Children with Both ADHD and Autism Face Greater Anxiety Risk

Eliza Gordon-Lipkin, MD

Children with both attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) face an increased risk for conditions that affect mood and anxiety, according to research involving more than 3000 young people.

“We newly recognized in this study that anxiety disorder and mood disorder, while very common in ASD, are even more common when children also have ADHD,” Eliza Gordon-Lipkin, MD, lead author of the study told MD Magazine.

“Recognizing and treating anxiety and mood disorders can lead to improved quality of life for patients and their families,” said Gordon-Lipkin, Fellow, Department of Neurology and Developmental Medicine at Kennedy Krieger Institute and at Johns Hopkins School of Medicine, both in Baltimore.

Researchers have already determined that mental health disorders often occur together. This is particularly true in children with ASD.

The authors took that finding a step further. Their study is the largest to compare comorbidities in patients with ASD alone to those who have both ASD and ADHD, Gordon-Lipkin said.

To investigate the 2 groups, researchers examined data from a cross-sectional survey of children aged 6 to 17 who have ASD. These children were enrolled between 2006 and 2013 in the Interactive Autism Network (IAN), an initiative at Kennedy Krieger that facilitates research on ASD through a parent-reported registry.

Of the 3319 children who met the study’s criteria, 1503 of them, or 45.3%, also had ADHD. The researchers reviewed data from the registry on diagnosis or treatment of ADHD, anxiety disorder, and mood disorder. They also assessed the severity of ASD.

The team found that the children with both ASD and ADHD had 2.2 times the risk of anxiety disorder and 2.7 times the risk of other mood disorders. The researchers also identified increasing age as the most significant contributor to the presence of the anxiety and mood symptoms.

“The specific etiology behind the relationships among these conditions is unclear at this time,” the researchers wrote.

The study did not provide a comparison to peers without diagnoses of ASD and ADHD, because the IAN registry includes only information about individuals with autism and does not have data on their typical peers.

However, the authors did offer some hypotheses on why children with ASD and ADHD face elevated mood and anxiety risks.

“It is possible that there is a genetic basis for an increased risk of multiple psychiatric disorders,’’ Gordon-Lipkin said. Previous studies have shown evidence that ASD and ADHD may have genetic and neurologic overlap, she noted.

It’s also possible that one condition is an early manifestation of the other, or that the development of one increases the risk for the other, she said.

“Children with ADHD and ASD are at a generally increased risk for behavioral problems, and these may contribute to anxiety or mood symptoms,” she said.

Asked about future studies to advance understanding of the topic, Gordon-Lipkin replied: “An important area for further research is clarifying how mood and anxiety disorders may present in both ASD and ADHD populations so that clinicians, healthcare providers, and families may optimally screen, assess, and diagnose these disorders.”

As for clinicians today, those who treat children with ASD should be vigilant about screening for anxiety and mood symptoms, Gordon-Lipkin said.

“Recognizing these mental health disorders is the first important step toward treatment,” she said.

“If the clinician is not comfortable managing these problems on their own, referrals for therapy to a psychologist or for medication management to a specialized medical doctor such as a psychiatrist, developmental pediatrician or neurologist is important.”

The study, “Anxiety and Mood Disorder in Children With Autism Spectrum Disorder and ADHD,” was published in Pediatrics.