A Causal and Mediation Analysis of the Comorbidity Between Attention Deficit Hyperactivity Disorder (ADHD) and Autism Spectrum Disorder (ASD)

Elena Sokolova*, Anoek M. Oerlemans, Nanda Rommelse, Perry Groot, Catharina A. Hartman, Jeffrey C Glennon, Tom Claassen, Tom Heskes, Jan K. Buitelaar

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Autism spectrum disorder (ASD) and Attention-deficit/hyperactivity disorder (ADHD) are often comorbid. The purpose of this study is to explore the relationships between ASD and ADHD symptoms by applying causal modeling. We used a large phenotypic data set of 417 children with ASD and/or ADHD, 562 affected and unaffected siblings, and 414 controls, to infer a structural equation model using a causal discovery algorithm. Three distinct pathways between ASD and ADHD were identified: (1) from impulsivity to difficulties with understanding social information, (2) from hyperactivity to stereotypic, repetitive behavior, (3) a pairwise pathway between inattention, difficulties with understanding social information, and verbal IQ. These findings may inform future studies on understanding the pathophysiological mechanisms behind the overlap between ASD and ADHD.

Original languageEnglish
Pages (from-to)1595-1604
Number of pages10
JournalJournal of Autism and Developmental Disorders
Issue number6
Publication statusPublished - Jun-2017


  • Adolescent
  • Age Factors
  • Attention Deficit Disorder with Hyperactivity/diagnosis
  • Autism Spectrum Disorder/diagnosis
  • Child
  • Comorbidity
  • Female
  • Humans
  • Internationality
  • Male
  • Sex Factors
  • Siblings/psychology
  • Statistics as Topic/methods
  • Stereotyped Behavior/physiology

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