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Evaluation of the ADHD Rating Scale in Youth with Autism


Scientists and clinicians regularly use clinical screening tools for attention deficit/hyperactivity disorder (ADHD) to assess comorbidity without empirical evidence that these measures are valid in youth with autism spectrum disorder (ASD). We examined the prevalence of youth meeting ADHD criteria on the ADHD rating scale fourth edition (ADHD-RS-IV), the relationship of ADHD-RS-IV ratings with participant characteristics and behaviors, and its underlying factor structure in 386, 7–17 year olds with ASD without intellectual disability. Expected parent prevalence rates, relationships with age and externalizing behaviors were observed, but confirmatory factor analyses revealed unsatisfactory fits for one-, two-, three-factor models. Exploratory analyses revealed several items cross-loading on multiple factors. Implications of screening ADHD in youth with ASD using current diagnostic criteria are discussed.

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  1. A total of 9 children had IQ scores below 70, the traditional cut-off for establishing an Intellectual Disability diagnosis. Excluding these children had no significant effect on our results. For example, on all confirmatory factor analyses changes in fit indices was 0.002 or less. For this reason, we elected to include these children in our final sample.


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We would like to thank the youth and family members who gave their time and energy to participate in this study. The study was sponsored by grants from the National Institute of Mental Health (K23MH086111; PI: B.E. Yerys, R21MH092615; PI: B.E. Yerys, RC1MH088791; R.T. Schultz), and a New Program Development Award to B.E. Yerys through the Intellectual and Developmental Disabilities Research Center funded by the Eunice Kennedy Shriver National Institute of Child and Human Development (P30HD026979; PI: M. Yudkoff), a grant from the Philadelphia Foundation, a grant from the Pennsylvania Department of Health (SAP #4100042728) to R.T. Schultz, a grant from the Pennsylvania Department of Health (SAP #4100047863) to R.T. Schultz, a grant from Pfizer to R.T. Schultz, and a grant from the Robert Wood Johnson Foundation, #6672 to R.T. Schultz. T.J. Power receives compensation for the ADHD-IV rating scale.

Author Contributions

BEY, JNT, AdM, TJP, and RTS conceived the study’s key aims and objectives. LA contributed to data collection, data cleaning, and preliminary analyses. MWW conducted factor analyses, interpretation, and drafting of factor analyses. BEY drafted the initial manuscript with significant revisions from all authors.

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Correspondence to Benjamin E. Yerys.

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Conflict of Interest

Thomas J. Power receives financial compensation for the ADHD rating scale 4th edition. Benjamin E. Yerys declares that he has no conflict of interest. Jenelle Nissley-Tsiopinis declares that she has no conflict of interest. Ashley de Marchena declares that she has no conflict of interest. Marley W. Watkins declares that he has no conflict of interest. Ligia Antezana declares that she has no conflict of interest. Robert T. Schultz declares that he has no conflict of interest.

Ethical Approval

All procedures performed in this study with human participants were in accordance with the ethical standards of the institutional research board committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This included obtaining informed parental consent and child assent for all participants.

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Yerys, B.E., Nissley-Tsiopinis, J., de Marchena, A. et al. Evaluation of the ADHD Rating Scale in Youth with Autism. J Autism Dev Disord 47, 90–100 (2017).

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  • Autism
  • Attention deficit/hyperactivity disorder
  • Comorbidity
  • Screening
  • Factor analysis