Children with autism spectrum disorder and comorbid attention deficit hyperactivity disorder. Relationships between symptoms and executive function, social cognition, and behavioral problems

Numerous studies have mentioned the importance of discovering the mechanisms underlying the association between autism spectrum disorder (ASD) and comorbid attention deficit hyperactivity disorder (ADHD), with executive function (EF) deficits and theory of mind (ToM) being the most widely investigated cognitive processes. The present study proposed, first, to analyze the executive profile and social cognition processes in children with ASD, ASD+ADHD, ADHD, and typical development (TD). A second objective was to explore the relationship between ASD and ADHD symptoms and EF, ToM, and behavioral problems in children with ASD+ADHD. Participants were 124 children between 7 and 11 years old, distributed in four groups: 37 TD, 35 ADHD, 30 ASD, and 22 ASD+ADHD, matched on age and IQ. The teachers evaluated the EF with the BRIEF, and the parents assessed the application of ToM skills and the behavioral problems. In addition, a subscale of the NEPSY-II battery was administered to measure performance on emotion recognition. The results showed a similar profile of executive deficits in the ASD+ADHD and ADHD groups, whereas the difficulties in ToM skills in the group with ASD+ADHD were similar to those of the group with ASD. Finally, in children with ASD+ADHD, inattention symptoms were significantly associated with metacognitive deficits and ToM difficulties, and ASD symptoms were associated with behavioral problems. These findings support the need to take inattention symptoms into account and provide training in communication strategies when designing treatments for children with ASD