Journal 2

Received: 8 June 2021 | Revised: 11 August 2022 | Accepted: 11 September 2022

DOI: 10.1002/pits.22808

R E S E A R CH AR T I C L E

Diagnosis and treatment of children and adolescents with autism and ADHD

Burt Hatch1 | Girija Kadlaskar2 | Meghan Miller2

1School of Psychology, Victoria University of

Wellington, Wellington, New Zealand

2Department of Psychiatry & Behavioral

Sciences and MIND Institute, University of

California, Davis, California, USA

Correspondence

Burt Hatch, School of Psychology, Victoria

University of Wellington, PO Box 600,

Wellington 6140, New Zealand.

Email: [email protected]

Funding information

Eunice Kennedy Shriver National Institute of

Child Health and Human Development,

Grant/Award Number: U54HD103526;

National Institute of Mental Health,

Grant/Award Numbers: R00 MH106642, T32

MH073124

Abstract

Attention‐deficit/hyperactivity disorder (ADHD) and autism

are neurodevelopmental disorders that emerge in childhood.

There is increasing recognition that ADHD and autism

frequently co‐occur. Yet, questions remain among clinicians

regarding the best ways to evaluate and treat co‐occurring

autism and ADHD. This review outlines issues relevant to

providing evidence‐based practice to individuals and families

who may be experiencing difficulties associated with co‐

occurring autism and ADHD. After describing the complexities

of the co‐occurrence of autism and ADHD, we present

practical considerations for best practice assessment and

treatment of co‐occurring autism and ADHD. Regarding

assessment, this includes considerations for interviewing

parents/caregivers and youth, using validated parent and

teacher rating scales, conducting cognitive assessments, and

conducting behavior observations. Regarding treatment, con-

sideration is given to behavioral management, school‐based

interventions, social skills development, and the use of

medications. Throughout, we note the quality of evidence that

supports a particular component of assessment or treatment,

highlighting when evidence is most relevant to those with co‐

occurring autism and ADHD across stages of development. In

light of the current evidence for assessment and treatment of

Psychology in the Schools. 2023;60:295–311. wileyonlinelibrary.com/journal/pits | 295

This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial‐NoDerivs License, which

permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no

modifications or adaptations are made.

© 2022 The Authors. Psychology in the Schools Published by Wiley Periodicals LLC.

To appear in: Psychology in the Schools special issue “Best Practices in Assessment of Autism Spectrum Disorders”

[Correction amended on 20 February 2023, after first online publication: grammatical error has been rectified by adding "of" in the article title

Diagnosis and treatment of children and adolescents with autism and ADHD.]

co‐occurring autism and ADHD, we conclude by outlining

practical implications for clinical and educational practice.

K E YWORD S

assessment, Autism ADHD Comorbidity, treatment

1 | INTRODUCTION

Autism and attention‐deficit/hyperactivity disorder (ADHD) are two prevalent neurodevelopmental disorders, with

estimates of 1.5%–2% (Maenner et al., 2020) and 5%–9% (Danielson et al., 2018), respectively. Diagnostically,

autism is characterized by pervasive challenges with social communication and the presence of restricted and/or

repetitive behaviors and interests, while ADHD is characterized by developmentally inappropriate symptoms of

inattention and/or hyperactivity‐impulsivity (American Psychiatric Association, 2013). Although symptom profiles

are conceptually distinct, consistent empirical evidence demonstrates that co‐occurrence is common, something

now formally recognized in the Diagnostic and Statistical Manual‐5th Edition (DSM‐5) which no longer prohibits a

comorbid diagnosis. Critically, for educational and healthcare practitioners, recognition that autism and ADHD co‐

occur underscores a need to move beyond previously established guidelines developed based on the assumption

that autism and ADHD are strictly independent conditions and incorporate practice approaches that do recognize

the co‐occurrence of autism and ADHD (Young et al., 2020).

Previous recommendations for the assessment and treatment of co‐occurring autism and ADHD have been

generated through expert consensus, largely based on evidence for assessing and treating each disorder separately

(Young et al., 2020). Given the immediate need to provide support for those with co‐occurring autism and ADHD,1

this strategy is reasonable yet poses some complications. For instance, those with co‐occurring autism and ADHD

exhibit greater impairment on a range of measures than those with either diagnosis alone, including cognitive

(Andersen et al., 2013; Rao & Landa, 2014) and psychosocial functioning (Sikora et al., 2012), and additional

comorbidities like oppositional defiant disorder (Jang et al., 2013).

The goal of this paper is to describe evidence‐based approaches for assessing and treating co‐occurring autism and

ADHD by highlighting, whenever possible, findings from research that specifically included measures of both autism and

ADHD symptoms and/or diagnoses. We first briefly summarize the research on such co‐occurrence. Second, we review

research on the assessment of autism and ADHD with a focus on practical applications for differential diagnosis (i.e.,

cases where there's some degree of symptoms of both conditions involved, and the clinical question is whether it's one

or the other, or both). Third, we describe research on the treatment of co‐occurring autism and ADHD. Unique from

previous such reviews, we highlight implications for the educational setting. The hope is that this review provides

relevant guidelines for practitioners when faced with students who evidence a combination of both autism and ADHD

symptoms, both with respect to diagnostic process and relevant intervention guidance.

2 | CO‐OCCURRENCE OF AUTISM AND ADHD

Compared to typically developing peers, children with ADHD are more likely to exhibit autism symptoms or

associated characteristics. For instance, Grzadzinski et al. (2016) showed that 21% of an ADHD group scored above

the cutoff for ASD on the Autism Diagnostic Observation Schedule (ADOS), and 30% met cut‐offs on all domains of

1Throughout, we use both person‐ and identity‐first language in light of varying stakeholder preferences (Botha et al., 2021).

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the Autism Diagnostic Interview‐Revised. Other studies have demonstrated that those with ADHD exhibit higher

autism symptom severity than typically developing peers (Kotte et al., 2013; Reiersen et al., 2007) and experience

more difficulties with interpersonal social communication as well as restricted, repetitive, and stereotyped

behaviors (Hollingdale et al., 2020; Jang et al., 2013). Moreover, like autistic children, children and adolescents with

ADHD differ from their typically developing peers across a range of laboratory‐based measures of social cognition,

including empathy and emotion recognition (Demopoulos et al., 2013; Uekermann et al., 2010), and sensory

processing (Little et al., 2018). Children with ADHD who have social communication difficulties are also more likely

to exhibit patterns of repetitive behaviors, developmental issues, and speech and language deficits similar to those

observed in autism (Santosh & Mijovic, 2004).

While inattention and hyperactivity‐impulsivity are defining features of ADHD, autistic children may also

exhibit differences in attention and activity level (Lyall et al., 2017; Sinzig et al., 2009). In a study examining ADHD

symptoms in children with autism, parents and teachers reported that 49%–50% children exhibited difficulties while

concentrating, 42%–44% exhibited elevated activity levels, and 60% were easily distracted (Lecavalier, 2006).

These findings have been supported by other studies focusing on the co‐occurrence of autism and ADHD

(Rowlandson & Smith, 2009; Yoshida & Uchiyama, 2004).

2.1 | Developmental changes

Symptoms of autism and ADHD are known to present differently across development. For example, hyperactive‐impulsive

symptoms are more frequently reported in young children, while inattentive symptoms are endorsed more frequently in

older children (Curchack‐Lichtin et al., 2014). Studies of autism symptoms have shown that as individuals age, some

symptoms show stability (e.g., rigidity and insistence on sameness) and others show improvements (e.g., social reciprocity)

(Bal et al., 2019; Richler et al., 2010; Shattuck et al., 2007; Waizbard‐Bartov et al., 2021). The co‐occurrence of autism and

ADHD also appears to change with age. Converging evidence suggests correlations between autism and ADHD symptoms

are strongest during adolescence (see Hartman et al., 2016), although this is predominantly based on cross‐sectional

studies, it suggests that monitoring for co‐occurrence should be a continuous process over time.

2.2 | Co‐occurring autism and adhd and functional impairment

The co‐occurrence of ADHD and autism may impact other areas of functioning more than autism or ADHD in

isolation. For children diagnosed with autism, clinically significant ADHD symptoms are associated with

impairments in adaptive functioning and overall poorer quality of life (Sikora et al., 2012), greater cognitive delays

(Andersen et al., 2013; Rao & Landa, 2014; Sinzig et al., 2008), and impaired executive functioning (Yerys

et al., 2009). Likewise, higher autism symptom severity in children with ADHD is associated with increased

emotional and conduct problems and decreased quality of life (Green et al., 2016). Together, these findings

emphasize that autism symptoms should be evaluated in individuals with ADHD and vice versa and, if present,

should be included in the overall intervention plan.

