ADHD in Adults: Characterization, Diagnosis, and Treatment by Jan K. Buitelaar & Cornelis C. Kan & Philip Asherson

Author:Jan K. Buitelaar & Cornelis C. Kan & Philip Asherson
Language: eng
Format: mobi
ISBN: 9780521864312
Publisher: Cambridge University Press
Published: 2008-02-29T22:00:00+00:00

Section 4

Comorbidities of adult ADHD

Chapter

Overlap between ADHD and autism

14 spectrumdisorderinadults

Christopher Gillberg, I. Carina Gillberg, Henrik Anckarsäter,

and Maria R˚astam

Introduction

hood population. Even with a high prevalence of ASD

(say 1%), only a small proportion of all individuals

Autism was long considered to be a very rare disorder,

with ADHD could have comorbid ASD. This would

the best defined in child psychiatry (Rutter & Schopler,

be true even if all individuals with ASD had ADHD,

1992), and one that occurred in isolation, often with

which would be unlikely to be the case on theoretical

no comorbidity (except, possibly, mental retardation)

grounds and is not borne out by clinical experience.

and presumably with one etiology. It is now clear that

Very few empirical studies have ever addressed

autism in its classic variant is but part of a broader

the issue of whether ADHD – or the symptoms con-

spectrum of disorders that include not only “autistic

sidered typical of the disorder – shows some over-

disorder” (as defined by DSM-IV) but also a num-

lap/comorbidity with ASD. A small number of child

ber of conditions, including Asperger disorder and

studies exist, but no formal studies, other than those

so-called pervasive developmental disorders not oth-

from our own group, have ever been published look-

erwise specified (PDDNOS)/atypical autism (Wing &

ing at the phenomenon in adults.

Potter, 2002). It has also become generally accepted

In this chapter we briefly review the limited data

that these “autism spectrum disorders” (ASDs, includ-

that exist in the field, starting with what is known in

ing autistic disorder) are much more common than

children. Given that both ADHD and ASD show a

previously assumed, with overall childhood preva-

strong tendency to persist from childhood into adult

lence usually reported at just under 1% (Gillberg

life, it is important for understanding the overlap of

et al., 2006). To complicate things, genetic studies have

the two categories in adulthood to have a good knowl-

shown that ASDs extend into “lesser variants” and

edge base of their childhood comorbidity. A summary

“broader phenotypes” with some characteristic autism

of the evidence that exists in adults follows. We end

features but with little or no clinical impairment. Pop-

by summing up what the overlap of ASD with ADHD

ulation studies suggest that such lesser variants or fea-

might mean, clinically and neurobiologically, and what

tures of autism occur in several percent of children

the projected child findings infer in terms of adult out-

(Briskman, Happé, & Frith, 2001; Constantino & Todd,

come. The chapter also includes a brief survey of inter-

2003; Posserud et al., 2006).

ventions that might be helpful.

The comorbidity issue in autism has not been

resolved, and authorities in the field still argue about

whether autism can be associated with other disor-

Diagnostic boundaries in ASDs

ders, including ADHD. Both the DSM-IV and ICD-

Before considering the issue of whether features of

10 include a section of the diagnostic criteria that

autism occur in ADHD, there is a need to be clear

is difficult to interpret but that would tend to make

about some of the diagnostic boundaries and problems

researchers and clinicians loathe to diagnose coexist-

in the field.

ing/comorbid ADHD in ASD.

First, in this context, we disregard the hierarchi-

Conversely, ADHD has long been agreed to be a

cal criteria of the diagnosis of autism/ASD (such as

common type of childhood behavior disorder and one

those of the ICD-10); that is, we assume that ASD can

that does blend into normality.

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