Guidance for identification and treatment of individuals with attention deficit/hyperactivity disorder and autism spectrum disorder based upon expert consensus

Susan Young¹, Jack Hollingdale², Michael Absoud^{3

4}, Patrick Bolton², Polly Branney⁵, William Colley⁶, Emily Craze⁷, Mayuri Dave⁸, Quinton Deeley⁷, Emad Farrag⁹, Gisli Gudjonsson¹⁰, Peter Hill¹¹, Ho-Lan Liang¹², Clodagh Murphy^{13

14}, Peri Mackintosh⁷, Marianna Murin¹⁵, Fintan O'Regan¹⁶, Dennis Ougrin¹⁷, Patricia Rios¹⁸, Nancy Stover¹⁹, Eric Taylor¹⁷, Emma Woodhouse¹⁴

Affiliations

¹ Psychology Services Limited, London, UK. suzyyoung@aol.com.
² South London & Maudsley NHS Foundation Trust, Service for Complex Autism and Associated Neurodevelopmental Disorders, London, UK.
³ Department of Children's Neurosciences, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK.
⁴ Department of Women & Children's Health, King's College, London, UK.
⁵ Oxford ADHD & Autism Centre, Oxford, UK.
⁶ CLC Consultancy, Perth, UK.
⁷ South London & Maudsley NHS Foundation Trust, National Autism Unit, Kent, UK.
⁸ Positive Behaviour, Learning Disability, Autism and Mental Health Service (PALMS) Hertfordshire Communication Disorders Clinics, Hertfordshire Community NHS Trust, St Albans, UK.
⁹ South London & Maudsley NHS Foundation Trust, Maudsley Health, Abu Dhabi, UAE.
¹⁰ Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
¹¹ Private Practice, London, UK.
¹² Great Ormond Street Hospital, London, UK.
¹³ Behavioural and Developmental Psychiatry Clinical Academic Group, Behavioural Genetics Clinic, National Adult Autism and ADHD Service, South London and Maudsley Foundation NHS Trust, London, UK.
¹⁴ Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
¹⁵ Anna Freud Centre, London, UK.
¹⁶ Helen Arkell Centre, Guildford, UK.
¹⁷ Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
¹⁸ Diagnostic Assessments and Treatment Services (DATS), Hertfordshire, UK.
¹⁹ Stover Consultancy, Santa Barbara, CA, USA.

PMID: 32448170
PMCID: PMC7247165
DOI: 10.1186/s12916-020-01585-y

Guidance for identification and treatment of individuals with attention deficit/hyperactivity disorder and autism spectrum disorder based upon expert consensus

Susan Young et al. BMC Med. 2020.

. 2020 May 25;18(1):146.

doi: 10.1186/s12916-020-01585-y.

Authors

Affiliations

¹ Psychology Services Limited, London, UK. suzyyoung@aol.com.
² South London & Maudsley NHS Foundation Trust, Service for Complex Autism and Associated Neurodevelopmental Disorders, London, UK.
³ Department of Children's Neurosciences, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK.
⁴ Department of Women & Children's Health, King's College, London, UK.
⁵ Oxford ADHD & Autism Centre, Oxford, UK.
⁶ CLC Consultancy, Perth, UK.
⁷ South London & Maudsley NHS Foundation Trust, National Autism Unit, Kent, UK.
⁸ Positive Behaviour, Learning Disability, Autism and Mental Health Service (PALMS) Hertfordshire Communication Disorders Clinics, Hertfordshire Community NHS Trust, St Albans, UK.
⁹ South London & Maudsley NHS Foundation Trust, Maudsley Health, Abu Dhabi, UAE.
¹⁰ Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
¹¹ Private Practice, London, UK.
¹² Great Ormond Street Hospital, London, UK.
¹³ Behavioural and Developmental Psychiatry Clinical Academic Group, Behavioural Genetics Clinic, National Adult Autism and ADHD Service, South London and Maudsley Foundation NHS Trust, London, UK.
¹⁴ Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
¹⁵ Anna Freud Centre, London, UK.
¹⁶ Helen Arkell Centre, Guildford, UK.
¹⁷ Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
¹⁸ Diagnostic Assessments and Treatment Services (DATS), Hertfordshire, UK.
¹⁹ Stover Consultancy, Santa Barbara, CA, USA.