3 | DIAGNOSTIC ASSESSMENT AND INTERVENTION

3.1 | Collaborative partnerships

Collaborative partnerships, often described as family‐professional partnerships when referring to cooperation

between schools and families, have long been recognized as integral to successful assessment and treatment of

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psychological and behavioral problems in childhood and adolescence (Esler et al., 2002). Collaborative partnerships

include using shared decision‐making processes, such that assessments and treatments are sensitive to each

individual's and family's unique profiles of strengths and challenges, as well as personal preferences (Liverpool

et al., 2021). Collaborative partnerships also provide opportunities for psychoeducation, which includes clarifying with

families any potential misconceptions about a condition and problem‐solving barriers to intervention adherence (Dahl

et al., 2020). While all children and families likely benefit from a collaborative approach tailored to each family, it is

especially important to engaging older children and adolescents in the assessment and treatment process (Hogue

et al., 2020). Evidence demonstrates that collaborative partnerships improve family engagement in assessment and

treatment of ADHD (Dahl et al., 2020) and autism (Dawson‐Squibb et al., 2020; Levy et al., 2016) separately. Thus, it is

also likely to be an important element in the treatment of co‐occurring autism and ADHD. Best practice assessment

and treatment of co‐occurring autism and ADHD should occur within a collaborative partnership framework.

3.2 | Neurodiversity

There is increasing interest in perspectives on autism and ADHD raised by proponents of the neurodiversity movement

(Sonuga‐Barke & Thapar, 2021). This has raised awareness that research on evidence‐based best practices can benefit by

adopting collaborative and coproduction practices, such as members of the autistic community informing research

priorities (Pellicano & Houting, 2022). Additionally, the neurodiversity movement has highlighted that environmental

adjustments may also benefit autistic individuals and others by promoting acceptance and inclusion (Pellicano &

Houting, 2022). These perspectives, although not often integrated into the current evidence‐base that informs the

assessment and interventions for co‐occurring autism and ADHD (at least explicitly), may provide useful guidance for

future developments, including developments in assessment and interventions in the context of schools. One such

example is the proposal of a school‐wide approach to supporting autistic students (Roberts & Webster, 2022)

3.3 | Assessment of co‐occurring autism and ADHD and differential diagnosis

The value of carefully assessing both autism and ADHD is highlighted by data demonstrating that a diagnosis of ADHD in

young children can delay a diagnosis of autism by several years (Miodovnik et al., 2015). Indeed, the overlap of symptoms

and impairments in autism and ADHD often complicates the clinical picture and poses challenges for clinicians. For

example, autistic children often exhibit elevated parent‐ and teacher‐reported ADHD symptoms (Sinzig et al., 2009;

Yoshida & Uchiyama, 2004) but it can be difficult to decipher what this means. Do elevated levels of inattention or

hyperactivity‐impulsivity in the context of autism represent the same thing as they do outside that context? For instance,

high activity levels exemplified by aimless wandering and difficulty sitting in a chair may represent frank motor activity

consistent with ADHD, or alternatively, be secondary to social or communication challenges consistent with autism.

Similarly, inattention in the context of autism may not index the same quality of inattentiveness or distractibility as would

be expected in ADHD, instead reflecting alternate interests in sensory stimuli or lack of cooperation with teacher requests

more consistent with social inattention. Likewise, the presence of certain ADHD symptoms—such as inattentiveness in

social situations—could result in inaccurate endorsement of autism symptoms in the absence of thorough evaluation.

These challenges make careful evaluation and conceptualization of symptoms critical.

Rates of co‐occurring diagnoses may be lower when reported by clinicians than based on standardized parent

interviews alone (Grzadzinski et al., 2016), and may indicate that clinicians view some parent‐reported ADHD

symptoms as being accounted for by the autism diagnosis. When considering a co‐occurring diagnosis of autism and

ADHD, it is important to avoid using the same behavior to satisfy both sets of diagnostic criteria. However, it is also

important to avoid diagnostic overshadowing by assuming that all symptoms of one condition are attributable to

the other. The issue of diagnostic overshadowing is even more challenging when intellectual impairments are part

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of the clinical picture. There are, to our knowledge, no adequate best practice recommendations for this clinical

scenario. However, in general, the child's developmental level should be taken into account when considering a dual

diagnosis of ADHD and autism. This is because ADHD symptoms must be developmentally inappropriate based on

the individual's developmental level, not just their chronological age.

Ultimately, the literature indicates that clinical judgment and good clinician training in differential diagnosis is

critical, but also reveals the challenges inherent to assessment and diagnosis of co‐occurring autism and ADHD.

Below, we highlight key ‘best practice’ considerations when assessing for autism, ADHD, or both. Assessment tools

are provided as examples but should not be considered an exhaustive list.

3.3.1 | Developmental history and symptom interview

A thorough developmental history with the youth's caregiver(s) is critical to understanding the developmental

context of any apparent autism or ADHD symptoms, as well as for establishing any potential medical issues that

may account for or contribute to symptom development. Consistent with general best practice guidelines, clinicians

should obtain information about key developmental milestones (e.g., pregnancy and delivery history, age of first

single words, phrase speech, crawling, walking), ask about age and type of first concerns, inquire about any

regression history, query about prior diagnoses, obtain information about current services, and review medical

history (e.g., physical or medical problems, hearing or vision concerns, sleep, appetite, weight change/loss, allergies,

medications, major surgeries, history of hospitalizations). Clinical risks should also be evaluated including self‐injury

or aggression risk, elopement risk, other safety concerns, as well as family stressors/trauma and quality of the

parent‐child relationship. Clinicians should also inquire about current supports and strengths of the child as well as

about the family's key concerns and desired services and goals.

In addition, a structured or semi‐structured clinical symptom interview with the caregiver(s) should be conducted

and, when appropriate based on developmental stage (i.e., middle childhood, adolescence), with the child themselves.

Examples include the Kiddie‐Schedule for Affective Disorders & Schizophrenia (Kaufman et al., 1997) and the Diagnostic

Interview Schedule for Children (Shaffer et al., 2000), among others. The goal is to better understand the diagnostic

landscape, to rule in or out any other potential contributing diagnoses, and to gain more in‐depth information than can

be gleaned from paper‐and‐pencil rating scales (see below). Such interviews are also key to evaluating symptom

chronicity (especially when making first‐time diagnoses of ADHD) and cross‐situational impairment.

3.3.2 | Multi‐informant ratings representing behavior across settings

Validated broadband questionnaires should be completed by both the caregiver(s) and teacher(s) and may include

measures like the Behavior Assessment System for Children (Reynolds & Kamphaus, 2015) or Child Behavior

Checklist (Achenbach & Rescorla, 2001). Narrowband parent ratings of both ASD and ADHD symptoms should also

be completed by caregiver(s) and teacher(s) to aid in differential diagnosis and/or the determination of co‐occurring

conditions. These may include the Social Communication Questionnaire (Rutter et al., 2003) and/or Social

Responsiveness Scale (Constantino & Gruber, 2012) for autism, and the ADHD Rating Scale (DuPaul et al., 1998)

and/or Conners for ADHD (Conners, 2008). It is crucial to obtain ADHD symptom ratings from multiple reporters to

determine evidence of cross‐situational presence of symptoms as well as presence of impairment in various

settings. If symptoms are apparent in only one context, this may be suggestive of alternative diagnoses.

Discrepancies between reporters are not uncommon for ADHD symptoms in particular, potentially reflecting

differences in context/setting, and in general can be viewed as providing unique clinical information (Narad

et al., 2015). In addition, a report of the child's adaptive skills is critical to understanding impairment; validated

adaptive behavior ratings should be completed by the caregiver(s) and, if possible, the teacher. Examples include the

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Vineland Adaptive Behavior Scales (Sparrow et al., 2012) and the Adaptive Behavior Assessment System (Harrison

& Oakland, 2000). When appropriate based on developmental stage and level, self‐report ratings may also be

obtained from youth. Incorporating self‐report measures may provide unique insights that are not ascertainable by

informant reports or direct observation, such as experiences of internalizing symptoms (Bakhtiari et al., 2021; Makol

et al., 2020; Skarphedinsson et al., 2021).

3.3.3 | Cognitive assessment

Cognitive assessments may not be necessary in all cases (e.g., in cases of straightforward ADHD without concerns

of co‐occurring autism) but should always be considered, particularly when intellectual functioning is of concern.

Moreover, direct assessment of the child's cognitive abilities provides important contextual information and may

indicate additional diagnostic considerations (e.g., global developmental delay or intellectual disability). For young

children, cognitive testing comes in the form of developmental assessments such as the Mullen Scales of Early

Learning (Mullen, 1995) (0–68 months) or the Bayley Scales of Infant Development (Bayley, 2006) (1–42 months).

For older children and adolescents, a validated, reliable cognitive/IQ test should be employed (e.g., Stanford‐Binet

[Roid, 2003], Wechsler Scales [Wechsler, 2003], Differential Abilities Scale [Elliott, 2007]); abbreviated IQ tests may

also suffice in situations where time and/or resources are limited, as is common in school settings (e.g., Wechsler

Abbreviated Scales of Intelligence [Wechsler, 2011]).

3.3.4 | Behavioral observation and direct assessment of symptoms

Throughout the assessment process, the psychologist should note any behaviors indicative of autism and/or ADHD,

and the contexts in which such behaviors arise. Direct assessment of autism symptoms should be utilized whenever

possible, not because the scores are necessarily determinative, but because the tools designed for such evaluations

provide an opportunity to directly probe for relevant behaviors. The gold‐standard tool for this purpose is the Autism

Diagnostic Observation Schedule, 2nd Edition (ADOS‐2; Lord et al., 2012). There are no equivalent gold‐standard,

clinically‐validated tools available for direct assessment of ADHD. In fact, direct observation during clinical assessment

may not always reveal ADHD symptoms since children with ADHD can often regulate their attention and behavior

adequately for brief periods of time, especially in structured settings and/or novel environments with unfamiliar

adults. However, school (playground and/or classroom‐based) observations may provide an opportunity to observe

the degree to which symptoms are impairing in social and academic settings, particularly for elementary‐aged children.

