A new five-year program aims to enhance early detection strategies and improve treatment for children who have both Autism Spectrum Disorder and Attention Deficit Hyperactivity Disorder. 

Funded by the National Institutes of Health, the $12.5 million program will focus on improving treatment for patients with both disabilities by analyzing the connection between them. The initiative is intended to gain more information about the effects of having both autism and ADHD—a combination that scientists say warrants more research. 

“Both ADHD and autism are very problematic, and they can be devastating for families and health systems," said Scott Kollins, director of the Duke ADHD Program and co-investigator in the study. "Both are increasing in prevalence—approximately 50 percent of kids who have autism have ADHD as well, and we don’t really understand that much about how it effects clinical trajectories and treatment."

One primary aim of the new program is to develop specific approaches to interventions and treatment for children with coinciding conditions. Geraldine Dawson, director of the Duke Center for Autism and Brain Development, said such approaches are needed because there are currently no strategies on how to treat children who have both autism and ADHD. 

Each of the three projects included in the program will address a specific aim. The first project will follow about 9,000 children who visit Duke primary care clinics to undergo screening for autism and ADHD. Researchers will compare the symptoms, progression and health outcomes among the children during a three-year period. 

In a 2016 study by the Duke Center for Autism and Brain Development, researchers focused on how technology could make an autism screening tool—the Modified Checklist for Autism in Toddlers—more effective. 

Dawson explained that current screening practices for autism often fail to correctly diagnose children who also have ADHD. The researchers will therefore use their data after the three years to review any negative autism tests for children who eventually tested positive for both disabilities.

“We’ll understand better why these children are being missed and use that to develop better strategies for screening," Dawson said. 

The second study will examine the neurobiological, behavioral and neurocognitive aspects of concurrent ADHD and autism. By examining children from four different groups—autism only,  ADHD only, both and neither—the researchers will look at patterns in brain activity and search for commonalities across kids with autism and ADHD. The hope is that identifying such patterns will also help improve screening mechanisms. 

“We want to find biomarkers that differentiate [the children in these four groups] to see if there are ways to screen for them earlier," Kollins said. 

The final project will evaluate the success of combining behavioral intervention and the use of Adzenys-XR-ODT—an ADHD drug approved by the Food and Drug Administration—to treat children will both autism and ADHD. The researchers will focus specifically on how the treatment affects patterns of brain activity. 

"One of our hypotheses is that if a child with autism has ADHD, this makes it more difficult for them to benefit from traditional early interventions that we provide to children with autism because a lot of behavioral interventions require the child to interact with other people and sustain their engagement,” Dawson said. 

Five other schools including Yale University and the University of California, Los Angeles also received grants and will undertake separate studies as part of the program. Dawson noted that such grants help spark collaboration between researchers and scientists that can help create new treatments and interventions. 

"What’s exciting about a center grant is that we bring together people with lots of different expertise from different disciplines," she said.