High Concordance of Parent and Teacher Attention-Deficit/Hyperactivity Disorder Ratings in Medicated and Unmedicated Children with Autism Spectrum Disorders

Abstract

Objective: Parent and teacher ratings of core attention-deficit/hyperactivity disorder (ADHD) symptoms, as well as behavioral and emotional problems commonly comorbid with ADHD, were compared in children with autism spectrum disorders (ASD). Method: Participants were 86 children (66 boys; mean: age = 9.3 years, intelligence quotient [IQ] = 84) who met American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM-IV) criteria for an ASD on the Autism Diagnostic Interview-Revised (ADI-R) and the Autism Diagnostic Observation Schedule (ADOS). Parent and teacher behavioral ratings were compared on the Conners' Parent and Teacher Rating Scales (CPRS-R; CTRS-R). The degree to which age, ASD subtype, severity of autistic symptomatology, and medication status mediated this relationship was also examined. Results: Significant positive correlations between parent and teacher ratings suggest that a child's core ADHD symptoms-as well as closely related externalizing symptoms-are perceived similarly by parents and teachers. With the exception of oppositional behavior, there was no significant effect of age, gender, ASD subtype, or autism severity on the relationship between parent and teacher ratings. In general, parents rated children as having more severe symptomatology than did teachers. Patterns of parent and teacher ratings were highly correlated, both for children who were receiving medication, and for children who were not. Conclusions: Parents and teachers perceived core symptoms of ADHD and closely-related externalizing problems in a similar manner, but there is less agreement on ratings of internalizing problems (e.g., anxiety). The clinical implication of these findings is that both parents and teachers provide important behavioral information about children with ASD. However, when a clinician is unable to access teacher ratings (e.g., during school vacations), parent ratings can provide a reasonable estimate of the child's functioning in these domains in school. As such, parent ratings can be reliably used to make initial diagnostic and treatment decisions (e.g., medication treatment) regarding ADHD symptoms in children with ASDs.

Effects of Extended Release Methylphenidate Treatment on Ratings of Attention-Deficit/Hyperactivity Disorder (ADHD) and Associated Behavior in Children with Autism Spectrum Disorders and ADHD Symptoms

“…Our findings in this study are very consistent with those of the RUPP (2005) study of MPH treatment in children with ASD and symptoms of ADHD, perhaps reflecting the fact that the highest dose administered in this trial was nearly identical to that of the dose in the RUPP (0.50 mg/kg). As our group has noted (Pearson et al 2012), it may be that parents of children with ASD share a similar perspective with teachers. Whatever the reason, it appears that clinicians can feel confident in titrating medication under circumstances in which only parent ratings are available.…”

“…Although parents and teachers are generally consistent with each other in their behavioral ratings (see Pearson et al 2012), clinicians may find that teachers report effective response to treatment before parents are able to detect improvement in the home. Therefore, it is ideal for clinicians to assess behavioral response in both the home and school settings when titrating MPH treatment in children with ASD and significant ADHD symptomatology.…”

The comorbidity of ADHD and autism spectrum disorder

“…For example, Pearson et al studied 86 children with ASD (mean age = 9) and assessed parent and teacher concordance on ADHD ratings [30]. Concordance levels were generally in the 0.4-0.6 range for ADHD symptoms and these levels did not vary as a function of child age, gender, medication status, ASD subtype or ASD severity [30]. These concordance rates are comparable with (or somewhat higher than) those in the non-ASD ADHD population [31].…”

Inattention and hyperactivity in association with autism spectrum disorders in the CHARGE study

“…For example, work from the National Survey of Children’s Health found that approximately 20% of nearly 1,500 children aged 2–17 with parent-reported ASD were initially given a diagnosis of ADHD, and were diagnosed with ASD three years later than children without ADHD concerns (Miodovnik et al 2015). Studies also indicate differences in response to treatments based on presence/absence of ADHD symptoms in children with ASD (Antshel et al 2011; Cortese et al 2012; Pearson et al 2012; Simonoff et al 2013). Finally, concerns about attention problems, in both those with ASD and their siblings, that persist into middle childhood and school settings also underscore the importance of developing a better understanding of how the two disorders manifest alone and together in childhood (Miller et al 2015).…”