3.3.5 | Other considerations for assessment

Other domains that may be relevant include academic achievement testing, speech and language testing (often a

core component of autism assessments), motor and perceptual skills assessment, and curriculum‐based

assessments. Assessing for the co‐occurrence of learning disabilities via validated academic achievement tests

may be warranted given frequent co‐occurrence with both ADHD (DuPaul et al., 2013) and autism (Boucher, 2012;

Keen et al., 2016). Assessment of co‐occurring symptoms may also benefit from a dimensional approach, since

these measures are better suited to providing a more nuanced profile of relative strengths and challenges for a

given individual (Hartman et al., 2016; Mikami et al., 2019).

Different approaches to assessment are required depending on developmental level and age since symptom

presentations change over the course of development. Indeed, the extent to which a particular symptom

description is useful to understanding the presentation of ASD or ADHD depends upon age/developmental level

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(DuPaul et al., 2020). This is also important because of concomitant changes in the environment; for example, while

high school students cycle through multiple teachers over the course of a day, elementary students are generally

assigned to a single teacher (Sibley et al., 2012). Careful consideration of which informants are most familiar with

the child is required (Jepsen et al., 2012; Sibley et al., 2012). Likewise, careful consideration of appropriate

measures is imperative, prioritizing measures that have norms for autism and ADHD and include individuals with

both conditions in the normative samples.

3.3.6 | Integration of assessment information

Integrating assessment information across sources is always an important aspect to the diagnostic process, however

this can be particularly difficult when questions of both autism and ADHD are involved. In general, when multiple

co‐occurring diagnoses are being considered, it is important to ask how many diagnoses are needed to describe the

child's set of difficulties. Ocam's razor (also often referred to as the “principle of parsimony”) states that one should

not make more assumptions than the minimum needed. When making these decisions, it can be helpful to consider

whether the symptoms in question are beyond the scope of autism or ADHD in isolation, whether there has been a

change from previous functioning such as new symptoms or the worsening of certain behaviors, and, if

interventions have been implemented, whether they have been effective. On the other hand, as noted previously,

it's important to be aware of issues of diagnostic overshadowing. Clinicians should ensure that, when integrating

information to arrive at a clinical best estimate diagnosis, they avoid “double counting” of symptoms to meet criteria

for both conditions, and they are consider any potential symptoms within the context of an individual's

developmental level.

3.4 | Treatment/intervention for co‐occurring autism and ADHD

A key goal of assessment is to inform the provision of treatment/intervention. In general, the primary goal of

treatment should be to reduce impairment and/or disability, in accordance with each individual child's/family's

goals. As previously noted, interventions should be sensitive to each individual's and family's unique profiles of

strengths and challenges, as well as personal goals. This point is emphasized by research on lived‐experiences

perspectives highlighting that treatment goals of autistic individuals can often be overlooked (Hodges et al., 2020;

Leaf et al., 2022). In addition to focusing individual needs, interventions and supports should also be evidence‐

based; however, unlike the body of research for treating autism and ADHD separately, research for treating their

co‐occurrence is less substantial. Thus, in outlining the treatment options below, we indicate the quality of

supporting evidence and highlight research conducted with preschool‐ to high school‐aged children presenting with

co‐occurring autism and ADHD.

3.4.1 | Home‐based behavioral management

Behaviorally‐based strategies are a recommended first‐line intervention for autism (Dawson & Burner, 2011), and

are commonly recommended for ADHD (Daley et al., 2018; Halperin & Marks, 2019) especially in combination with

medication. These strategies are founded on established principles of learning and behavioral conditioning, with an

emphasis on implementing reinforcements for desired target behaviors and ignoring unwanted or off‐task

behaviors (Hinshaw, 2018). Evidence‐based strategies for young children diagnosed with autism typically involve

one‐on‐one sessions with a trained behavioral specialist. In addition, practitioners may also work one‐on‐one with

the parents/family members to implement reinforcing consequences for developmentally appropriate social and

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communication behaviors. Improvements in social communication, language, and play skills have been documented,

particularly when implemented in a naturalistic setting (e.g., at home or within the classroom) with natural rewards

such as praise (Sandbank et al., 2020; Schreibman et al., 2015). Although much of this evidence is from studies of

toddlers, there is also evidence supporting similar results for older autistic children and adolescents (Dawson &

Burner, 2011; Ratliff‐Black & Therrien, 2021).

Behavioral interventions for ADHD typically comes in the form of time‐limited parent training sessions

(individual or group‐based) focused on building the parent's ability to provide reinforcement of appropriate

behaviors (e.g., waiting one's turn) and ignoring disruptive behaviors (e.g., temper‐tantrums). Often these strategies

are combined with medication (discussed further below). Although behavioral interventions are not as effective at

improving core ADHD symptoms as medication, randomized controlled trials (RCTs) suggest that behavioral

interventions for ADHD that are based on these strategies have an overall positive effect across a range of outcome

measures, including core ADHD symptoms, parent‐child interactions, internalizing symptoms, conduct problems,

and disruptive classroom behavior (reviewed in Daley et al., 2018; Hinshaw, 2007). Much of this evidence is for

elementary or middle‐school‐age children (i.e., 5–10 years) (Jensen et al., 2001; Van der Oord et al., 2008) and

preschool age children (Abikoff et al., 2015; Franke et al., 2020; Mulqueen et al., 2015; Rimestad et al., 2019), with

fewer studies on the efficacy of parent‐based behavioral management strategies for adolescents (reviewed in Chan

et al., 2016).

Given that behavioral management strategies for autism or ADHD alone differ in behavioral targets and

method of delivery, it is unclear how to best integrate these approaches for children with co‐occurring autism and

ADHD (Brookman‐Frazee et al., 2006). Several studies have examined whether parent training programs similar to

those shown to be effective for reducing disruptive behaviors of children with ADHD can be adapted for children

with autism (Tarver et al., 2019), demonstrating that behavioral parent training can reduce disruptive or

noncompliant behavior and hyperactivity/impulsivity in children ages 3–15 years (Bearss et al., 2015; Handen

et al., 2015; Tarver et al., 2019). These findings are promising, but several issues must be addressed. First, whether

these effects will hold when outcome measures are obtained from those unaware of the treatment, such as

teachers, is unclear. Second, further work is required to clarify what elements of training are most beneficial for

treating co‐occurring autism and ADHD, particularly since some elements (e.g., time‐out) may reduce disruptive

behavior for those with ADHD but reinforce disruptive behavior for those with autism (Tarver et al., 2019).

3.4.2 | School‐based behavioral interventions

As noted previously, autism and ADHD are associated with disruptions in functioning across multiple settings,

including social and academic difficulties at school; effective interventions for co‐occurring autism and ADHD must

therefore also target functioning at school. To our knowledge, no study has specifically evaluated the effectiveness

of behavioral interventions on school functioning for children with co‐occurring ADHD and ASD. As such, we must

rely on extrapolating from evidence for children with each individual diagnosis.

Most research on school‐based behavioral interventions for ADHD has concerned classroom contingency

management for elementary students (DuPaul et al., 2012). This includes the use of daily report cards by which

parents provide home‐based rewards contingent on target behaviors at school (Merrill et al., 2017), token

economies (Trout et al., 2007), and time out from positive reinforcement (Fabiano et al., 2004). There has been

consistent evidence of positive effects on both behavior and academic functioning for elementary‐ and middle

school‐age children (DuPaul et al., 2012). Currently, we know of no published trials examining the effectiveness of

classroom contingency management for high school children with ADHD.

Research on school‐based interventions for autism has had a focus on improving social behaviors and skills in

preschool and elementary school‐age children (Whalon et al., 2015). The need for these interventions is clear, given

that social skills interventions delivered outside of school may not generalize across to school settings (Gates

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et al., 2017). However, although interventions involving training school staff or peers to support social

communication behaviors have some positive effects on social skills for preschool and elementary students with

autism, further research involving RCT designs is required (Whalon et al., 2015).

3.4.3 | Academic interventions

Co‐occurring autism and ADHD is often linked to academic difficulties (Chiang & Gau, 2016), which are typically

addressed by a combination of accommodations and/or modifications. Often delivered through what are referred

to as Individualized Education Plans (IEP) or Section 504 plans in the United States, these adjustments to

educational practices include allowing extended time to complete tests and assignments, providing teacher or peer

prepared notes from class, and reducing lengths of assignments (Harrison et al., 2013), as well as other supports

targeting specific goals identified through the IEP process (e.g., speech‐language therapy, occupational therapy,

social skills groups, other school‐based behavioral supports).

There is evidence that organizational skills training (e.g., time management, planning, and study skills), provided

via individual clinic sessions, specialist after‐school programs, or school psychologists or counselors during the

school day, can have positive effects on academic skills and grades for elementary‐, middle‐, and early high school‐

age children diagnosed with ADHD (Abikoff et al., 2013; Evans et al., 2014, 2018; Langberg et al., 2011, 2012).

