title: Timing of the Diagnosis of Attention-Deficit/Hyperactivity Disorder and Autism Spectrum Disorder.
abstract: OBJECTIVE
  Symptoms of inattention, hyperactivity, and impulsivity are core features of attention-deficit/hyperactivity disorder (ADHD). However, children with autism spectrum disorder (ASD) often present with similar symptoms and may receive a diagnosis of ADHD first. We investigated the relationship between the timing of ADHD diagnosis in children with ASD and the age at ASD diagnosis.
  
  
  METHODS
  Data were drawn from the 2011-2012 National Survey of Children's Health, which asked parents to provide the age(s) at which their child received a diagnosis of ADHD and/or ASD. Using weighted prevalence estimates, we examined the association between a previous diagnosis of ADHD and the age at ASD diagnosis, while controlling for factors known to influence the timing of ASD diagnosis.
  
  
  RESULTS
  Our study consisted of 1496 children with a current diagnosis of ASD as reported by parents of children ages 2 to 17 years. Approximately 20% of these children had initially been diagnosed with ADHD. Children diagnosed with ADHD before ASD were diagnosed with ASD ∼3 years (95% confidence interval 2.3-3.5) after children in whom ADHD was diagnosed at the same time or after ASD. The children with ADHD diagnosed first were nearly 30 times more likely to receive their ASD diagnosis after age 6 (95% confidence interval 11.2-77.8). The delay in ASD diagnosis was consistent across childhood and independent of ASD severity.
  
  
  CONCLUSIONS
  To avoid potential delays in ASD diagnosis, clinicians should consider ASD in young children presenting with ADHD symptoms.
authors.affiliation: Division of Developmental Medicine, and Harvard Medical School, Boston, Massachusetts.
authors.forename: Amir
authors.initials: A
authors.lastname: Miodovnik
authors.affiliation: Division of Developmental Medicine, and Harvard Medical School, Boston, Massachusetts.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Harstad
authors.affiliation: Division of Developmental Medicine, and Harvard Medical School, Boston, Massachusetts Clinical Research Center, Boston Children's Hospital, Boston, Massachusetts; and.
authors.forename: Georgios
authors.initials: G
authors.lastname: Sideridis
authors.affiliation: Division of Developmental Medicine, and Harvard Medical School, Boston, Massachusetts.
authors.forename: Noelle
authors.initials: N
authors.lastname: Huntington
mesh_terms: D000293:Adolescent; D001289:Attention Deficit Disorder with Hyperactivity / Q000175:diagnosis* / Q000453:epidemiology; D000067877:Autism Spectrum Disorder / Q000175:diagnosis* / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D015995:Prevalence; D013997:Time Factors