Summary: A study has uncovered significant overlaps in neurodivergent traits among children diagnosed with autism.
The research, which evaluated medical records of children referred for autism assessments, revealed that 76.2% of these children also exhibited traits associated with other neurotypes such as ADHD. Over half (55.6%) of the children assessed for autism potentially met the criteria for ADHD, indicating a high level of co-occurrence.
This study, a pioneering effort in Scotland, emphasizes the need for holistic assessments in child neurodevelopment, considering multiple neurotypes for accurate diagnosis and tailored support.
The study found a substantial overlap in neurodivergence, with 76.2% of autistic children displaying traits of other neurotypes, including ADHD.
Over 55% of children assessed for autism might also meet the diagnostic threshold for ADHD, highlighting the necessity of holistic neurotype assessments.
Despite the clinical overlap, only 26% of children with additional traits were investigated for an underlying diagnosis, stressing the need for more comprehensive evaluation methods.
Source: University of Glasgow
Three quarters of children (76.2%) who were diagnosed with autism also had traits of other neurodivergent neurotypes—including traits associated with Attention Deficit Hyperactivity Disorder (ADHD), learning and motor differences—according to a new study.
The research—led by the University of Glasgow and published in PLOS One—found that more than half (55.6%) of children referred for autism assessment may also meet the diagnostic threshold for ADHD, and certainly have at least some significant ADHD traits.
The study only looked at a small selection of possible neurotypes, suggesting the actual number of children with autism and other neurotypes may be higher.
This study is believed to be the first time the level of overlap of different neurodivergences in children has been studied in Scotland, where services aim to move away from single neurotype assessments to a more holistic assessment model, where all possible overlapping neurotypes are explored and identified.
The research showed there was a positive association between the number of neurodivergence detected and an earlier age of referral and also suggested that neurodivergent females were less likely than males to be identified before the age of five. However, despite clinical overlap and co-occurrence of neurodivergence in children, just 26% of those in the study with other traits were investigated for an additional underlying diagnosis.
For the study, the researchers evaluated anonymized medical records of children aged between two and 17 years old who were referred for an autism assessment, using validated questionnaires to assess for neurodivergent traits.
The research suggests that validated questionnaires may help clinicians identify co-occurring neurodivergence at the first assessment, allowing for earlier support and the development of whole-system insight into a child’s neurotype.
Dr. Jason Lang, Clinical Senior Lecturer in Neurodevelopment and Honorary Consultant in Child and Adolescent Psychiatry, said, “This study is extremely important, as it shows how vital it is to have a holistic approach to assessing children, to identify possible overlapping neurotypes properly. As well as a better understanding of the neurodivergent population as a whole, identifying a child’s precise ‘make and model’ will help provide better and more bespoke support for these children when needed.”
“However, it can be challenging for professionals to work across various neurotypes. As such, more work must be done to ensure services are truly holistic for overlapping traits to be properly identified. Our work suggests that one way to help is for services to use holistic questionnaires to gather this information.”
“And while this work is based in children’s services, we would also recommend that similar studies be carried out in adult populations, where current approaches remain, to a large extent, siloed in approach.”
Towards system redesign: An exploratory analysis of neurodivergent traits in a childhood population referred for autism assessment
Children’s health services in many countries are moving from single condition diagnostic silo assessments to considering neurodevelopment in a more holistic sense. There has been increasing recognition of the importance of clinical overlap and co-occurrence of different neurotypes when assessing neurodivergent children. Using a cross-sectional service evaluation design, we investigated the overlap of neurodivergences in a cohort of children referred for autism assessment, focusing on motor, learning, and attention/activity level domains. We aimed to determine what proportion of children in a cohort referred for an autism assessment showed traits of additional neurodivergences, and what proportion were further investigated.
We evaluated anonymised medical records of children aged between two and 17 years referred for autism assessment. We used validated questionnaires to assess for neurodivergent traits. A weighted scoring system was developed to determine traits in each neurodevelopmental domain and a score above the median was considered to indicate a neurodivergent trait. Evidence of further investigations were recorded. We then examined the relationships between autism traits and traits of additional neurodivergence.
114 participants were included for evaluation. 62.3% (n = 71) had completed questionnaires for analysis. Of these, 71.8% (n = 51) scored greater than the median for at least one additional neurotype, indicating the presence of other neurodivergent traits, and 88.7% (n = 64) attracted a diagnosis of autism. Only 26.3% of children with evidence of additional neurotypes were further investigated beyond their autism assessment.
Our results demonstrate the extensive overlap between additional neurodivergent traits in a population of children referred with suspected autism and show that only a small proportion were further investigated. The use of standardised questionnaires to uncover additional neurodivergences may have utility in improving the holistic nature of neurodevelopmental assessments.