Overlapping and Distinct Cognitive Impairments in Attention-Deficit/Hyperactivity and Autism Spectrum Disorder without Intellectual Disability
Attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) are commonly comorbid, share genetic liability, and often exhibit overlapping cognitive impairments. Clarification of shared and distinct cognitive effects while considering comorbid symptoms across disorders has been lacking. In the current study, children ages 7–15 years assigned to three diagnostic groups:ADHD (n = 509), ASD (n = 97), and controls (n = 301) completed measures spanning the cognitive domains of attention/arousal, working memory, set-shifting, inhibition, and response variability. Specific processes contributing to response variability were examined using a drift diffusion model, which separately quantified drift rate (i.e., efficiency of information processing), boundary separation (i.e., speed-accuracy trade-offs), and non-decision time. Children with ADHD and ASD were impaired on attention/arousal, processing speed, working memory, and response inhibition, but did not differ from controls on measures of delayed reward discounting, set-shifting, or interference control. Overall, impairments in the ASD group were not attributable to ADHD symptoms using either continuous symptom measures or latent categorical grouping approaches. Similarly, impairments in the ADHD group were not attributable to ASD symptoms. When specific RT parameters were considered, children with ADHD and ASD shared impairments in drift rate. However, children with ASD were uniquely characterized by a wider boundary separation. Findings suggest a combination of overlapping and unique patterns of cognitive impairment for children with ASD as compared to those with ADHD, particularly when the processes underlying reaction time measures are considered separately.
KeywordsAttention-deficit/hyperactivity disorder (ADHD) Autism spectrum disorders (ASD) Executive function Neuropsychology Reaction time variability Diffusion model
This project was supported by Simons Foundation #177894 and by National Institutes of Health R01 MH096773 (Fair), R00MH091238 (Fair), R01 MH086654 (Nigg), R37 MH059105 13 (Nigg), and K23 MH108656 (Karalunas). We thank Corinne Stevens, Libby Nousen, and Andrew Bontemps for assistance with data collection and preparation. We gratefully acknowledge the participants and their caregivers, as well as the graduate students, staff, and research assistants whose remarkable dedication has made this research possible.
Compliance with Ethical Standards
Conflict of Interest
The authors have no conflicts of interest or financial disclosures to report.
All procedures were approved by the Oregon Health & Science University’s Institutional Review Board.
Parents provided written informed consent and children provided written assent.
- Benjamini, Y., & Hochberg, Y. (1995). Controlling the false discovery rate: a practical and powerful approach to multiple testing. Journal of the royal statistical society. Series B (Methodological), 289–300.Google Scholar
- Bishop, D. V. M. (2003). The Children’s Communication Checklist, Second Edition (CCC-2). London: The Psychological Corporation.Google Scholar
- Conners, C. K. (2008). The Conners 3rd Edition (Conners 3). North Tonawanda: Multi-Health System.Google Scholar
- Constantino, J. N., & Gruber, C. P. (2012). The social responsiveness scale, Second Edition (SRS-2). Los Angeles: Western Psychological Services.Google Scholar
- Corbett, B. A., Constantine, L. J., Hendren, R., Rocke, D., & Ozonoff, S. (2009). Examining executive functioning in children with autism spectrum disorder, attention deficit hyperactivity disorder and typical development. Psychiatry Research, 166(2), 210–222.CrossRefPubMedPubMedCentralGoogle Scholar
