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Comparing Eye-tracking Data of Children with High-functioning ASD, Comorbid ADHD, and of a Control Watching Social Videos

Comparing Eye-tracking Data of Children with High-functioning ASD, Comorbid ADHD, and of a Control Watching Social Videos

Published on: December 7, 2018

Cognitive and emotional profiles in children with ASD, ADHD, and comorbid presentations: evidence for a distinct

Antonio Narzisi¹, Federica Barbetti¹, Maddalena Fabbri-Destro²

¹Department of Child Psychiatry and Psychopharmacology, IRCCS Foundation Stella Maris, Pisa, Italy.

Frontiers in Psychiatry

|March 19, 2026

Abstract

Background:

Autism Spectrum Disorder (ASD) and Attention-Deficit/Hyperactivity Disorder (ADHD) frequently co-occur, yet their comorbid presentation (ASD+ADHD) remains under- characterized. Clarifying cognitive and behavioral profiles is crucial for accurate diagnosis and effective intervention.

Methods:

A total of 207 children and adolescents (ages 6-16) were assessed using the Wechsler Intelligence Scale for Children - Fourth Edition (WISC-IV) and the Child Behavior Checklist (CBCL 6-18). Participants were grouped into ASD (n = 21), ADHD (n = 103), and ASD+ADHD (n = 83) cohorts. Group differences were analyzed through ANOVAs with Bonferroni corrections; Pearson correlations explored associations between cognitive indices and behavioral outcomes.

Results:

Children with ASD+ADHD scored significantly lower than the ASD group in working memory, processing speed, and full-scale IQ, while no significant differences emerged between the ASD+ADHD and ADHD groups. Behaviorally, ADHD participants exhibited higher externalizing symptoms (e.g., aggression, rule-breaking), while the ASD group showed greater withdrawn/depressed traits. The comorbid group presented the broadest dysregulation, with elevated scores across both internalizing and externalizing domains, including Sluggish Cognitive Tempo and obsessive-compulsive symptoms. Notably, protective associations between cognitive abilities and behavioral regulation, present in ASD and ADHD, were absent in the ASD+ADHD group.

Conclusions:

Findings suggest that ASD+ADHD comorbidity represents a distinct clinical profile, marked by compounded cognitive impairments and pervasive emotional-behavioral dysregulation. These patterns underscore the need for differential diagnostic approaches and tailored interventions that account for the unique neurocognitive architecture of comorbid presentations.

Keywords:

ADHD ASD CBCL WISC-IV behavioral dysregulation cognitive profile comorbidity executive functioning

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