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Early developmental pathways to childhood symptoms of attention-deficit hyperactivity disorder (ADHD), anxiety, and autism spectrum disorder (ASD)

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Shephard, Elizabeth 
Bedford, Rachael 


Background Children with autism spectrum disorder (ASD) often have co-occurring symptoms of attention-deficit/hyperactivity disorder (ADHD) and/or anxiety. It is unclear whether these disorders arise from shared or distinct developmental pathways. We explored this question by testing the specificity of early-life (infant and toddler) predictors of mid-childhood ADHD and anxiety symptoms compared to ASD symptoms. Methods Infants (n = 104) at high and low familial risk for ASD took part in research assessments at 7, 14, 24, and 38 months and 7 years of age. Symptoms of ASD, ADHD, and anxiety were measured by parent report at age 7. Activity levels and inhibitory control, also measured by parent report, in infancy and toddlerhood were used as early-life predictors of ADHD symptoms. Fearfulness and shyness measured in infancy and toddlerhood were used as early-life predictors of anxiety symptoms. Correlations and path analysis models tested associations between early-life predictors and mid-childhood ADHD and anxiety symptoms compared to mid-childhood ASD symptoms, and the influence of controlling for ASD symptoms on those associations. Results Increased activity levels and poor inhibitory control were correlated with ADHD symptoms and not ASD or anxiety; these associations were unchanged in path models controlling for risk-group and ASD symptoms. Increased fearfulness and shyness were correlated with anxiety symptoms, but also ASD symptoms. When controlling for risk-group in path analysis, the association between shyness and anxiety became non-significant, and when further controlling for ASD symptoms the association between fearfulness and anxiety became marginal. Conclusions The specificity of early-life predictors to ADHD symptoms suggests early developmental pathways to ADHD might be distinct from ASD. The overlap in early-life predictors of anxiety and ASD suggests that these disorders are difficult to differentiate early in life, which could reflect the presence of common developmental pathways or convergence in early behavioural manifestations of these disorders.

Keywords ASD, ADHD, anxiety, comorbidity, early developmental pathways



Autism spectrum disorder, attention‐deficit/hyperactivity disorder, anxiety, comorbidity, early developmental pathways

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Journal of Child Psychology and Psychiatry and Allied Disciplines

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Medical Research Council (MR/R011427/1)
Medical Research Council (MR/K021389/1)
Medical Research Council (G0701484)
Medical Research Council (G0701484/1)
We are very grateful for the important contributions BASIS families have made towards this study. The research was supported by the BASIS funding consortium led by Autistica (, Autism Speaks, a UK Medical Research Council Programme Grant (G0701484) to M.H. Johnson, and the National Institute for Health Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Trust and King’s College London. R. Bedford is supported by a Sir Henry Wellcome Postdoctoral Fellowship. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. The authors have no conflicts of interests.