- De Luca, C. R., Wood, S. J., Anderson, V., Buchanan, J. A., Proffitt, T. M., Mahony, K., & Pantelis, C. (2003). Normative data from the CANTAB. I: development of executive function over the lifespan. Journal of Clinical Experimental Neuropsychology, 25(2), 242–254. https://doi.org/10.1076/jcen.184.108.40.20639.CrossRefPubMedGoogle Scholar
- Delis, D. C., Kaplan, E., & Kramer, J. H. (2001). Delis-Kaplan Executive Function System (D-KEFS). San Antonio: The Pscyhological Corporation.Google Scholar
- Di Martino, A., Zuo, X.-N., Kelly, C., Grzadzinski, R., Mennes, M., Schvarcz, A., & Milham, M. P. (2013). Shared and distinct intrinsic functional network centrality in autism and attention-deficit/hyperactivity disorder. Biological Psychiatry, 74(8), 623–632.CrossRefPubMedPubMedCentralGoogle Scholar
- DuPaul, G., Power, T., Anastopoulos, A., & Reid, R. (1998). ADHD Rating Scale—IV: Checklists, Norms, and Clinical Interpretation. NY: Guilford Press.Google Scholar
- Fair, D. A., Bathula, D., Nikolas, M. A., & Nigg, J. T. (2012). Distinct neuropsychological subgroups in typically developing youth inform heterogeneity in children with ADHD. Proceedings of the National Academy of Sciences of the USA, 109(17), 6769–6774. https://doi.org/10.1073/pnas.1115365109.CrossRefPubMedPubMedCentralGoogle Scholar
- Happe, F., Booth, R., Charlton, R., & Hughes, C. (2006). Executive function deficits in autism spectrum disorders and attention-deficit/hyperactivity disorder: examining profiles across domains and ages. Brain and Cognition, 61(1), 25–39. https://doi.org/10.1016/j.bandc.2006.03.004.CrossRefPubMedGoogle Scholar
- Harris, P. A., Taylor, R., Thielke, R., Payne, J., Gonzalez, N., & Conde, J. G. (2009). Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. Journal of Biomedical Informatics, 42(2), 377–381. https://doi.org/10.1016/j.jbi.2008.08.010.CrossRefPubMedGoogle Scholar
- Hulst, B. M., Zeeuw, P., Bos, D. J., Rijks, Y., Neggers, S. F., & Durston, S. (2017). Children with ADHD symptoms show decreased activity in ventral striatum during the anticipation of reward, irrespective of ADHD diagnosis. Journal of Child Psychology and Psychiatry, 58(2), 206–214.CrossRefPubMedGoogle Scholar
- Insel, T., Cuthbert, B., Garvey, M., Heinssen, R., Pine, D. S., Quinn, K., & Wang, P. (2010). Research domain criteria (RDoC): toward a new classification framework for research on mental disorders. The American Journal of Psychiatry, 167(7), 748–751. https://doi.org/10.1176/appi.ajp.2010.09091379.CrossRefPubMedGoogle Scholar
- Kane, M.J., Conway, A., Hambrick, D.Z., & Engle, R.W. (2007). Variation in working memory capacity as variation in executive attention and control Variation in Working Memory (pp. 21–48).Google Scholar
- Karalunas, S. L., Geurts, H. M., Konrad, K., Bender, S., & Nigg, J. T. (2014). Annual research review: Reaction time variability in ADHD and autism spectrum disorders: measurement and mechanisms of a proposed trans-diagnostic phenotype. Journal of Child Psychology and Psychiatry, 55(6), 685–710. https://doi.org/10.1111/jcpp.12217.CrossRefPubMedPubMedCentralGoogle Scholar
- Karalunas, S. L., Gustafsson, H. C., Dieckmann, N., Tipsord, J., Mitchell, S. H., & Nigg, J. T. (2017). Heterogeneity in development of aspects of working memory predicts longitudinal ADHD symptom change. Journal of Abnormal Psychology, 126(6), 774.Google Scholar
- Logan, G. (1994). On the ability to inhibit thought and action: A users' guide to the stop signal paradigm. In D. Dagenbach & T. H. Carr (Eds.), Inhibitory processes in attention, memory, and language (pp. 189–239). San Diego: Academic Press.Google Scholar
- Lord, C., Rutter, M., DiLavore, P. C., & Risi, S. (2001). Autism Diagnostic Observation Schedule (ADOS). Los Angeles: Western Psychological Services.Google Scholar
