Anxiety, depression prevalent in children with comorbid autism and ADHD

The work of Gordon-Lipkin et al. is one of the largest studies analyzing the relationships between autism, ADHD, and anxiety and mood disorders. But because of the inherent behavioral and biological complexity of autism, changes in the diagnostic criteria, and the use of parent-reported data, the current study might not reflect what is truly occurring in patients with autism, Christopher J. McDougle, MD, said in an interview.

“There are a number of things to say about [the study]. [One] of the strengths of the paper [is] the sample size,” Dr. McDougle said.“It’s always good to have a big sample size. The downside to having informant-databased information is that it is exactly what it is. This is fine, but the information may be inaccurate.”

In addition to parent-reported data, physicians are dealing with the relatively new diagnostic criteria. The May 2013 update of the Diagnostic and Statistical Manual of Mental Disorders to the DSM-5 brought with it the ability to diagnose ADHD with autism, when just the day before the DSM-5 was released, this differential diagnosis was not listed in the manual, Dr. McDougle said. “If something that important can change with the strike of the clock, it makes me concerned.” He also said listing the differential diagnosis in the diagnostic manual underscored the uncertainty of medicine’s understanding of comorbid autism and ADHD.

“That’s reflective of the field’s lack of knowledge. Sometimes I think we like to portray things as though we understand what’s going on, when I think it’s better to be honest and say we really don’t; we are just doing our best.”

Dr. McDougle is the director of the Lurie Center for Autism at Massachusetts General Hospital and is the Nancy Lurie Marks Professor of Psychiatry at Harvard Medical Center, both in Boston. He treats children, adolescents, and adults with autism spectrum disorder and other neurodevelopmental disorders. He was asked to comment on this study.