Moreover, some recent research also supports the feasibility of providing organizational skills training customized

to autistic adolescents (e.g., greater use of visual supports, interactive activities, and directive teaching) (Kenworthy

et al., 2014; Tamm et al., 2021). Taken together, this suggests that organizational skills training may also be

beneficial for co‐occurring autism and ADHD.

It is important to acknowledge that practitioners working in school settings, including mental health

professionals, may often operate within implementation frameworks, including the response to intervention (RTI)

framework. Briefly the RTI framework provides a set of problem‐solving oriented processes for assessing and

treating children within the school setting (Berkeley et al., 2009; Hughes & Dexter, 2011) without reference to

particular diagnosis. RTI stipulates a tiered approach to matching service delivery to academic and behavioral needs,

as indicated from universal screening and progress monitoring (Hughes & Dexter, 2011). More research is needed in

terms of identifying the ways in which frameworks such as RTI can best accommodate evidence‐based practices

specific to the assessment and treatment of co‐occurring autism and ADHD.

3.4.4 | Social skills training

An important distinction to recognize when considering overlaps in social difficulties between children with autism

and ADHD is that ADHD is largely characterized by a problems with performance rather than knowledge, whereas

autism tends to be characterized more by knowledge gaps (reviewed in Mikami et al., 2019). That is, children with

ADHD generally know the appropriate behavior and often possess social skills such as perspective taking and

emotion recognition but have difficulty implementing it due to impulsive tendencies or attention problems, while

children with autism tend to experience more fundamental social knowledge difficulties as well as challenges

executing social skills. This implies that supporting social skills acquisition in children with co‐occurring autism and

ADHD might adopt an approach that targets both knowledge and performance difficulties. One such intervention is

the Program for the Education and Enrichment of Relational Skills (PEERS) (Frankel et al., 1998; Laugeson

et al., 2012, 2014), which consists of both social skills training aimed at improving social knowledge gaps, and

training parents to structure environments (e.g., during home play dates) to support children's engagement in social

interactions. Although no data exists on the outcome of this intervention for co‐occurring autism and ADHD, it

does appear to benefit children with autism

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(Frankel et al., 2010; Laugeson et al., 2012, 2014). Evidence for the effectiveness of social skills training for

children with ADHD has been less clear (Frankel et al., 1998; Morris et al., 2021). Taken together this suggests that

social skills training may have some promise for co‐occurring autism and ADHD primarily related to social

communication challenges associated with autism versus ADHD‐specific difficulties, but there is a need for further

empirical evidence.

3.4.5 | Medication management

For ADHD, there is consistent evidence that stimulant and non‐stimulant medications can result in clinically

significant reductions in core symptoms for those of elementary school age and older (Catalá‐López et al., 2017).

Notably, there is also evidence that stimulant and non‐stimulant medications can have clinically meaningful effects

in reducing symptoms of inattention and hyperactivity‐impulsivity in children and adolescents with co‐occurring

autism and ADHD (Patra et al., 2019; Rodrigues et al., 2020; Sturman et al., 2017). While the evidence for the use of

stimulant and non‐stimulant medications to treat ADHD symptoms in those with autism is promising, several

caveats are notable. For stimulant medications, response rates (defined as ADHD symptom reduction of at least

25% and an improved clinical impression) are much lower in children with co‐occurring autism (~50%) compared to

children with ADHD alone (~70–90%) (Handen et al., 2000). Moreover, stimulant and non‐stimulant medications

appear to be more likely to have intolerable side effects (e.g., irritability, social withdrawal) for individuals with

autism compared to those with ADHD alone (Handen et al.,, 2015; Patra et al., 2019). Evidence on the effectiveness

of medications for preschoolers with elevated ADHD symptoms is limited; while there is some indication of positive

effect on symptom remission, it is somewhat smaller than that observed in older children (Greenhill et al., 2006;

Riddle et al., 2013).

Based on the current body of evidence, it has been recommended that stimulant‐based medications be

considered for individuals with autism who continue to present with clinically elevated ADHD symptoms after

consistent implementation of evidence‐based behavioral strategies for ADHD (Rodrigues et al., 2020; Young

et al., 2020). The American Academy of Pediatrics recommends behavioral interventions, rather than medication, as

the first‐line approach for children with ADHD under the age of 6 (Wolraich et al., 2019), consistent with the UK

National Institute for Health and Care Excellence guidelines (National Institute for Health and Care

Excellence., 2018). There is currently no evidence supporting the use of medication to directly treat core autism

symptoms.

In the context of treating ADHD alone, medication is often combined with other strategies. Research has

demonstrated that high quality medication management is particularly helpful for treating the core ADHD

symptoms while, as noted previously, behavioral strategies can be effective for improving academic functioning and

reducing oppositional behavior and anxiety/depression (Jensen et al., 2001). Likewise, in an RCT comparing the

effectiveness of atomoxetine and behavioral parent training in children with co‐occurring autism and ADHD, both

were found to reduce ADHD symptoms, but atomoxetine was slightly more effective than behavioral parent

training. However, behavioral parent training resulted in reductions in irritability and noncompliant behavior

(Handen et al., 2015). Additional research in this area is needed given the direct clinical implications of these

findings.

3.5 | Implications for clinical and educational practice

Given the current state of knowledge covered herein, several implications for school psychologists and other

clinicians are raised for assessing and treating co‐occurring autism and ADHD. First, assessment and treatment

should consider a child's functioning across multiple domains and settings, which requires collaborative

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partnerships. Given students experience a variety of different settings at school (e.g., social and nonsocial,

structured and unstructured), school professionals are uniquely positioned to inform both the assessment and

treatment of co‐occurring autism and ADHD. Thus, in addition to the important contributions of parents and youth,

professional personnel involved in this effort may include school mental health staff such as psychologists or school

counselors, as well as clinical psychologists, and psychiatrists, among others. Although the specific roles may vary

depending upon available resources, time constraints, and local laws and regulations, some should have specialized

training in the assessment and treatment of autism and ADHD.

Beyond addressing questions of differential diagnosis (i.e., autism only, ADHD only, co‐occurring autism and

ADHD), assessments should also provide information on a particular child's/family's profile of strengths, weaknesses,

and goals. Interviews with parent(s)/caregiver(s) should be conducted to obtain a developmental history of difficulties

characteristic of autism and ADHD, and to screen for any medical issues, and structured or semi‐structured interviews

should be conducted to detail clinical symptoms. To complement information gained by interview, parents and teachers

should be asked to complete validated questionnaires specific to autism and ADHD as well as those that cover a broad

range of other clinically relevant symptoms. Direct observations of behavior following a validated procedure should also

be considered when assessing for autism. Cognitive measures should be used to assess for possible additional

considerations (i.e., global developmental delay or intellectual disability) and can provide opportunities to gain additional

contextual information. When integrating assessment information, care should be taken to understand an individuals'

profile of strengths and weaknesses. These evaluations require specialized training, and depending on local licensing

regulations, it may not be possible to make such diagnoses in the school setting, requiring enough knowledge to know

when to refer for a specialty evaluation outside of the educational system. However, such evaluations will, at a

minimum, permit the identification of areas of strength and weakness which may be informative in terms of identifying

relevant goals and selecting school‐based services, accommodations, and modifications.

A rigorous assessment of co‐occurring autism and ADHD should be informative for guiding treatment/

intervention. While specific treatment/intervention components should be based on individual needs, it is likely that

interventions for co‐occurring autism and ADHD will involve the collaborative coordination of components across

multiple settings, notably home and school. Implementation should involve input from youth, parents, teachers, and

physicians, and should include a clear process to allow communication between parents and school to enhance

coordination across settings. Behavioral parent training and school‐based behavioral contingency strategies should be

considered across ages, and stimulant or non‐stimulant medications should be considered to reduce difficulties with

hyperactivity/impulsivity and inattention of children in elementary school or older. To help address academic

difficulties, developing skills such as organization and planning should be considered. Finally, combined social skills

training and parent training should be considered to address social communication and peer relationship difficulties.

4 | CONCLUSIONS AND FUTURE DIRECTIONS

There is an established empirical basis recognizing that autism and ADHD can co‐occur. The developing evidence‐

base for assessing and treating their co‐occurrence is encouraging, yet there are issues that require further

clarification. Research aimed at identifying which measures and procedures are most effective for assessing co‐

occurring autism and ADHD is warranted given most assessment tools were developed for the purpose of assessing

one condition in the absence of the other. Second, although there are several intervention approaches that hold

promise for addressing co‐occurring autism and ADHD, research empirically testing this is lacking. Third, there is

the sometimes overlooked but clear need to develop assessment and treatment approaches sensitive to cultural

differences and societal or economic disparities. Exemplary evidence indicating the need for this sensitivity includes

data demonstrating that perceptions of symptom presentation (Sonuga‐Barke et al., 1993) and rates of accessing

treatment (Bishop‐Fitzpatrick & Kind, 2017) and school services (DuPaul et al., 2019) differ by income, race, and/or

ethnicity. Fourth, as emphasized by the neurodiversity movement, there is a historically overlooked need to

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conduct research in collaboration with community members who have lived experiences with co‐occurring autism

and ADHD. Finally, there is a need for research examining how schools might most effectively make environmental

adjustments that benefit neurodiverse students by promoting acceptance and inclusivity.