- McDonald, J. H. (2014). Handbook of Biological Statistics (3rd ed.). Baltimore: Sparky House Publishing.Google Scholar
- Musser, E. D., Hawkey, E., Kachan-Liu, S. S., Lees, P., Roullet, J. B., Goddard, K., & Nigg, J. T. (2014). Shared familial transmission of autism spectrum and attention-deficit/hyperactivity disorders. Journal of Child Psychology and Psychiatry, 55(7), 819–827. https://doi.org/10.1111/jcpp.12201.CrossRefPubMedPubMedCentralGoogle Scholar
- Nyden, A., Niklasson, L., Stahlberg, O., Anckarsater, H., Wentz, E., Rastam, M., & Gillberg, C. (2010). Adults with autism spectrum disorders and ADHD neuropsychological aspects. Research in Developmental Disabilities, 31(6), 1659–1668. https://doi.org/10.1016/j.ridd.2010.04.010.CrossRefPubMedGoogle Scholar
- Puig-Antich, J., & Ryan, N. (1986). Kiddie schedule for affective disorders and schizophrenia. Pittsburgh: Western Psychiatric Institute.Google Scholar
- Raymaekers, R., Antrop, I., van der Meere, J. J., Wiersema, J. R., & Roeyers, H. (2007). HFA and ADHD: a direct comparison on state regulation and response inhibition. Journal of Clinical and Experimental Neuropsychology, 29(4), 418–427. https://doi.org/10.1080/13803390600737990.CrossRefPubMedGoogle Scholar
- Rommelse, N., Geurts, H., Franke, B., Buitelaar, J., & Hartman, C. (2011). A review on cognitive and brain endophenotypes that may be common in autism spectrum disorder and attention-deficit/hyperactivity disorder and facilitate the search for pleiotropic genes. Neuroscience & Biobehavioral Reviews, 35, 1363–1396.CrossRefGoogle Scholar
- Rommelse, N. N., Franke, B., Geurts, H. M., Hartman, C. A., & Buitelaar, J. K. (2010). Shared heritability of attention-deficit/hyperactivity disorder and autism spectrum disorder. European Child & Adolescent Psychiatry, 19(3), 281–295. https://doi.org/10.1007/s00787-010-0092-x.CrossRefGoogle Scholar
- Ronald, A., Simonoff, E., Kuntsi, J., Asherson, P., & Plomin, R. (2008). Evidence for overlapping genetic influences on autistic and ADHD behaviours in a community twin sample. Journal of Child Psychology and Psychiatry, 49(5), 535–542. https://doi.org/10.1111/j.1469-7610.2007.01857.x.CrossRefPubMedGoogle Scholar
- Rutter, M., Le Couteur, A., & Lord, C. (2003). Autism Diagnostic Interview–Revised (ADI-R). Los Angeles: Western Psychological Services.Google Scholar
- Sanislow, C. A., Pine, D. S., Quinn, K. J., Kozak, M. J., Garvey, M. A., Heinssen, R. K., & Cuthbert, B. N. (2010). Developing constructs for psychopathology research: research domain criteria. Journal of Abnormal Psychology, 119(4), 631–639. https://doi.org/10.1037/a0020909.CrossRefPubMedGoogle Scholar
- Semrud-Clikeman, M., Walkowiak, J., Wilkinson, A., & Butcher, B. (2010). Executive functioning in children with Asperger syndrome, ADHD-combined type, ADHD-predominately inattentive type, and controls. Journal of Autism and Developmental Disorders, 40(8), 1017–1027. https://doi.org/10.1007/s10803-010-0951-9.CrossRefPubMedGoogle Scholar
- van der Meer, J. M., Oerlemans, A. M., van Steijn, D. J., Lappenschaar, M. G., de Sonneville, L. M., Buitelaar, J. K., & Rommelse, N. N. (2012). Are autism spectrum disorder and attention-deficit/hyperactivity disorder different manifestations of one overarching disorder? Cognitive and symptom evidence from a clinical and population-based sample. Journal of the American Academy of Child and Adolescent Psychiatry, 51(11), 1160–1172 e1163. https://doi.org/10.1016/j.jaac.2012.08.024.CrossRefPubMedGoogle Scholar
- Willcutt, E. G., Doyle, A., Nigg, J. T., Faraone, S. V., & Pennington, B. F. (2005). Validity of the executive function theory of attention-deficit/hyperactivity disorder: A meta-analytic review. Biological Psychiatry, 57(11), 1336–1346. https://doi.org/10.1016/j.biopsych.2005.02.006.CrossRefPubMedGoogle Scholar