Background: Autism Spectrum Disorder (ASD) and Attention-Deficit/Hyperactivity Disorder (ADHD) frequently co-occur, yet their comorbid presentation (ASD+ADHD) remains under- characterized. Clarifying cognitive and behavioral profiles is crucial for accurate diagnosis and effective intervention. Methods: A total of 207 children and adolescents (ages 6–16) were assessed using the Wechsler Intelligence Scale for Children – Fourth Edition (WISC-IV) and the Child Behavior Checklist (CBCL 6–18). Participants were grouped into ASD (n = 21), ADHD (n = 103), and ASD+ADHD (n = 83) cohorts. Group differences were analyzed through ANOVAs with Bonferroni corrections; Pearson correlations explored associations between cognitive indices and behavioral outcomes. Results: Children with ASD+ADHD scored significantly lower than the ASD group in working memory, processing speed, and full-scale IQ, while no significant differences emerged between the ASD+ADHD and ADHD groups. Behaviorally, ADHD participants exhibited higher externalizing symptoms (e.g., aggression, rule-breaking), while the ASD group showed greater withdrawn/depressed traits. The comorbid group presented the broadest dysregulation, with elevated scores across both internalizing and externalizing domains, including Sluggish Cognitive Tempo and obsessive-compulsive symptoms. Notably, protective associations between cognitive abilities and behavioral regulation, present in ASD and ADHD, were absent in the ASD+ADHD group. Conclusions: Findings suggest that ASD+ADHD comorbidity represents a distinct clinical profile, marked by compounded cognitive impairments and pervasive emotional-behavioral dysregulation. These patterns underscore the need for differential diagnostic approaches and tailored interventions that account for the unique neurocognitive architecture of comorbid presentations.
Cognitive and emotional profiles in children with ASD, ADHD, and comorbid presentations: evidence for a distinct clinical phenotype
Cardillo, Ramona;
2026
Abstract
Background: Autism Spectrum Disorder (ASD) and Attention-Deficit/Hyperactivity Disorder (ADHD) frequently co-occur, yet their comorbid presentation (ASD+ADHD) remains under- characterized. Clarifying cognitive and behavioral profiles is crucial for accurate diagnosis and effective intervention. Methods: A total of 207 children and adolescents (ages 6–16) were assessed using the Wechsler Intelligence Scale for Children – Fourth Edition (WISC-IV) and the Child Behavior Checklist (CBCL 6–18). Participants were grouped into ASD (n = 21), ADHD (n = 103), and ASD+ADHD (n = 83) cohorts. Group differences were analyzed through ANOVAs with Bonferroni corrections; Pearson correlations explored associations between cognitive indices and behavioral outcomes. Results: Children with ASD+ADHD scored significantly lower than the ASD group in working memory, processing speed, and full-scale IQ, while no significant differences emerged between the ASD+ADHD and ADHD groups. Behaviorally, ADHD participants exhibited higher externalizing symptoms (e.g., aggression, rule-breaking), while the ASD group showed greater withdrawn/depressed traits. The comorbid group presented the broadest dysregulation, with elevated scores across both internalizing and externalizing domains, including Sluggish Cognitive Tempo and obsessive-compulsive symptoms. Notably, protective associations between cognitive abilities and behavioral regulation, present in ASD and ADHD, were absent in the ASD+ADHD group. Conclusions: Findings suggest that ASD+ADHD comorbidity represents a distinct clinical profile, marked by compounded cognitive impairments and pervasive emotional-behavioral dysregulation. These patterns underscore the need for differential diagnostic approaches and tailored interventions that account for the unique neurocognitive architecture of comorbid presentations.
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