ACKNOWLEDGMENTS

Work on this manuscript was supported by grants from the National Institute of Mental Health R00 MH106642

(MM) and R01MH121416 (MM), and the National Institute of Child Health & Human Development Intellectual and

Developmental Disabilities Research Center U54HD103526 (Abbeduto). GSK is supported by the University

Matching Funds associated with the National Institute of Mental Health funded training program Interdisciplinary

Training for Autism Researchers, T32 MH073124. Open access publishing facilitated by Victoria University of

Wellington, as part of the Wiley ‐ Victoria University of Wellington agreement via the Council of Australian

University Librarians.

CONFLICT OF INTEREST

The authors declare no conflict of interest.

ORCID

Burt Hatch http://orcid.org/0000-0003-3813-9852

REFERENCES

Abikoff, H., Gallagher, R., Wells, K. C., Murray, D. W., Huang, L., Lu, F., & Petkova, E. (2013). Remediating organizational

functioning in children with ADHD: Immediate and long‐term effects from a randomized controlled trial. Journal of Consulting and Clinical Psychology, 81(1), 113–128.

Abikoff, H. B., Thompson, M., Laver‐Bradbury, C., Long, N., Forehand, R. L., Miller Brotman, L., Klein, R. G., Reiss, P., Huo, L., & Sonuga‐Barke, E. (2015). Parent training for preschool ADHD: A randomized controlled trial of specialized and generic programs. Journal of Child Psychology and Psychiatry, 56(6), 618–631.

Achenbach, T. M., & Rescorla, L. A. (2001). Manual for the ASEBA school‐age forms & profiles. University of Vermont, Research Center for Children, Youth, & Families.

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.) Andersen, P. N., Hovik, K. T., Skogli, E. W., Egeland, J., & Øie, M. (2013). Symptoms of ADHD in children with high‐

functioning autism are related to impaired verbal working memory and verbal delayed recall. PLoS One, 8(5), e64842.

Bakhtiari, R., Hutchison, S. M., & Iarocci, G. (2021). How do children and youth with autism spectrum disorder self‐report on behavior? A study of the validity indexes on the Behavior Assessment System for Children, Second Edition, self‐report of personality. Autism, 25(4), 1100–1113.

Bal, V. H., Kim, S.‐H., Fok, M., & Lord, C. (2019). Autism spectrum disorder symptoms from ages 2 to 19 years: Implications

for diagnosing adolescents and young adults. Autism Research, 12(1), 89–99. Bayley, N. (2006). Bayley scales of infant and toddler development, third edition: Technical manual. Harcourt. Bearss, K., Johnson, C., Smith, T., Lecavalier, L., Swiezy, N., Aman, M., Mcadam, D. B., Butter E., Stillitano C., Minshawi N.,

Sukhodolsky D. G., Mruzek D. W., Turner K., Neal T., Hallett V., Mulick J. A., Green B., Handen B., Deng Y., … Scahill L. (2015). Effect of parent training vs parent education on behavioral problems in children with autism spectrum

disorder: A randomized clinical trial. Journal of the American Medical Association, 313(15), 1524–1533. Berkeley, S., Bender, W. N., Gregg Peaster, L., & Saunders, L. (2009). Implementation of response to intervention: A

snapshot of progress. Journal of Learning Disabilities, 42(1), 85–95. Bishop‐Fitzpatrick, L., & Kind, A. J. H. (2017). A scoping review of health disparities in autism spectrum disorder. Journal of

Autism and Developmental Disorders, 47(11), 3380–3391. Botha, M., Hanlon, J., & Williams, G. L. (2021). Does language matter? Identity‐first versus person‐first language use in

autism research: A response to vivanti. Journal of Autism and Developmental Disorders, 1–9. https://doi.org/10.1007/ s10803-020-04858-w

Boucher, J. (2012). Research review: Structural language in autistic spectrum disorder—characteristics and causes: Structural language in ASD. Journal of Child Psychology and Psychiatry, 53(3), 219–233.

Brookman‐Frazee, L., Stahmer, A., Baker‐Ericzén, M. J., & Tsai, K. (2006). Parenting interventions for children with autism spectrum and disruptive dehavior disorders: Opportunities for cross‐fertilization. Clinical Child and Family Psychology

Review, 9(3–4), 181–200.

306 | HATCH ET AL.

15206807, 2023, 2, D ow

nloaded from https://onlinelibrary.w

iley.com /doi/10.1002/pits.22808, W

iley O nline L

ibrary on [22/08/2023]. See the T erm

s and C onditions (https://onlinelibrary.w

iley.com /term

s-and-conditions) on W iley O

nline L ibrary for rules of use; O

A articles are governed by the applicable C

reative C om

m ons L

icense

Catalá‐López, F., Hutton, B., Núñez‐Beltrán, A., Page, M. J., Ridao, M., Macías Saint‐Gerons, D., Catalá, M. A., Tabarés‐ Seisdedos, R., & Moher, D. (2017). The pharmacological and non‐pharmacological treatment of attention deficit hyperactivity disorder in children and adolescents: A systematic review with network meta‐analyses of randomised trials. PLoS One, 12(7), e0180355.

Chan, E., Fogler, J. M., & Hammerness, P. G. (2016). Treatment of attention‐deficit/hyperactivity disorder in adolescents: A

systematic review. Journal of the American Medical Association, 315(18), 1997–2008. Chiang, H.‐L., & Gau, S. S.‐F. (2016). Comorbid psychiatric conditions as mediators to predict later social adjustment in

youths with autism spectrum disorder. Journal of Child Psychology and Psychiatry, 57(1), 103–111. Conners, C. K. (2008). Conners (3rd ed.). Multi‐Health Systems.

Constantino, J. N., & Gruber, C. P. (2012). Social responsiveness scale: SRS‐2. Western Psychological Services. Curchack‐Lichtin, J. T., Chacko, A., & Halperin, J. M. (2014). Changes in ADHD symptom endorsement: Preschool to school

age. Journal of Abnormal Child Psychology, 42(6), 993–1004. Dahl, V., Ramakrishnan, A., Spears, A. P., Jorge, A., Lu, J., Bigio, N. A., & Chacko, A. (2020). Psychoeducation interventions

for parents and teachers of children and adolescents with ADHD: A systematic review of the literature. Journal of

developmental and physical disabilities, 32(2), 257–292. Daley, D., Van Der Oord, S., Ferrin, M., Cortese, S., Danckaerts, M., Doepfner, M., Van den Hoofdakker, B. J., Coghill, D.,

Thompson, M., Asherson, P., Banaschewski, T., Brandeis, D., Buitelaar, J., Dittmann, R. W., Hollis, C., Holtmann, M., Konofal, E., Lecendreux, M., Rothenberger, A., … Sonuga‐Barke E. J. (2018). Practitioner review: Current best practice in the use of parent training and other behavioural interventions in the treatment of children and adolescents with

attention deficit hyperactivity disorder. Journal of Child Psychology and Psychiatry, 59(9), 932–947. Danielson, M. L., Bitsko, R. H., Ghandour, R. M., Holbrook, J. R., Kogan, M. D., & Blumberg, S. J. (2018). Prevalence of

parent‐reported ADHD diagnosis and associated treatment among U.S. children and adolescents, 2016. Journal of Clinical Child & Adolescent Psychology, 47(2), 199–212.

Dawson, G., & Burner, K. (2011). Behavioral interventions in children and adolescents with autism spectrum disorder: A

review of recent findings. Current Opinion in Pediatrics, 23(6), 616–620. Dawson‐Squibb, J.‐J., Davids, E. L., Harrison, A. J., Molony, M. A., & de Vries, P. J. (2020). Parent education and training for

autism spectrum disorders: Scoping the evidence. Autism, 24(1), 7–25. Demopoulos, C., Hopkins, J., & Davis, A. (2013). A comparison of social cognitive profiles in children with autism spectrum

disorders and attention‐deficit/hyperactivity disorder: A matter of quantitative but not qualitative difference? Journal of Autism and Developmental Disorders, 43(5), 1157–1170.

DuPaul, G J., Chronis‐Tuscano, A., Danielson, M. L., & Visser, S. N. (2019). Predictors of receipt of school services in a national sample of youth with ADHD. Journal of attention disorders, 23(11), 1303–1319.

DuPaul, G J., Eckert, T. L., & Vilardo, B. (2012). The effects of school‐based interventions for attention deficit hyperactivity

disorder: A meta‐analysis 1996–2010. School psychology review, 41(4), 387–412. DuPaul, G. J., Fu, Q., Anastopoulos, A. D., Reid, R., & Power, T. J. (2020). ADHD parent and teacher symptom ratings:

Differential item functioning across gender, age, race, and ethnicity. Journal of Abnormal Child Psychology, 48(5), 679–691.

