Social Communication, Repetitive Behaviors and Interests, and Adaptive Behavior in Girls With Autism Spectrum Disorder Without Intellectual Disability.
Poor sleep and weak executive skills each boost ADHD symptom reports in autistic grade-schoolers—screen both before you diagnose.
01Research in Context
What this study did
Whaling et al. (2025) asked parents of autistic 7- to 11-year-olds about sleep, executive skills, and ADHD signs.
They used surveys only—no lab tests or treatment.
The goal was to see if poor sleep and weak executive skills each raise ADHD risk.
What they found
Kids whose parents reported sleep trouble were more likely to also show ADHD symptoms.
The same was true for kids with executive-function problems like forgetfulness or poor planning.
Each factor added risk on its own; together they gave the highest chance of ADHD signs.
How this fits with other research
Berenguer et al. (2018) showed that autistic kids with ADHD have a ‘double-hit’ of both executive and theory-of-mind deficits.
The new study keeps the executive piece but adds sleep as a second, separate warning flag.
Faso et al. (2016) already linked sensory-motor repetitive behaviors to sleep issues; M et al. now say sleep issues link straight to ADHD risk, closing the loop.
Reus et al. (2013) warned that ADHD inflates parent-rated autism severity; M et al. answer by telling clinicians to check sleep and EF before labeling ADHD.
Why it matters
Next time you score high ADHD ratings on the BASC or Conners, pause. Ask about bedtime routines and night waking. Run a quick working-memory probe like digit span backwards. Addressing sleep hygiene or teaching organizational skills may cut ADHD-like behaviors without medication.
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02At a glance
03Original abstract
BACKGROUND: Many children with autism spectrum disorder (ASD) experience comorbid symptoms of attention-deficit/hyperactivity disorder (ADHD). Additionally, children with ASD and ADHD often have sleep disturbances and deficits in executive functioning (EF). In typical development, sleep disturbances are causally linked to EF deficits and exacerbate ADHD-like symptoms. AIM: The aim of this study was to determine whether caregiver-report sleep and EF difficulties predict ADHD symptoms in children with ASD. METHODS: Caregiver-report of child sleep, EF, and ADHD symptom severity was collected for 101 children with ASD, 7-11 years of age. Hierarchical linear regressions tested the independent and interactive effects of sleep and EF in predicting ADHD symptoms. RESULTS: Children with ASD were more likely to have symptoms of ADHD if they experienced both sleep and EF difficulties. Children with difficulties in working memory were particularly at risk for clinically significant symptoms of ADHD. Notably, however, sleep did not mediate or moderate the relation between working memory and ADHD symptoms in this sample, suggesting that these variables act through independent mechanisms to increase vulnerability for comorbidity. CONCLUSIONS: These results have clinical significance as sleep and EF deficits may identify an ASD subgroup that is at increased risk for a comorbid ADHD diagnosis.
Journal of autism and developmental disorders, 2025 · doi:10.1001/jama.289.1.49