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

Susan Young, Jack Hollingdale, Michael Absoud, Patrick Bolton, Polly Branney, William Colley, Emily Craze, Mayuri Dave, Quinton Deeley, Emad Farrag, Gisli Gudjonsson, Peter Hill, Ho-Lan Liang, Clodagh Murphy, Peri Mackintosh, Marianna Murin, Fintan O'Regan, Dennis Ougrin, Patricia Rios, Nancy Stover, Eric Taylor, Emma Woodhouse, Susan Young, Jack Hollingdale, Michael Absoud, Patrick Bolton, Polly Branney, William Colley, Emily Craze, Mayuri Dave, Quinton Deeley, Emad Farrag, Gisli Gudjonsson, Peter Hill, Ho-Lan Liang, Clodagh Murphy, Peri Mackintosh, Marianna Murin, Fintan O'Regan, Dennis Ougrin, Patricia Rios, Nancy Stover, Eric Taylor, Emma Woodhouse

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).

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.

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Source: PubMed

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