dexamphetamine to patients with autism spectrum disorders (ASD) because

of both doubts about efficacy and concern that these medications make

stereotypies worse. Recently, a number of small trials have suggested

that methyphenidate does have a role in the management of hyperactivity

in children with autistic spectrum disorders. METHODS: Children with ASD

and attention deficit hyperactivity disorder (ADHD), and children with

ADHD without ASD received standard treatment with methyphenidate from one

specialist centre. A combination of standardized and novel outcome tools

was used to allow both an exploratory retrospective study of 174 children

and then a prospective study of a further 52 children to be carried out.

RESULTS: After treatment with stimulants, the subjects in both groups

showed statistically significant improvements in target symptoms of

'hyperactivity', 'impulsivity', 'inattention', 'oppositionality',

'aggression' and 'intermittent explosive rage'. The Clinical Global

Impression-Improvement and efficacy index measures also improved in each

group. In both the retrospective and the prospective studies, there was

no statistically significant difference in the degree of improvements

between each group. Importantly, neither tics nor repetitive behaviours

worsened in either group. Children in the 'ADHD-only' group who were

prescribed stimulants experienced significant 'nausea', 'giddiness',

'headaches' and 'sleep difficulties', whereas sleep difficulties were the

only side effect that emerged in children in the ASD with ADHD group.

CONCLUSIONS: Both studies presented here support previous findings from

smaller studies that show children with autism and ADHD can respond as

well to stimulants as children with ADHD alone. Although randomized

controlled trials remain the gold standard for efficacy studies, systems

like this that allow clinicians to continue rigorous and consistent

monitoring for many years have a valuable role to play. Furthermore, such

monitoring systems which now exist electronically can easily accumulate

large data sets and reveal details about long-term effectiveness and

long-term side effects of medication that are unlikely to be discovered

in short-term trials.

PMID: 16919137

Attention-deficit hyperactivity disorder symptoms in a clinic sample

of children and adolescents with pervasive developmental

disorders

Lee DO, Ousley OY.

J Child Adolesc Psychopharmacol. 2006 Dec;16(6):737-46.

OBJECTIVES: The aims of this systematic chart review were to determine

the frequency of attention-deficit/hyperactivity disorder (ADHD) in a

clinic sample of children and adolescents with autism spectrum disorders

(ASD), to compare ADHD symptoms in children with Autistic Disorder,

Asperger's Disorder, and pervasive developmental disorders-not otherwise

specified (PDD-NOS), to compare ADHD symptoms in individuals with and

without ADHD-related chief complaints, and to determine the correlation

between ADHD Rating Scale (ADHD RS) scores and age. METHOD: This

systematic chart review examined data from children and adolescents who

were consecutively referred to a university-based autism

psychopharmacology program. All individuals were diagnosed by

semistructured interview for ASD and ADHD, and ADHD symptoms were

assessed using ADHD RS scores. RESULTS: Of 83 children, 78% fulfilled

Diagnostic and Statistical Manual of Mental Disorders, 4th edition

(DSM-IV) criteria for ADHD and exceeded the 93rd percentile norm for the

ADHD RS. Hyperactivity-impulsivity scores were significantly greater in

individuals with autism than those with other ASDs. DSM-IV ADHD diagnosis

was represented equally in individuals with and without ADHD as their

chief complaints. ADHD RS hyperactivity-impulsivity and total scores were

negatively correlated with age. CONCLUSION: ADHD symptoms are pervasive

in clinically referred children and adolescents with ASD.

PMID: 17201617

Autistic symptoms in children with attention deficit-hyperactivity

disorder

T, Feehan C, Tinline C, Vostanis P.

Eur Child Adolesc Psychiatry. 1999 Mar;8(1):50-5.

Children with the syndrome of disorders of attention, motor control and

perception (DAMP) invariably fill diagnostic criteria for attention

deficit hyperactivity disorder (ADHD) and commonly have symptoms of

autistic spectrum disorders. This study estimates the rate of autistic

symptoms in a sample of children with ADHD by using the parent-rated

Autism Criteria Checklist. A high proportion of parents (between 65-80%)

reported significant difficulties in social interaction (particularly in

empathy and peer relationships), and communication (particularly in

imaginative ability, nonverbal communication and maintaining

conversation). The nature and relationship between ADHD and pervasive

developmental disorders is considered, as well as implications for

assessment, diagnosis and treatment.

PMID: 10367741

Brief report: pervasive developmental disorder can evolve into ADHD:

case illustrations

Fein D, Dixon P, J, Levin H.

J Autism Dev Disord. 2005 Aug;35(4):525-34.

Despite prominent attentional symptoms in Pervasive Developmental

Disorders (PDD) the relationship between PDD and Attention Deficit

Hyperactivity Disorder (ADHD) has received little direct examination. In

addition, outcome studies of children with PDD often focus on language,

educational placement, or adaptive skills, but seldom on loss of the PDD

diagnosis or change to another clinical syndrome. We present three cases

in detail, and tabular data on eight more, that illustrate a clinical

presentation in which prototypical cases of PDD evolve into clear-cut

cases of ADHD from early to middle childhood.

PMID: 16134038

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Sheri Nakken, former R.N., MA, Hahnemannian

Homeopath

Vaccination Information & Choice Network, Nevada City CA & Wales

UK

Vaccines -

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Sept 10, 2008