DuPaul, G. J., Gormley, M. J., & Laracy, S. D. (2013). Comorbidity of LD and ADHD: Implications of DSM‐5 for assessment

and treatment. Journal of Learning Disabilities, 46(1), 43–51. DuPaul, G. J., Power, T. J., Anastopoulos, A. D., & Reid, R. (1998). ADHD rating scale‐IV: Checklist, norms, and clinical

interpretation. Guilford Press. Elliott, C. (2007). Differential abilities scale (DAS‐II) Manual (2nd ed.). Harcourt Assessment, Inc. Esler A. N., & Godber Y, Christenson SL. Best Practices in Supporting Home‐School Collaboration. In: Best Practices in

School Psychology IV, Vols. 1–2. National Association of School Psychologists; 2002, 389–411. Evans, S. W., Langberg, J. M., Egan, T., & Molitor, S. J. (2014). Middle school–based and high school–based interventions for

adolescents with ADHD. Child and Adolescent Psychiatric Clinics of North America, 23(4), 699–715. Evans, S. W., Owens, J. S., Wymbs, B. T., & Ray, A. R. (2018). Evidence‐based psychosocial treatments for children and

adolescents with attention deficit/hyperactivity disorder. Journal of Clinical Child & Adolescent Psychology, 47(2),

157–198. Fabiano, G. A., Pelham, W. E., Manos, M. J., Gnagy, E. M., Chronis, A. M., Onyango, A. N., Lopez‐Williams, A., Burrows‐

MacLean, L., Coles, E. K., Meichenbaum, D. L., Caserta, D. A., & Swain, S. (2004). An evaluation of three time‐out procedures for children with attention‐deficit/hyperactivity disorder. Behavior Therapy, 35(3), 449–469.

Franke, N., Keown, L. J., & Sanders, M. R. (2020). An RCT of an online parenting program for parents of preschool‐aged children with ADHD symptoms. Journal of attention disorders, 24(12), 1716–1726.

Frankel, F., Myatt, R., Cantwell, D. P., & Feinberg, D. T. (1998). Parent‐assisted transfer of children's social skills training: Effects on children with and without attention‐deficit hyperactivity disorder. Annual Progress in Child Psychiatry and

Child Development, 36(8), 1056–1064.

HATCH ET AL. | 307

15206807, 2023, 2, D ow

nloaded from https://onlinelibrary.w

iley.com /doi/10.1002/pits.22808, W

iley O nline L

ibrary on [22/08/2023]. See the T erm

s and C onditions (https://onlinelibrary.w

iley.com /term

s-and-conditions) on W iley O

nline L ibrary for rules of use; O

A articles are governed by the applicable C

reative C om

m ons L

icense

Frankel, F., Myatt, R., Sugar, C., Whitham, C., Gorospe, C. M., & Laugeson, E. (2010). A randomized controlled study of parent‐assisted children's friendship training with children having autism spectrum disorders. Journal of Autism and

Developmental Disorders, 40(7), 827–842. Gates, J. A., Kang, E., & Lerner, M. D. (2017). Efficacy of group social skills interventions for youth with autism spectrum

disorder: A systematic review and meta‐analysis. Clinical Psychology Review, 52, 164–181. Green, J. L., Sciberras, E., Anderson, V., Efron, D., & Rinehart, N. (2016). Association between autism symptoms and

functioning in children with ADHD. Archives of Disease in Childhood, 101(10), 922–928. Greenhill, L., Kollins, S., Abikoff, H., Mccracken, J., Riddle, M., Swanson, J., Mcgough, J., Wigal, S., Wigal, T., Vitiello, B.,

Skrobala, A., Posner, K., Ghuman, J., Cunningham, C., Davies, M., Chuang, S., & Cooper, T. (2006). Efficacy and safety

of immediate‐release methylphenidate treatment for preschoolers with ADHD. Journal of the American Academy of

Child & Adolescent Psychiatry, 45(11), 1284–1293. Grzadzinski, R., Dick, C., Lord, C., & Bishop, S. (2016). Parent‐reported and clinician‐observed autism spectrum disorder

(ASD) symptoms in children with attention deficit/hyperactivity disorder (ADHD): Implications for practice under DSM‐5. Molecular Autism, 7(1), 7.

Halperin, J. M., & Marks, D. J. (2019). Practitioner review: Assessment and treatment of preschool children with attention‐ deficit/hyperactivity disorder. Journal of Child Psychology and Psychiatry, 60(9), 930–943.

Handen, B. L., Aman, M. G., Arnold, L. E., Hyman, S. L., Tumuluru, R. V., Lecavalier, L., Corbett‐Dick, P., Pan, X., Hollway, J. A., Buchan‐Page, K. A., Silverman, L. B., Brown, N. V., Rice, R. R., Jr, Hellings, J., Mruzek, D. W., McAuliffe‐ Bellin, S., Hurt, E. A., Ryan, M. M., Levato, L., … Smith, T. (2015). Atomoxetine, parent training, and their combination in

children with autism spectrum disorder and attention‐deficit/hyperactivity disorder. Journal of the American Academy

of Child & Adolescent Psychiatry, 54(11), 905–915. Handen, B. L., Johnson, C. R., & Lubetsky, M. (2000). Efficacy of methylphenidate among children with autism and

symptoms of attention‐deficit hyperactivity disorder. Journal of Autism and Developmental Disorders, 30(3), 245–255. Harrison, J. R., Bunford, N., Evans, S. W., & Owens, J. S. (2013). Educational accommodations for students with behavioral

challenges: A systematic review of the literature. Review of educational research, 83(4), 551–597. Harrison, P. L., & Oakland, T. (2000). Adaptive behavior assessment system. Psychological Corporation San Antonio. Hartman, C. A., Geurts, H. M., Franke, B., Buitelaar, J. K., & Rommelse, N. N. J. (2016). Changing ASD‐ADHD symptom co‐

occurrence across the lifespan with adolescence as crucial time window: Illustrating the need to go beyond childhood.

Neuroscience & Biobehavioral Reviews, 71, 529–541. Hinshaw, S. P. (2007). Moderators and mediators of treatment outcome for youth with ADHD: Understanding for whom

and how interventions work. Journal of Pediatric Psychology, 32(6), 664–675. Hinshaw, S P. (2018). Attention deficit hyperactivity disorder (ADHD): Controversy, developmental mechanisms, and

multiple levels of analysis. Annual review of clinical psychology, 14(1), 291–316. Hodges, A., Joosten, A., Bourke‐Taylor, H., & Cordier, R. (2020). School participation: The shared perspectives of parents

and educators of primary school students on the autism spectrum. Research in Developmental Disabilities, 97, 103550. Hogue, A., Horan Fisher, J., Dauber, S., Bobek, M., Porter, N., Henderson, C. E., & Evans, S. W. (2020). Randomized trial of

academic training and medication decision‐making for adolescents with ADHD in usual care. Journal of Clinical Child &

Adolescent Psychology, 50, 874–887. Hollingdale, J., Woodhouse, E., Young, S., Fridman, A., & Mandy, W. (2020). Autistic spectrum disorder symptoms in

children and adolescents with attention‐deficit/hyperactivity disorder: A meta‐analytical review. Psychological

Medicine, 50(13), 2240–2253. Hughes, C. A., & Dexter, D. D. (2011). Response to intervention: A research‐based summary. Theory Into Practice, 50(1),

4–11. Jang, J., Matson, J. L., Williams, L. W., Tureck, K., Goldin, R. L., & Cervantes, P. E. (2013). Rates of comorbid symptoms in

children with ASD, ADHD, and comorbid ASD and ADHD. Research in Developmental Disabilities, 34(8), 2369–2378. Jensen, P. S., HIinshaw, S. P., Swanson, J. M., Greenhil, L. L., Conners, C. K., Arnold, L. E., Abikoff, H. B., Elliott, G.,

Hechtman, L., Hoza, B., March, J. S., Newcorn, J. H., Severe, J. B., Vitello, B., Wells, K., & Wigel, T. (2001). Findings from the NIMH multimodal treatment study of ADHD (MTA): Implications and applications for primary care providers.

Journal of Developmental & Behavioral Pediatrics, 22, 60–73. Jepsen, M. I., Gray, K. M., & Taffe, J. R. (2012). Agreement in multi‐informant assessment of behaviour and emotional

problems and social functioning in adolescents with Autistic and Asperger's Disorder. Research in autism spectrum

disorders, 6(3), 1091–1098. Kaufman, J., Birmaher, B., Brent, D., Rao, U., Flynn, C., Moreci, P., Williamson, D., & Ryan, N. (1997). Schedule for affective disorders

and schizophrenia for school‐age children‐present and lifetime version (K‐SADS‐PL): Initial reliability and validity data. Journal of the American Academy of Child and Adolescent Psychiatry, 36(7), 980–988.

Keen, D., Webster, A., & Ridley, G. (2016). How well are children with autism spectrum disorder doing academically at school? An overview of the literature. Autism, 20(3), 276–294.

308 | HATCH ET AL.

15206807, 2023, 2, D ow

nloaded from https://onlinelibrary.w

iley.com /doi/10.1002/pits.22808, W

iley O nline L

ibrary on [22/08/2023]. See the T erm

s and C onditions (https://onlinelibrary.w

iley.com /term

s-and-conditions) on W iley O

nline L ibrary for rules of use; O

A articles are governed by the applicable C

reative C om

m ons L

icense

Kenworthy, L., Anthony, L. G., Naiman, D. Q., Cannon, L., Wills, M. C., Luong‐Tran, C., Werner, M. A., Alexander, K. C., Strang, J., Bal, E., Sokoloff, J. L., & Wallace, G. L. (2014). Randomized controlled effectiveness trial of executive function intervention for children on the autism spectrum. Journal of Child Psychology and Psychiatry, 55(4), 374–383.

