Impact of Sensorimotor Deficits in Adaptive Behavior in ADHD Associated with or without HFA

Background: The association of Attention Deficit Hyperactivity Disorder (ADHD) and Autism Spectrum Disorder (ASD), mainly High Functioning Austism (HFA), was reported in several studies (Goldstein and Schwebach, 2004; Frazier et al., 2001) although these two diagnoses are considered mutually exclusive according to the criteria of DSM-IV-TR (APA, 2000) thus the growing interest in the particularities of children with a dual diagnosis. Actually, very few studies have explored the characteristics of this group on their sensorimotor and adaptive skills despite the impact of sensorimotor impairment on the clinical and functional characteristics (Hilton et al., 2007; Baker et al., 2008; Ben-Sasson et al., 2008; Yochman et al., 2004; Mangeot et al., 2001; Jasmin et al., 2009). The study of sensorimotor and adaptive characteristics, and their impact on the daily functioning of children with a dual diagnosis, HFA + ADHD compared to those with ADHD alone, could help better understand the complex links between these two disorders.

Objectives: The two objectives of this study are: 1- Compare sensory, motor and adaptive skills in children of the same age with a dual diagnosis of HFA + ADHD with those with ADHD alone. 2 - Determine the impact of sensorimotor deficits on the children’s autonomy. Our hypothesis is that children with HFA + ADHD will have greater sensory, motor and adaptive impairment than those of children with ADHD alone, and that this will influence moderately the level of autonomy in adaptive behavior.

Methods: Thirty children aged 5-14 years diagnosed with HFA + ADHD (n = 13) or ADHD alone (n = 17) were recruited from four establishments in the greater Quebec City region (Canada) and evaluated with sensory (Sensory Profile), motor (Bruininks-Oseretsky Test of Motor Proficiency-II) and adaptive evaluations (Adaptive Behavior Assessment System-II). Analysis of variance was used to compare the sensory, motor and adaptive functioning between the two groups, and correlation analysis examined the influence of sensorimotor disorders on the children’s autonomy.

Results: Compared to children with ADHD alone, children with HFA + ADHD scores were significantly lower in three of the four sensory quadrants, such as low registration, sensation avoidance and sensation sensitivity; in three of the six sections of the Sensory Profile on the treatment of sensory visual, vestibular and tactile information; in three of the eight specific motor skills, such as balance, running speed and agility and strength/endurance and in 8 of 9 adaptive functions, such as communication, functional academics, self-direction, leisure, social, community use, health and safety and self-care. For all children, a decrease in autonomy is correlated with sensory (r = 0,667, p <0.001) and motor disorders (r = 0,571, p = 0002).

Conclusions: Children with HFA + ADHD have more sensorimotor and adaptive disorders than those with ADHD alone. These disorders have a negative effect on their daily functioning. The assessment and appropriate intervention for sensorimotor deficits in ADHD with or without HFA would potentially improve the children’s autonomy.