Epidemiological surveys of ASD: advances and remaining challenges.
ASD plus ADHD equals more anxiety, depression, and meds—screen and plan for the double hit.
01Research in Context
What this study did
Fombonne et al. (2021) ran a big cross-sectional survey. They asked parents about 102,341 kids across the United States.
The team counted how many children had autism, ADHD, or both. They also noted who took psychotropic meds and who had anxiety or behavior problems.
What they found
Kids with both ASD and ADHD had the highest rates of anxiety, depression, and behavior issues. Each condition alone was lower.
These dual-diagnosis children were also more likely to be on medication. The combo creates extra mental-health load.
How this fits with other research
Rosello et al. (2022) pooled 34 studies and saw the same pattern: ASD+ADHD means worse cognitive, adaptive, and emotional scores than either label alone. Their review includes the Eric survey, so the two papers reinforce each other.
Casseus (2022) asked 88,051 US parents the same question and got a similar answer: about 1 in 80 kids have the combo. Sample size differed, but the message—ASD+ADHD is common and burdensome—was replicated.
Dellapiazza et al. (2021) dug deeper into the same 2021 data. They showed social impairment is driven by autism traits, while externalizing behaviors track with ADHD severity. Eric gave the big picture; Florine explained the moving parts.
Why it matters
When you see a child with both diagnoses, plan for extra layers of anxiety, mood, and behavior issues. Screen early, coordinate care, and watch medication effects closely. Use the higher comorbidity signal to justify comprehensive treatment plans and to advocate for integrated services.
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02At a glance
03Original abstract
There is a lack of nationally representative studies examining the co-occurrence of autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) in children. This study examines comorbid mental, behavioral, and developmental disorders (MBDDs) and associated treatment modalities for children with co-occurring ASD and ADHD. Cross-sectional analyses were conducted using data from the pooled 2016-2018 National Survey of Children's Health (sample n = 102,341). Nationally representative prevalences were estimated for sociodemographic variables, comorbidities, psychotropic medication, and behavioral treatment. We assessed multivariable associations between co-occurring ASD + ADHD and MBDDs, use of psychotropic medication, and receipt of behavioral treatment after adjustment for sociodemographic confounders. Compared to children with ASD without co-occurring ADHD, children with ASD + ADHD had higher prevalence of most MBDDs, including anxiety (AOR 4.03 [95% CI 2.77, 4.87]), depression (AOR 3.08 [95% CI 1.77, 5.36]), behavior or conduct problems (AOR 4.06 [95% CI 2.72, 6.06]), and other mental health conditions. Similarly, compared to children with ADHD without ASD, children with ASD + ADHD had higher odds of anxiety (AOR 3.49 [95% CI 2.65, 4.61]), depression (AOR 1.67 [95% CI 1.21, 2.29]), behavior or conduct problems (AOR 2.31 [95% CI 1.68, 3.17]), and other mental health conditions. Children with ASD + ADHD were significantly more likely to take psychotropic medication than children with ASD without ADHD. Among children with ASD + ADHD, males had higher odds of receiving behavioral treatment, whereas older children and adolescents were more likely to take psychotropic medication. A multidisciplinary approach is necessary to support the complex needs of these children.
Journal of autism and developmental disorders, 2021 · doi:10.1177/1087054717713638