Kotte, A., Joshi, G., Fried, R., Uchida, M., Spencer, A., Woodworth, K. Y., Kenworthy, T., Faraone, S. V., & Biederman, J. (2013). Autistic traits in children with and without ADHD. Pediatrics, 132(3), e612–e622. https://doi.org/10.1542/ peds.2012-3947

Langberg, J. M., Epstein, J. N., Becker, S. P., Girio‐Herrera, E., & Vaughn, A. J. (2012). Evaluation of the Homework, Organization, and Planning Skills (HOPS) intervention for middle school students with ADHD as implemented by school mental health providers. School psychology review, 41(3), 342–364.

Langberg, J. M., Vaughn, A. J., Williamson, P., Epstein, J. N., Girio‐Herrera, E., & Becker, S. P. (2011). Refinement of an organizational skills intervention for adolescents with ADHD for implementation by school mental health providers. School Mental Health, 3(3), 143–155.

Laugeson, E. A., Ellingsen, R., Sanderson, J., Tucci, L., & Bates, S. (2014). The ABC's of teaching social skills to adolescents with autism spectrum disorder in the classroom: the UCLA PEERS® program. Journal of Autism and Developmental

Disorders, 44(9), 2244–2256. Laugeson, E. A., Frankel, F., Gantman, A., Dillon, A. R., & Mogil, C. (2012). Evidence‐based social skills training for

adolescents with autism spectrum disorders: The UCLA PEERS program. Journal of Autism and Developmental

Disorders, 42(6), 1025–1036. Leaf, J. B., Cihon, J. H., Leaf, R., McEachin, J., Liu, N., Russell, N., Unumb, L., Shapiro, S., & Khosrowshahi, D. (2022).

Concerns about ABA‐Based intervention: An evaluation and recommendations. Journal of Autism and Developmental

Disorders, 52(6), 2838–2853. Lecavalier, L. (2006). Behavioral and emotional problems in young people with pervasive developmental disorders: Relative

prevalence, effects of subject characteristics, and empirical classification. Journal of Autism and Developmental

Disorders, 36(8), 1101–1114. Levy, S. E., Frasso, R., Colantonio, S., Reed, H., Stein, G., Barg, F. K., Mandell, D. S., & Fiks, A. G. (2016). Shared decision

making and treatment decisions for young children with autism spectrum disorder. Academic Pediatrics, 16(6), 571–578.

Little, L. M., Dean, E., Tomchek, S., & Dunn, W. (2018). Sensory processing patterns in autism, attention deficit hyperactivity

disorder, and typical development. Physical & Occupational Therapy in Pediatrics, 38(3), 243–254. Liverpool, S., Pereira, B., Hayes, D., Wolpert, M., & Edbrooke‐Childs, J. (2021). A scoping review and assessment of essential

elements of shared decision‐making of parent‐involved interventions in child and adolescent mental health. European Child & Adolescent Psychiatry, 30(9), 1319–1338.

Lord, C., Rutter, M., DiLavore, P. C., Gotham, K., & Bishop, S. (2012). Autism diagnostic observation schedule (2nd ed.).

Western Psychological Services. Lyall, K., Schweitzer, J. B., Schmidt, R. J., Hertz‐Picciotto, I., & Solomon, M. (2017). Inattention and hyperactivity in

association with autism spectrum disorders in the CHARGE study. Research in autism spectrum disorders, 35, 1–12. Maenner, M. J., Shaw, K. A., Baio, J., EdS1, Washington, A., Patrick, M., DiRienzo, M., Christensen, D. L., Wiggins, L. D.,

Pettygrove, S., Andrews, J. G., Lopez, M., Hudson, A., Baroud, T., Schwenk, Y., White, T., Rosenberg, C. R., Lee, L.‐C., Harrington, R. A., … Dietz, P. M. (2020). Prevalence of Autism Spectrum Disorder Among Children Aged 8 Years — Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2016. MMWR. Surveillance

Summaries, 69(4), 1–12. https://doi.org/10.15585/mmwr.ss6904a1 Makol, B. A., Youngstrom, E. A., Racz, S. J., Qasmieh, N., Glenn, L. E., & De Los Reyes, A. (2020). Integrating multiple

informants' reports: How conceptual and measurement models may address long‐standing problems in clinical

decision‐making. Clinical Psychological Science, 8(6), 953–970. Merrill, B. M., Morrow, A. S., Altszuler, A. R., Macphee, F. L., Gnagy, E. M., Greiner, A. R., Coles, E. K., Raiker, J. S., Coxe, S., &

Pelham, W. E. (2017). Improving homework performance among children with ADHD: A randomized clinical trial. Journal of Consulting and Clinical Psychology, 85(2), 111–122.

Mikami, A. Y., Miller, M., & Lerner, M. D. (2019). Social functioning in youth with attention‐deficit/hyperactivity disorder

and autism spectrum disorder: Transdiagnostic commonalities and differences. Clinical Psychology Review, 68, 54–70. Miodovnik, A., Harstad, E., Sideridis, G., & Huntington, N. (2015). Timing of the diagnosis of attention‐deficit/hyperactivity

disorder and autism spectrum disorder. Pediatrics, 136(4), e830–e837. Morris, S., Sheen, J., Ling, M., Foley, D., & Sciberras, E. (2021). Interventions for adolescents with ADHD to improve peer

social functioning: A systematic review and Meta‐Analysis. Journal of attention disorders, 25(10), 1479–1496. Mullen, E. M. (1995). Mullen Scales of Early Learning, AGS Edition: Manual and Item Administrative Books. American Guidance

Services, Inc. Mulqueen, J. M., Bartley, C. A., & Bloch, M. H. (2015). Meta‐analysis: Parental interventions for preschool ADHD. Journal of

attention disorders, 19(2), 118–124.

HATCH ET AL. | 309

15206807, 2023, 2, D ow

nloaded from https://onlinelibrary.w

iley.com /doi/10.1002/pits.22808, W

iley O nline L

ibrary on [22/08/2023]. See the T erm

s and C onditions (https://onlinelibrary.w

iley.com /term

s-and-conditions) on W iley O

nline L ibrary for rules of use; O

A articles are governed by the applicable C

reative C om

m ons L

icense

Narad, M. E., Garner, A. A., Peugh, J. L., Tamm, L., Antonini, T. N., Kingery, K. M., Simon, J. O., & Epstein, J. N. (2015). Parent–teacher agreement on ADHD symptoms across development. Psychological Assessment, 27(1), 239–248.

National Institute for Health and Care Excellence. (2018). Attention deficit hyperactivity disorder: Diagnosis and management

[NICE Guideline No. 87]. https://www.nice.org.uk/guidance/ng87 Patra, S., Nebhinani, N., Viswanathan, A., & Kirubakaran, R. (2019). Atomoxetine for attention deficit hyperactivity disorder

in children and adolescents with autism: A systematic review and meta‐analysis. Autism Research, 12(4), 542–552. Pellicano, E., & Houting, J. (2022). Annual Research Review: Shifting from ‘normal science’ to neurodiversity in autism

science. Journal of Child Psychology and Psychiatry, 63(4), 381–396. Rao, P. A., & Landa, R. J. (2014). Association between severity of behavioral phenotype and comorbid attention deficit

hyperactivity disorder symptoms in children with autism spectrum disorders. Autism, 18(3), 272–280. https://doi.org/ 10.1177/1362361312470494

Ratliff‐Black, M., & Therrien, W. (2021). Parent‐mediated interventions for school‐age children with ASD: A meta‐analysis. Focus on autism and other developmental disabilities, 36(1), 3–13.

Reiersen, A. M., Constantino, J. N., Volk, H. E., & Todd, R. D. (2007). Autistic traits in a population‐based ADHD twin

sample. Journal of Child Psychology and Psychiatry, 48(5), 464–472. https://doi.org/10.1111/j.1469-7610.2006. 01720.x

Reynolds, C. R., & Kamphaus, R. W. (2015). Behavior assessment system for children. Pearson. Richler, J., Huerta, M., Bishop, S. L., & Lord, C. (2010). Developmental trajectories of restricted and repetitive behaviors and

interests in children with autism spectrum disorders. Development and Psychopathology, 22(1), 55–69. Riddle, M. A., Yershova, K., Lazzaretto, D., Paykina, N., Yenokyan, G., Greenhill, L., Abikoff, H., Vitiello, B., Wigal, T.,

McCracken, J. T., Kollins, S. H., Murray, D. W., Wigal, S., Kastelic, E., McGough, J. J., dosReis, S., Bauzó‐Rosario, A., Stehli, A., & Posner, K. (2013). The preschool attention‐deficit/hyperactivity Disorder Treatment Study (PATS) 6‐year follow‐up. Journal of the American Academy of Child & Adolescent Psychiatry, 52(3), 264‐278.e2.

Rimestad, M. L., Lambek, R., Zacher Christiansen, H., & Hougaard, E. (2019). Short‐ and long‐term effects of parent training

for preschool children with or at risk of ADHD: A systematic review and meta‐analysis. Journal of attention disorders, 23(5), 423–434.

Roberts, J., & Webster, A. (2022). Including students with autism in schools: A whole school approach to improve outcomes for students with autism. International Journal of Inclusive Education, 26(7), 701–718.

