Comorbidity and differential diagnosis of autism spectrum disorder and attention-deficit/hyperactivity disorder

doi:10.11852/zgetbjzz2024-0822

Abstract

Abstract: Autism spectrum disorder (ASD), as a neurodevelopmental disorder, often co-occurs with other psychiatric conditions. Approximately 96% of children with ASD have at least one comorbid condition, such as attention-deficit/hyperactivity disorder (ADHD), obsessive-compulsive disorder, intellectual disability, anxiety disorders, bipolar disorder, depression, and tic disorders, among which ADHD is the most common. ASD and ADHD have a high overlap in genetics, immune system, intestinal microbiota, environmental exposure and behavioral manifestations, and there is a lack of clear distinguishing markers. Since the publication of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), which permits comorbid diagnosis of ASD and ADHD, there has been a lack of expert consensus and guidelines, making the clinical differential diagnosis of ASD, ADHD, and their comorbidities challenging. Therefore, this article elucidates the similarities and differences among ASD, ADHD, and their comorbidities in terms of pathogenic mechanisms and clinical symptoms, which has potential significance for future research on biomarkers of the three and development of cross-diagnostic assessment tools.

Key words: autism spectrum disorder, attention deficit hyperactivity disorder, comorbidity, differential diagnosis

摘要： 孤独症谱系障碍(ASD)作为一种神经发育障碍性疾病,常合并其他神经发育障碍疾病,约96%的ASD儿童至少共患一种疾病,如注意缺陷多动障碍(ADHD)、强迫症、智力障碍、焦虑症、双相情感障碍、抑郁症和抽动障碍等,其中ADHD最为常见。ASD和ADHD在遗传、免疫系统、胃肠道症状、环境暴露以及行为表现等方面重叠度较高,且缺乏明确区分的标志物,自《美国精神障碍诊断与统计手册(第5版)》(DSM-5)发布以来,虽允许ASD与ADHD进行共患诊断,但缺少专家共识与指南,ASD和ADHD及其共患病的临床鉴别诊断仍较为困难。因此,本文从ASD和ADHD及其共患的致病机制和临床症状方面阐述三者的异同,对未来研究三者的生物标志物和开发跨诊断特征的评估工具具有潜在意义。

关键词: 孤独症谱系障碍, 注意缺陷多动障碍, 共患病, 鉴别诊断

CLC Number:

R749.94

DUAN Cailing, ZHOU Xue, LIU Lijun, LIU Yinchi, GUO Lanmin. Comorbidity and differential diagnosis of autism spectrum disorder and attention-deficit/hyperactivity disorder[J]. Chinese Journal of Child Health Care, 2025, 33(11): 1233-1239.

段彩灵, 周雪, 刘丽君, 刘音池, 郭岚敏. 孤独症谱系障碍和注意缺陷多动障碍共患与鉴别[J]. 中国儿童保健杂志, 2025, 33(11): 1233-1239.

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