ADHD symptoms moderate the relation between ASD status and internalizing symptoms in 3-6-year-old children.
High ADHD symptoms in preschoolers with ASD are a red flag for depression and somatic pain—screen early.
01Research in Context
What this study did
Researchers looked at 3-young learners with and without autism.
They asked parents to rate ADHD symptoms, depression, and tummy aches.
Then they checked if high ADHD scores made internalizing worse only in kids with ASD.
What they found
Kids with ASD plus high ADHD symptoms had the most depressive and somatic complaints.
Typical kids with high ADHD did not show the same jump in internalizing.
So ADHD symptoms act like a volume knob that turns up distress only when autism is present.
How this fits with other research
Reus et al. (2013) saw the same pattern one year earlier: ADHD boosted parent-rated autism severity.
Green et al. (2015) flipped the lens and found kids with ADHD also show more ASD traits.
Tonizzi et al. (2022) extended the idea to older ages, showing ADHD worsens working memory and adaptive skills in ASD.
Together, these papers say the same thing: when ASD and ADHD travel together, every problem looks bigger.
Why it matters
If you assess a preschooler with ASD, always screen for ADHD symptoms.
High scores signal you should also probe for sadness, worry, and stomach complaints.
Early detection lets you add coping skills and parent training before kindergarten starts.
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02At a glance
03Original abstract
The current study sought to understand the relation between diagnostic status (autism spectrum disorders [ASD] versus typically developing) and internalizing problems in children with and without co-occurring attention deficit hyperactivity disorder (ADHD) symptoms. Participants were 88 children, ages 3:0-6:11, their parents and teachers. Findings indicated that ADHD symptoms moderated the relation between diagnostic status and depressive and somatic symptoms. High ADHD symptoms in children with ASD were associated with increased depressive and somatic symptoms compared to children with typical development. Findings suggest poor prognostic outcomes for children with ASD and co-occurring ADHD symptoms and highlight the need for early identification and targeted intervention.
Journal of autism and developmental disorders, 2014 · doi:10.1007/s10803-013-1995-4