Is ADHD a useful indicator of comprehension problems?

In a recent study published in Scientific reportsIn this study, researchers evaluated the importance of attention deficit hyperactivity disorder (ADHD) traits as predictors of comprehension problems.

Study: Attention Deficit Hyperactivity Disorder traits are a more important predictor of internal problems than autism traits.  Image credit: StepanPopov/Shutterstock
Stady: ADHD traits are a more important predictor of internalizing problems than autistic traits. Image credit: StepanPopov/Shutterstock

Autism spectrum disorder (ASD) is described as difficulties with social communication and repetitive, limiting tendencies in behaviour. Besides the core symptoms of autism spectrum disorder, a significant amount of research has examined links between mental health issues and AS, especially internalizing disorders. Notably, internalization issues have also been associated with reduced quality of life, physical health, and social activity in ASD, making them critical intervention targets. Attention deficit hyperactivity disorder (ADHD) is another neurodevelopmental disease associated with introspective disorders such as anxiety, obsessive-compulsive disorder (OCD), and depression. However, studies on internal issues and clinical practice focus more on ASD than ADHD.

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In this study, researchers investigated distinct links between self-reported ADHD and ASD features and internalization issues.

Recruitment was done by Prolific, which yielded a representative sample of the UK adult population, with consideration given to age and sex distribution. The sample included 504 people between the ages of 18 and 79. In the International Standard Classification of Education, participants indicated their age, gender, and education level between zero and seven. No additional data on clinical diagnosis were collected.

The 28-item autism spectrum quotient (AQ-Short) assessed social and nonsocial ASD features, yielding a score ranging from 28 for some autistic features to 112 for several autistic traits. The AQ-Short can be used by both men and women. In addition, the ADHD Self-Report Scale (ASRS) measures ADHD characteristics. Its 18 items reflected the frequency of symptoms associated with hyperactivity/impulsivity and inattention, with scores ranging from zero for no ADHD traits to 72 for several ADHD traits. Notably, in the current investigation, the ASRS reliability was high.

The 7-item Generalized Anxiety Disorder Scale (GAD-735) measures how frequently people experienced symptoms of anxiety in the past two weeks, resulting in a score between 0 for not anxious and 21 for very anxious. The 9-item Depression Module on the Patient Health Questionnaire (PHQ-936) assessed the frequency of depressive symptoms over the past two weeks, yielding a score between 0 for non-depression and 27 for major depression.


The results of the study indicated that none of the observed data points were identified as multivariate outliers. Visual evaluation of the QQ plot of normative residues as well as a scatter plot that compares normative residues to standardized expected values ​​suggested that the assumptions of homeopathy and normality may have been violated.

In accordance with the expected overlap between ADHD and ASD, intermediate associations between ASD and ADHD features were revealed. Anxiety and depression have been linked to features of ASD and ADHD. Depression and anxiety also showed a strong association. To eliminate multiple collinearity issues in the multivariate analysis, depression and anxiety were combined into a composite estimate of internalization issues. Internalizing difficulties have been associated with ASD as well as features of ADHD.

Age, gender, and educational level were factors in a multiple regression analysis examining specific associations between ASD and ADHD features and internalization issues. Internalization issues are uniquely predicted by ASD and ADHD traits. The beta coefficients indicated that ADHD trait was a more accurate predictor than ASD trait. However, the team noted that comparing beta coefficients was not sufficient to determine the relative importance of the predictors.

As the strongest predictor of internalization problems, features of ADHD clearly exceeded features of ASD. The investigation also showed that this estimated dominance relationship had a recurrence rate of 100%. This indicates that ADHD traits will always outweigh ASD features as a population-level predictor of internalization issues.

The team also compared models that include a predictor of interest, namely ADHD features or ASD traits, with null models that include other variables. Bayes factors (BF10) categorized ASD and ADHD characteristics as independent predictors of internalization issues. There was “extreme” evidence that ADHD as well as ASD traits predicted internalizing problems, although ADHD traits were significantly more predictive than ASD traits. The general trend of results was the same for the anxiety as well as depression analyses.


The results of the study indicated that ADHD and ASH specifically predicted internalizing disorders such as depression and anxiety. Importantly, ADHD features were a significantly better predictor of internalization problems, and this association is virtually guaranteed in all populations. While additional research is required to replicate these findings and elucidate the processes behind the observed associations, this study has provided vital new evidence related to neurodevelopmental disorders and adult mental health.

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