Assessing the Contribution of Measures of Attention and Executive Function to Diagnosis of ADHD or Autism.
Parent-report symptom scales beat direct neuropsych tests for spotting ADHD or autism in youth.
01Research in Context
What this study did
Kelsey and team looked at thousands of kids from the big ABCD study. They wanted to see what tells autism or ADHD apart from typical development.
They compared two tools: direct neuropsych tests of attention and executive function, and parent-report symptom scales.
The sample spanned late elementary to high-school age. All data came from the same national dataset.
What they found
Parent-report symptom scales did most of the work. They explained 31 percent of the variance for ADHD versus typical kids.
The same scales explained only 2.7 percent of the variance for autism versus typical kids.
Direct cognitive tests added almost nothing once the symptom reports were in the model.
How this fits with other research
Ng et al. (2019) saw the same clash: objective tests missed attention problems that parents caught. The new numbers now show how big the gap is.
Tonizzi et al. (2022) pooled past studies and found that kids with both ASD and ADHD have sharper executive-function deficits. Harkness et al. (2025) quantify that parent scales, not lab tasks, flag these kids best.
Wilmut et al. (2013) reported clear attention differences in adults with ASD. That looks like a contradiction, but the 2025 study tested adolescents and used different measures. Age and test type likely explain the split.
Why it matters
When you need to rule in or rule out ADHD, start with broad symptom checklists like the SWAN or Conners. Save the pricey neuropsych battery for treatment planning, not for diagnosis. For autism, keep using gold-standard interviews and observations; the extra EF tests rarely change the picture. In short, let the parents talk first.
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02At a glance
03Original abstract
Attention and executive function (EF) dysregulation are common in a number of disorders including autism and attention-deficit/hyperactivity disorder (ADHD). Better understanding of the relationship between indirect and direct measures of attention and EF and common neurodevelopmental diagnoses may contribute to more efficient and effective diagnostic assessment in childhood. We obtained cognitive (NIH Toolbox, Little Man Task, Matrix Reasoning Task, and Rey Delayed Recall) and symptom (CBCL, and BPMT) assessment data from the Adolescent Brain and Cognitive Development (ABCD) database for three groups, autistic (N = 110), ADHD (N = 878), and control without autism or ADHD diagnoses (N = 9130) and used ridge regression to determine which attention and EF assessments were most strongly associated with autism or ADHD. More variance was accounted for in the model for the ADHD group (31%) compared to the autism group (2.7%). Finally, we ran odds ratios (using clinical cutoffs where available and 2 standard deviations below the mean when not) for each assessment measure, which generally demonstrated a greater significance within the indirect measures when compared to the direct measures. These results add to the growing literature of symptom variably across diagnostic groups allowing for better understanding of presentations in autism and ADHD and how best to assess diagnosis. It also highlights the increased difficulty in differentiating autism and controls when compared to ADHD and controls and the importance of indirect measures of attention and EF in this differentiation.
Journal of autism and developmental disorders, 2025 · doi:10.1186/1741-7015-10-99