PMID: 32448170
PMCID: PMC7247165
DOI: 10.1186/s12916-020-01585-y

Abstract

Background: Individuals with co-occurring hyperactivity disorder/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) can have complex presentations that may complicate diagnosis and treatment. There are established guidelines with regard to the identification and treatment of ADHD and ASD as independent conditions. However, ADHD and ASD were not formally recognised diagnostically as co-occurring conditions until the Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5) was published in 2013. Hence, awareness and understanding of both conditions when they co-occur is less established and there is little guidance in the clinical literature. This has led to uncertainty among healthcare practitioners when working with children, young people and adults who present with co-existing ADHD and ASD. The United Kingdom ADHD Partnership (UKAP) therefore convened a meeting of professional experts that aimed to address this gap and reach expert consensus on the topic that will aid healthcare practitioners and allied professionals when working with this complex and vulnerable population.

Method: UK experts from multiple disciplines in the fields of ADHD and ASD convened in London in December 2017. The meeting provided the opportunity to address the complexities of ADHD and ASD as a co-occurring presentation from different perspectives and included presentations, discussion and group work. The authors considered the clinical challenges of working with this complex group of individuals, producing a consensus for a unified approach when working with male and female, children, adolescents and adults with co-occurring ADHD and ASD. This was written up, circulated and endorsed by all authors.

Results: The authors reached a consensus of practical recommendations for working across the lifespan with males and females with ADHD and ASD. Consensus was reached on topics of (1) identification and assessment using rating scales, clinical diagnostic interviews and objective supporting assessments; outcomes of assessment, including standards of clinical reporting; (2) non-pharmacological interventions and care management, including psychoeducation, carer interventions/carer training, behavioural/environmental and Cognitive Behavioural Therapy (CBT) approaches; and multi-agency liaison, including educational interventions, career advice, occupational skills and training, and (3) pharmacological treatments.

Conclusions: The guidance and practice recommendations (Tables 1, 4, 5, 7, 8 and 10) will support healthcare practitioners and allied professionals to meet the needs of this complex group from a multidisciplinary perspective. Further research is needed to enhance our understanding of the diagnosis, treatment and management of individuals presenting with comorbid ADHD and ASD.

Keywords: Assessment; Autism spectrum disorder (ASD); Comorbidity; Consensus; Education; Guidance; Interventions; Occupation; Psychiatry; Psychology; School; Treatment; hyperactivity disorder/hyperactivity disorder (ADHD).

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Conflict of interest statement

In the last 5 years, SY has received honoraria for consultancy and educational talks years from Janssen, HB Pharma and/or Shire. She is an author of the RATE Scales [70]; the Diagnostic Autism Spectrum Interview (DASI) [78]; the ADHD Child Evaluation (ACE) [82] and ACE+ for adults [83]; Helping Children with ADHD CBT programme [101]; The Star Programme for children with cognitive, behavioural, emotional and social problems [102, 103]; and R&R2 for ADHD Youths and Adults [113]. PH has received honoraria for consultancy and educational talks in the last 5 years from Shire, Janssen and Flynn. He has acted as an expert witness for Lilly. PB has received honoraria for educational talks from Shire and research grants from Action Medical Research and the UK Tuberous Sclerosis Association for research on ASD and ADHD. In addition, SY, PB, WC, PH, FOR, PR, NS and EW are affiliated on a full-time basis with consultancy firms/private practices. The remaining authors have no disclosures.

References

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1. Hollingdale J, Woodhouse E, Young S, Fridman A, Mandy W. Autistic spectrum disorder symptoms in children and adolescents with attention deficit/hyperactivity disorder: a meta-analytical review. Psychol Med, BMC Psychiatry. 19:404. 10.1186/s12888-019-2284-3.
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Guidance for identification and treatment of individuals with attention deficit/hyperactivity disorder and autism spectrum disorder based upon expert consensus

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Guidance for identification and treatment of individuals with attention deficit/hyperactivity disorder and autism spectrum disorder based upon expert consensus

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Conflict of interest statement

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