Duke researchers to lead $12.5 million program to study link between ADHD and autism

To enhance mechanisms for early detection and to better the treatment opportunities among children diagnosed with attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD), researchers from the Duke Center for Autism and Brain Development (Duke) will now lead a new five-year program, funded by the National Institutes of Health (NIH). The center will receive a $12.5 million grant as part of the NIH’s Autism Centers of Excellence (ACEs) program and will be joined by five other universities.

Having both ADHD and ASD simultaneously can increase the severity of autism symptoms in kids, including tantrums, higher school-related challenges and difficulty in making friends. Scott H. Kollins, director of the Duke ADHD Program and co-investigator of the study, said that nearly 50 percent of children diagnosed with autism also have ADHD and very limited research exists related to children with both the disorders. “We don’t really understand that much about how it effects clinical trajectories and treatment,” he said.

Geraldine Dawson, director of the Duke Center for Autism and Brain Development and another principal investigator, said that “young children with autism who also have ADHD are diagnosed with autism at a much later age and have poorer outcomes.” She added that children with both disabilities have a 30-time higher likelihood of being diagnosed with autism only after they turn six, whereas autism can be reliably diagnosed within 24 months. According to her, the researchers wanted to understand the delay in diagnoses and help children get early intervention.

ADHD diagnosis makes traditional early intervention for autism less effective

ADHD is a brain disorder characterized by inattention (difficulty sustaining focus), hyperactivity (inability to sit still; more active than usual) and impulsivity (acting hastily without thinking; prone to interrupting others). Its symptoms can interfere with academics and relationships, and induce antisocial behavior. One of the hypothesis of the researchers is that if children with autism are diagnosed with ADHD, it reduces the effectiveness of traditional early interventions for autism. This happens since several behavioral interventions necessitate ongoing interactions between children and other people.

Duke researchers will launch three major projects, each with a specific aim, as listed below:

  • Screening: The first project will follow about 9,000 children visiting Duke primary care clinics to undergo screening for ASD, ADHD or both. Children’s symptoms, progression and health outcomes will be compared for over three years. New screening tools will also be tested.
  • Brain dysfunction: The second project will focus on understanding similarities and differences between brain dysfunction in ASD and ADHD. The researchers will analyze patterns in brain activity or attention-related biomarkers to identify risk factors for both the conditions.
  • Combined treatment: The third project will evaluate the effectiveness of combining behavioral interventions with Adzenys-XR-ODT, an ADHD drug approved by the U.S. Food and Drug Administration (FDA). The impact of the combined treatment on autism, ADHD symptoms and patterns of brain activity will be analyzed.

Research may validate new approaches to early screening

Kollins said that the research has the possibility of significantly impacting clinical practice. “We hope it will validate new approaches to early screening, specifically in pediatric primary care,” he said. Since the two disorders are frequently diagnosed concurrently and are characterized by similar behavioral problems, it may be difficult to distinguish the symptoms. This may require consulting specialists with expertise in differentiating between symptoms and providing adequate treatment for both the problems.

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