An update on the comorbidity of Attention Deficit/Hyperactivity Disorder (ADHD) and Autism Spectrum Disorder (ASD) and its clinical management

Abstract

Introduction: in 2013, the DSM-5 officially removed the restriction that previously precluded the diagnosis of Attention-Deficit/Hyperactivity Disorder (ADHD) in individuals with Autism Spectrum Disorder (ASD). Over recent decades, research has identified both overlapping and distinct characteristics, risk factors, and genetic as well as neurobiological correlates associated with ADHD and ASD. This expanding body of evidence is increasingly informing the clinical management of individuals with comorbid ADHD and ASD.

Areas Covered: based on a targeted PubMed search conducted up to March 24,2025,24.03.25, prioritizing meta-analyses or umbrella reviews over primary studies (whenever relevant), with terms encompassing autism, assessment, and
treatment, this review addresses: 1) Shared and distinct phenotypic characteristics, neuropsychological features, and genetic and neuroimaging correlates of ADHD and ASD; 2) The assessment of individuals presenting with both ASD and ADHD symptoms; 3) Pharmacological and non-pharmacological strategies for the management for individuals with comorbid ASD and ADHD.

Expert opinion: the comorbidity of ADHD and ASD should not be overlooked. Nevertheless, before diagnosing comorbid ASD and ADHD, clinicians should perform a thorough differential diagnosis, ensuring that ADHD symptoms are not better explained by ASD. Regarding treatment, further research is warranted to develop personalized approaches, support long-term management strategies, and evaluate real-world outcomes such as quality of life, which are often underrepresented in clinical trials.

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Identifiers

ORCID for Samuele Cortese: orcid.org/0000-0001-5877-8075

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