Conceptualisation Paradigms for Childhood Autism and ADHD Co-occurrence: A Brief Review and Clinical Implications

Michael Ogundele

doi:10.58600/eurjther2502

Authors

Michael Ogundele Department of Community Paediatrics, King’s Mill Hospital, Sutton in Ashfield, UK https://orcid.org/0000-0003-0744-1434

DOI:

https://doi.org/10.58600/eurjther2502

Keywords:

Autism spectrum disorder, Attention Deficit and Hyperactivity Disorder, neurodevelopmental, Behavioral Disorder, Disability, Comorbidity, co-occurrence, Neuroconstructivism, Severe ASD Spectrum, Overarching Spectrum of ASD-ADHD disorder

Abstract

Objectives: ‘Neurodevelopmental disorders’ (NDD) and their related emotional, behavioural, and intellectual disorders (NDEBIDs) include ASD, ADHD and tic disorders. Co-occurrence of NDEBID with each other and with other mental health disorders is the norm. We aimed to review recent research up to March 2024, reporting on the comorbidity of discrete NDEBIDs in general and focus more specifically on the co-occurrence of ADHD and ASD.

Methods: This is a narrative review of recent research up to March 2024, reporting on the comorbidity of discrete NDEBIDs in general and focus more specifically on the co-occurrence of ADHD and ASD.

Results: Four alternative hypotheses are reviewed to conceptualise how co-occurring NDDs are described. These are concepts of Neuroconstructivism, ‘Neurodevelopmental Disability’, ‘Overarching Spectrum of ASD-ADHD disorder’ and ‘Severe ASD Spectrum’.
Neuroconstructivism argues that the brain gradually acquires specialised functions over its developmental period. The term ‘Neurodevelopmental Disability’ has been proposed as an alternative generic term for all NDEBIDs instead of separate discrete diagnoses.
An ‘overarching Spectrum of ASD-ADHD disorder’ has been proposed for children and young people (CYP) presenting with range of symptoms across both diagnostic categories. Other researchers have conceptualised the idea of co-occurring ASD and ADHD as a form of ‘severe Autism’ with a unique attentional trait and associated functional impairments, rather than two separate diagnoses.

Conclusion: The clinical and therapeutic implications for the ADHD-ASD co-occurrence are discussed. A unified description of NDEBID would buttress their common aetiologies. This would also encourage practitioners not to restrict individuals into constrained diagnostic boxes but to consider the full range of their difficulties, even if they do not meet the seemingly arbitrary threshold levels for diagnosis of the individual conditions.
Further research is needed to help analyse important peculiar neuropsychological features among individuals with the co-occurring ASD/ADHD features.

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