Attention Problems in ASD: Cognitive and Behavioral Correlates

Background:  Attention Problems are frequent in children with autism spectrum disorders (ASD; Gadow, DeVincent, and Pomeroy, 2006; Leyfer, Folstein, Bacalman, et al., 2006; Murray, 2010; Yerys, Wallace, Sokoloff, Shook, James, and Kenworthy, 2009). Some evidence has demonstrated a distinct phenotype of attention problems in conjunction with ASD, while some has instead found attentional difficulties to be a characteristic of the disorder. 

Objectives:  The current study examined whether the presence of attentional difficulties in a large sample of children with ASD represents a distinct phenotype of the disorder or is instead related to overall functioning.

Methods:  Data were collected at the Oregon Health and Sciences University (OHSU; Portland, OR) site of the Autism Treatment Network (ATN). Data on 400 diagnosed subjects (83% male; mean age: 5.4 years; range: 2.0-16.9 years) were available. Attention problems were defined as clinical elevation (T>70) on the Attention Deficit/Hyperactivity Problems scale of the CBCL. This measure also provided scales related to symptoms of emotional and behavioral problems. Data on intellectual functioning, autism severity, verbal level, adaptive behavior, and socio-demographic variables were available via parent self-report and clinical interviews in the ATN database.

Results:  Attention problems occurred in 26% of the children in this sample, consistent with previous findings of elevated prevalence of attentional difficulties in children with ASD. Clinically elevated attention problems were present significantly more frequently in children with IQ less than 70 (p<.01). Attentional difficulties were associated with more impaired communication (p<.05) and daily living skills (p=.05) on the Vineland, but not with social abilities (p=.07). Severity of social and communication symptomatology (p=.09) and restricted and repetitive interests (p=.72) on the ADOS were not related to attention problems. Attention problems were significantly associated with other CBCL broadband and DSM scales, ranging from .27 (Anxiety Problems) to .59 (Oppositional Defiant Problems). Attention problems were not related to age (p=.91), gender (p=.35), parent education (p=.18), race (p=.84), language level (p=.14), or the use of complementary or psychotropic medication (p=.17). 

Conclusions:  In sum, attention problems, as measured by the parent-report CBCL, appear to be associated with greater cognitive and adaptive impairment, and were not related to ASD-specific symptomatology. A measure that differentiates ASD-specific attentional behaviors from behaviors indicative of ADHD should be considered to explore the etiology of attentional difficulties in children with ASD. Such a measure may better examine whether attentional difficulties in ASD represent a distinct phenotype of the disorder.