Rodrigues, R., Lai, M., Beswick, A., Gorman, D. A., Anagnostou, E., Szatmari, P., Anderson, K. A., & Ameis, S. H. (2020). Practitioner review: Pharmacological treatment of attention‐deficit/hyperactivity disorder symptoms in children and youth with autism spectrum disorder: A systematic review and meta‐analysis. Journal of Child Psychology and

Psychiatry, 62, 680–700. Roid, G. H. (2003). Stanford Binet intelligence scales (5th ed.). Riverside Publishing.

Rowlandson, P. H., & Smith, C. (2009). An interagency service delivery model for autistic spectrum disorders and attention deficit hyperactivity disorder. Child: Care, Health and Development, 35(5), 681–690.

Rutter, M., Bailey, A., & Lord, C. (2003). The Social Communication Questionnaire. Western Psychological Services. Sandbank, M., Bottema‐Beutel, K., Crowley, S., Cassidy, M., Dunham, K., Feldman, J. I., Crank, J., Albarran, S. A., Raj, S.,

Mahbub, P., & Woynaroski, T. G. (2020). Project AIM: Autism intervention meta‐analysis for studies of young children.

Psychological Bulletin, 146(1), 1–29. Santosh, P., & Mijovic, A. (2004). Social impairment in hyperkinetic disorder: Relationship to psychopathology and

environmental stressors. European Child & Adolescent Psychiatry, 13, (3)141–150. Schreibman, L., Dawson, G., Stahmer, A. C., Landa, R., Rogers, S. J., McGee, G. G., Kasari, C., Ingersoll B., Kaiser A. P.,

Bruinsma Y., McNerney E., Wetherby A., & Halladay A. (2015). Naturalistic developmental behavioral interventions:

Empirically validated treatments for autism spectrum disorder. Journal of Autism and Developmental Disorders, 45(8), 2411–2428.

Shaffer, D., Fisher, P., Lucas, C. P., Dulcan, M. K., & Schwab‐Stone, M. E. (2000). NIMH Diagnostic Interview Schedule for Children Version IV (NIMH DISC‐IV): Description, differences from previous versions, and reliability of some common diagnoses. Journal of the American Academy of Child & Adolescent Psychiatry, 39(1), 28–38.

Shattuck, P. T., Seltzer, M. M., Greenberg, J. S., Orsmond, G. I., Bolt, D., Kring, S., Lounds, J., & Lord, C. (2007). Change in autism symptoms and maladaptive behaviors in adolescents and adults with an autism spectrum disorder. Journal of Autism and Developmental Disorders, 37(9), 1735–1747.

Sibley, M. H., Pelham, W. E., Molina, B. S. G., Gnagy, E. M., Waschbusch, D. A., Garefino, A. C., Kuriyan, A. B., Babinski, D. E.,

& Karch, K. M. (2012). Diagnosing ADHD in adolescence. Journal of Consulting and Clinical Psychology, 80(1), 139–150. Sikora, D. M., Vora, P., Coury, D. L., & Rosenberg, D. (2012). Attention‐deficit/hyperactivity disorder symptoms, adaptive

functioning, and quality of life in children with autism spectrum disorder. Pediatrics, 130(Suppl 2), S91–S97. Sinzig, J., Morsch, D., & Lehmkuhl, G. (2008). Do hyperactivity, impulsivity and inattention have an impact on the ability of

facial affect recognition in children with autism and ADHD? European Child and Adolescent Psychiatry, 17, 63–72.

310 | HATCH ET AL.

15206807, 2023, 2, D ow

nloaded from https://onlinelibrary.w

iley.com /doi/10.1002/pits.22808, W

iley O nline L

ibrary on [22/08/2023]. See the T erm

s and C onditions (https://onlinelibrary.w

iley.com /term

s-and-conditions) on W iley O

nline L ibrary for rules of use; O

A articles are governed by the applicable C

reative C om

m ons L

icense

Sinzig, J., Walter, D., & Doepfner, M. (2009). Attention deficit/hyperactivity disorder in children and adolescents with autism spectrum disorder: Symptom or syndrome? Journal of attention disorders, 13(2), 117–126.

Skarphedinsson, G., Jarbin, H., Andersson, M., & Ivarsson, T. (2021). Diagnostic efficiency and validity of the DSM‐oriented Child Behavior Checklist and Youth Self‐Report scales in a clinical sample of Swedish youth. PLoS One, 16(7), e0254953.

Sonuga‐Barke, E. J. S., Minocha, K., Taylor, E. A., & Sandberg, S. (1993). Inter‐ethnic bias in teachers’ ratings of childhood hyperactivity. British Journal of Developmental Psychology, 11(2), 187–200.

Sonuga‐Barke, E. J. S., & Thapar, A. (2021). The neurodiversity concept: is it helpful for clinicians and scientists? The Lancet Psychiatry, 8(7), 559–561.

Sparrow, S. S., Cicchetti, D., & Balla, D. A. (2012). Vineland Adaptive Behavior Scales, Second Edition [Data set]. American Psychological Association.

Sturman, N., Deckx, L., & van Driel, M. L. (2017). Methylphenidate for children and adolescents with autism spectrum disorder. Cochrane Database of Systematic Reviews, 2017(11), 2411–2428.

Tamm, L., Zoromski, A. K., Kneeskern, E. E., Patel, M., Lacey, H. M., Vaughn, A. J., Ciesielski, H. A., Weadick, H. K., &

Duncan, A. W. (2021). Achieving independence and mastery in school: An open trial in the outpatient setting. Journal of Autism and Developmental Disorders, 51(5), 1705–1718.

Tarver, J., Palmer, M., Webb, S., Scott, S., Slonims, V., Simonoff, E., & Charman, T. (2019). Child and parent outcomes following parent interventions for child emotional and behavioral problems in autism spectrum disorders: A systematic review and meta‐analysis. Autism, 23(7), 1630–1644.

Trout, A. L., Ortiz Lienemann, T., Reid, R., & Epstein, M. H. (2007). A review of non‐medication interventions to improve the academic performance of children and youth with ADHD. Remedial and Special Education, 28(4), 207–226.

Uekermann, J., Kraemer, M., Abdel‐Hamid, M., Schimmelmann, B. G., Hebebrand, J., Daum, I., Wiltfang, J., & Kis, B. (2010). Social cognition in attention‐deficit hyperactivity disorder (ADHD). Neuroscience and Biobehavioral Reviews, 34(5), 734–743.

Van der Oord, S., Prins, P. J. M., Oosterlaan, J., & Emmelkamp, P. M. G. (2008). Efficacy of methylphenidate, psychosocial treatments and their combination in school‐aged children with ADHD: A meta‐analysis. Clinical Psychology Review, 28(5), 783–800.

Waizbard‐Bartov, E., Ferrer, E., Young, G. S., Heath, B., Rogers, S., Wu Nordahl, C., Solomon, M., & Amaral, D. G. (2021).

Trajectories of Autism Symptom Severity Change During Early Childhood. Journal of Autism and Developmental

Disorders, 51(1), 227–242. Wechsler, D. (2003). Wechsler Intelligence Scale for Children‐Fourth Edition (WISC‐IV). Psychological Corporation. Wechsler, D. (2011). Wechsler Abbreviated Scale of Intelligence‐Second Edition (WASI‐II). Pearson. Whalon, K. J., Conroy, M. A., Martinez, J. R., & Werch, B. L. (2015). School‐based peer‐related social competence

interventions for children with autism spectrum disorder: A meta‐analysis and descriptive review of single case research design studies. Journal of Autism and Developmental Disorders, 45(6), 1513–1531

Wolraich, M. L., Hagan, J. F., Allan, C., Chan, E., Davison, D., Earls, M., Evans, S. W., Flinn, S. K., Froehlich, T., Frost, J., Holbrook, J. R., Lehmann, C. U., Lessin, H. R., Okechukwu, K., Pierce, K. L., Winner, J. D., Zurhellen, W., & Subcommittee on children and adolescents with attention‐deficit/hyperactive disorder. (2019). Clinical practice

guideline for the diagnosis, evaluation, and treatment of attention‐deficit/hyperactivity disorder in children and adolescents. Pediatrics, 144(4), e20192528.

Yerys, B. E., Wallace, G. L., Sokoloff, J. L., Shook, D. A., James, J. D., & Kenworthy, L. (2009). Attention deficit/hyperactivity disorder symptoms moderate cognition and behavior in children with autism spectrum disorders. Autism Research, 2(6), 322–333.

Yoshida, Y., & Uchiyama, T. (2004). The clinical necessity for assessing attention deficit/hyperactivity disorder (AD/HD) symptoms in children with high‐functioning pervasive developmental disorder (PDD). European Child & Adolescent

Psychiatry, 13(5), 307–314. https://doi.org/10.1007/s00787-004-0391-1 Young, S., Hollingdale, J., Absoud, M., Bolton, P., Branney, P., Colley, W., Craze, E., Dave M., Deeley Q., Farrag E.,

Gudjonsson G., Hill P., Liang H. L., Murphy C., Mackintosh P., Murin M., O'Regan F., Ougrin D., Rios P., … Woodhouse E. (2020). Guidance for identification and treatment of individuals with attention deficit/hyperactivity disorder and autism spectrum disorder based upon expert consensus. BMC Medicine, 18(1), 146.

How to cite this article: Hatch, B., Kadlaskar, G., & Miller, M. (2023). Diagnosis and treatment of children

and adolescents with autism and ADHD. Psychology in the Schools, 60, 295–311.

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