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<p>Over 20% of children with autism spectrum disorder (ASD) present co-occurring subthreshold attention-deficit/hyperactivity disorder (ADHD) traits. This study investigated the clinical profiles, executive function (EF) characteristics, and functional impacts in children with comorbid ASD and subthreshold ADHD, with an emphasis on dimensional relationships between ADHD symptom severity and neurocognitive outcomes. A total of 104 children aged 7–14 years (15 ASD alone, 33 ASD + subADHD, 30 ASD + ADHD, 26 typically developing) underwent multimodal assessments including behavioral measures, laboratory-based EF tasks, and eye-tracking tests. Group comparisons and regression analyses were conducted to examine symptom gradients and EF-mediated functional relationships. Children in the ASD + subthreshold ADHD group showed significant social, functional and executive function impairments relative to their typically developing (TD) peers. The severity of social, functional, and executive function impairments in this group tended to be more pronounced than those in the ASD alone group, but milder than in the ASD + ADHD group. We also observed linear correlations between specific clinical features and executive function impairments in the ASD + subthreshold ADHD group. Subthreshold ADHD traits in ASD operate dimensionally, bridging diagnostic categories through shared EF mechanisms. These findings advocate revising ADHD comorbidity criteria for ASD populations by integrating symptom severity and functional impairment indices while prioritizing EF-targeted interventions for affected children, irrespective of formal ADHD diagnostic thresholds.</p>

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Clinical and Cognitive Characteristics of Children with Co-occurring ASD and Subthreshold ADHD: Social, Functional and Executive Function Impairments

  • 期刊论文

  • 发表日期：

    2025年8月20日

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  • Le-Ran Xue,
  • Chao-Qun Cen,
  • Zhi Huang,
  • Fang Wang,
  • Hong-Zhu Deng,
  • Xiao-Bing Zou

摘要

Over 20% of children with autism spectrum disorder (ASD) present co-occurring subthreshold attention-deficit/hyperactivity disorder (ADHD) traits. This study investigated the clinical profiles, executive function (EF) characteristics, and functional impacts in children with comorbid ASD and subthreshold ADHD, with an emphasis on dimensional relationships between ADHD symptom severity and neurocognitive outcomes. A total of 104 children aged 7–14 years (15 ASD alone, 33 ASD + subADHD, 30 ASD + ADHD, 26 typically developing) underwent multimodal assessments including behavioral measures, laboratory-based EF tasks, and eye-tracking tests. Group comparisons and regression analyses were conducted to examine symptom gradients and EF-mediated functional relationships. Children in the ASD + subthreshold ADHD group showed significant social, functional and executive function impairments relative to their typically developing (TD) peers. The severity of social, functional, and executive function impairments in this group tended to be more pronounced than those in the ASD alone group, but milder than in the ASD + ADHD group. We also observed linear correlations between specific clinical features and executive function impairments in the ASD + subthreshold ADHD group. Subthreshold ADHD traits in ASD operate dimensionally, bridging diagnostic categories through shared EF mechanisms. These findings advocate revising ADHD comorbidity criteria for ASD populations by integrating symptom severity and functional impairment indices while prioritizing EF-targeted interventions for affected children, irrespective of formal ADHD diagnostic thresholds.