G470 Co-occurrence and co-morbidities among children and adolescents with adhd and asd in a scottish local authority

ADHD is the commonest childhood neuro-behavioural disorder, affecting 5% to 12% of school-age children and about 1% of children meet the criteria for ASD. Co-occurrence of ASD and ADHD is increasingly recognised after introduction of DSM-5. They both share difficulties with emotional control, attention and high levels of negative affect, with differing underlying motivational and behavioural tendencies. Objectives We analysed the clinical characteristics of children and young people with ADHD and ASD audited within two Community Child Health clinics of a Scottish NHS Trust over a 12 month period. Methods A retrospective review of all patients seen in the outpatient clinics between June 2016 and May 2017 within an NHS Region was carried out. ADHD was diagnosed using validated Swanson, Nolan, and Pelham –IV Questionnaire (SNAP-IV). Sleep problems were diagnosed empirically from detailed clinical history provided by the parents/carers/patients. ASD was diagnosed by a multidisciplinary approach involving detailed assessment individually by the Educational Psychologist, Clinical Psychologist, Speech and Language Therapist and the Community Paediatrician, followed by group discussion, using the ICD-10 checklist criteria to confirm or refute a Diagnosis. Results ASD and ADHD constituted 13% and 17% of the clinic caseloads respectively. They presented with similar characteristics including male gender preponderance (4.3:1 and 4.5:1), proportion of new referrals (20% and 18%) and discharges (22% and 19%) respectively. 19% of ASD children had ADHD while 14% of ADHD children had ASD. They had a similar range of co-morbidities but sleep, emotional problems and DCD were commoner among ADHD patients (52%, 25% and 19% vs 44%, 17% and 9% respectively). CAMHS and General Paediatricians were more commonly involved with ADHD patients (33% and 14% vs 20% and 6%) than ASD children. ASD patients were equally distributed between young (5–9 years) and older school age (10–14 years) children (20% and 18% respectively) while most ADHD patients were chiefly older (10–14 years). ADHD patients were on average 20 months older, attended more clinics (average 2.2 vs 1.6) and had higher number of co-morbidities (average 2.3 vs 1.6). Table 1 summarises the clinical and epidemiological characteristics of children and adolescents with ADHD and ASD.