Study Finds Parental Concerns of Autism Do Not Align with Reported Behaviors


There is a high association between parents' concerns of autism spectrum disorder in their children and identified symptoms of ADHD.

Margaret McAllister

Margaret McAllister

A new study presented at the 2021 American Professional Society of ADHD and Related Disorders (APSARD) Annual Virtual Meeting found that parents who tended to report child concerns of autism spectrum disorder (ASD) actually reported behavioral symptoms associated with ADHD.

These same parents also exhibited higher levels of stress associated with their child’s development.

A team led by Margaret McAllister, Duke Center for Autism for Brain Development, examined reports of child behaviors and parental stress in those concerned over potential ASD behaviors and diagnosis.

“With the co-occurrence of ASD and ADHD, it is important to understand how emerging ADHD and ASD related behaviors are reported by parents of toddlers as their concerns often trigger evaluation referrals,” they wrote.


The team evaluated a sample of 2118 parental reports, which they collected from a study of toddlers in community-based clinics. In that study, parents completed a variety of measures.

These assessments included the Modified Checklist for Autism in Toddlers, Revised with Follow-Up (MCHAT-R/F); the Caregiver Concern Questionnaire (CCQ), the Child Behavior Checklist (CBCL), and the Autism Parental Stress Index (APSI).

The 4 exams evaluated aspects of caregiver concern, especially as it relates to ASD; behavior and emotional problems in children; and parental stress linked with physical, social, and communication difficulties of their children.

McAllister and colleagues approached their review seeking to understand how often parents reported behaviors associated with ASD versus their level of concern. Further, they questioned how results tracked alongside attention problems reported by the CBCL.

From the total sample, 20 parents reported low scores on the MCHAT, but nonetheless expressed specific concerns for ASD. 

On the contrary, the 37 parents who reported high scores on the MCHAT had little to no concerns for ASD.

The outstanding cases had high MCHAT scores/high ASD concern and low MCHAT scores/low ASD concern.

Thus, an independent t-test compared the 2 discrepant groups on the CBCL subscales and APSI scores. This revealed that parents who reported high concern for ASD but low ASD behaviors in their children also reported significantly higher CBCL ADHD subscale scores t(45)=2.39, P = .021).

Furthermore, these same parents reported overall high stress on the APSI ((t(37)=2.89, p = .006).

The team also noted that a significant proportion of children with discrepant MCHAT and CCQ were generally identified as non-white race compared to others (61% vs 41%, respectively; C2 = 8.4; P < .01).

This pattern was similarly true for those of Hispanic/Latino ethnicity compared with others (32% vs 16, respectively; C2 = 9.0; P<.01).

McAllister and team suggested that these findings may indicate that parents lack the necessary information about their child’s development, which may lead to increased parental stress.

Further, it may be the case that parental concern is a mediator of parental stress, considering that parents who reported low concern for ASD also reported low stress.

“This analysis raises many questions about the best screening method for toddlers at risk for ADHD and/or ASD,” they wrote. “Future work can focus on the outcomes of these groups and associated diagnosis outcomes with parent report on ASD behaviors, ADHD behaviors, and parental concerns.”

The study, "ADHD Symptoms Influence Parental Report of Autism and Associated Behaviors and Concerns for Toddlers in Primary Care," was presented at APSARD 2021.

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