Cognitive and behavioral profiles in children with autism spectrum disorder with and without Attention-Deficit/hyperactivity disorder

Background Understanding the developmental trajectories of children with autism spectrum disorder (ASD) with and without comorbid ADHD is relevant to tailor care plans. This prospective study assessed, for the first time, cognitive, emotional, behavioral, and learning outcomes in adolescence of children with ASD-ADHD and in those with ASD+ADHD in childhood. Possible predictors of severity of ASD core symptoms in adolescence were also evaluated. Methods Forty-five adolescents without intellectual disability, 26 diagnosed in childhood with ASD-ADHD and 19 with ASD+ADHD, were evaluated at baseline (mean age: 8.6 +/- 1.3) and at 5-year follow-up (mean age: 12.9 +/- 0.9). Parents and teachers completed questionnaires on executive functions, theory of mind (ToM), emotional/behavioral difficulties (EBD), and learning style at both time points.. Results Overall different developmental trajectories for the two groups were found. In general, deficits in metacognition processes, ToM skills, EBD, and learning abilities were more pronounced in the ASD+ group. Over time, the ASD+ADHD group, but not the ASD-ADHD, tended to improve in EBD and metacognition but their level of development continued to be lower compared with ASD+ADHD. EBD in childhood were significant predictors of autism core symptoms of adolescents. Conclusions Our findings highlight the importance of an early identification of comorbid ADHD symptoms in ASD to offer treatment strategies based on specific developmental trajectories.