Autism traits: The importance of "co-morbid" problems for impairment and contact with services. Data from the Bergen Child Study.
Extra problems like ADHD, not autism traits themselves, explain why kids struggle and land in therapy.
01Research in Context
What this study did
McGarty et al. (2018) looked at kids in the Bergen Child Study who scored high on autism traits. They asked: Do these children have other problems too? They counted how many also had ADHD, anxiety, learning issues, or behavior troubles.
They then checked which factor best explained why a child struggled at school or saw specialists. Was it the autism traits alone, or the extra problems riding along?
What they found
Nine out of ten children with high ASD traits had at least one extra problem. ADHD was the most common tag-along, followed by emotional and learning issues.
The surprise: autism traits by themselves did not predict impairment or trips to the clinic. The add-on problems did. Services were contacted because of the combo, not the ASD alone.
How this fits with other research
Rosello et al. (2022) pooled 34 studies and saw the same pattern: kids with both ASD and ADHD have tougher cognitive and behavior profiles than kids with either label alone. M et al. adds the population proof that this combo is the norm, not the exception.
Dellapiazza et al. (2021) worked with clinic-referred children and found social impairment rose only when ADHD rode along. Their clinical sample extends M et al.'s population finding: the extra diagnosis, not the ASD severity, drives the day-to-day struggle.
McIntyre et al. (2017) seemed to disagree at first glance. They reported that parent-rated ADHD symptoms worsened specific social scores. Look closer: they measured symptom intensity, while M et al. counted full diagnoses. Both agree—ADHD presence amplifies problems; they just used different yardsticks.
Why it matters
Screen every child with ASD for ADHD, anxiety, and learning issues. Write goals that tackle the extra problem first—attention, mood, or academics—then weave in autism-specific skills. When you justify services to funders, point to the comorbidity, not the ASD label alone.
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02At a glance
03Original abstract
BACKGROUND: Co-occurring problems are common in individuals with clinical autism spectrum disorder (ASD) but their relevance for impairment and contact with health services in ASD is largely unexplored. AIMS: We investigated the extent of co-occurring problems in children with high ASD traits from a total population sample. We explored the contribution of co-occurring problems to impairment and service contact, and whether there were children without co-occurring problems in this group; as proxy for "ASD only". METHODS AND PROCEDURES: Children screening positive on the Autism Spectrum Screening Questionnaire (ASSQ) were used as proxy for ASD. Attention Deficit/Hyperactivity Disorder (ADHD) and Oppositional Defiant Disorder (ODD) were operationalised using symptom counts. A parent or teacher report above the 95th percentile counted as "problem" present for other symptom domains. OUTCOMES AND RESULTS: 92% of ASSQ high-scorers had a minimum of two other problems. Emotional problems, ADHD symptoms and learning problems were the most commonly reported problems, also predicting impairment and contact with services. CONCLUSIONS AND IMPLICATIONS: Co-occurring problems were common in ASD screen positive children and contributed strongly to both impairment and to contact with services. Gender differences indicated that female symptoms were perceived as less impairing by parents and teachers.
Research in developmental disabilities, 2018 · doi:10.1016/j.ridd.2016.01.002