Neurodevelopmental disorders such as attention-deficit hyperactivity disorder (ADHD) and autism affect approximately 1 in 10 children. These conditions affect learning, behavior, and development.
Executive function delays are at the core of the challenges experienced by people with neurodevelopmental disorders. This includes skills such as paying attention, switching attention, controlling impulses, planning, organizing, and problem solving.
These skills are important for learning and long-term development. They are associated with future occupational, social, academic, and mental health outcomes. Executive function skills improve, and children who support these skills perform better in the long term.
Decades of research have explained how difficulties with attention and impulse control underpin ADHD. On the other hand, difficulties with attention switching and thinking flexibility have been proposed to be the cause of autism.
As a result, different supports and interventions developed for different neurodevelopmental conditions target these skills. We build a system where a diagnosis is made first and then a range of support is provided based on that diagnosis.
However, our recent research published in Nature Human Behavior shows that executive function problems are similar across all neurodevelopmental conditions. Understanding these common needs can improve your access to support before waiting for a specific diagnosis.
Our study found more similarities than differences
We reviewed 180 studies spanning 45 years that compared executive function skills in two or more neurodevelopmental conditions.
We compiled research on all neurodevelopmental conditions defined in diagnostic manuals, including ADHD, Tourette syndrome, communication disorders, and intellectual disabilities.
Surprisingly, we found that most neurodevelopmental disorders show very similar delays in executive abilities.
For example, children with ADHD showed difficulties with attention and impulse control, but so did children with autism, communication, and certain learning conditions.
There were few differences between each neurodevelopmental condition and type of executive function delay.
This suggests that executive function delays are best considered a common difficulty in all children with neurodevelopmental disorders. All of these children could benefit from similar support to improve their executive skills.
But support is siled
For decades, research has failed to integrate findings across conditions. This has led to silos of research and practice across the fields of education, health and disability.
Our data show a gradual change in the types of symptoms that have been studied since 1980. In the early days, percentage-wise, a much higher proportion of research was done on tic disorders such as Tourette syndrome. Over the past decade, autism has received even more attention.
This means that research and practice are also siled, with a focus on funding and community concern. Some groups miss out on good science and practice when they become less visible in the political arena.
This has created a biased support system where only children with certain diagnoses can receive certain interventions. Access to support is also reduced when families cannot access diagnostic services. This is especially difficult in regional and rural communities.
Because of these diagnosis-driven research practices, there are now recommended assessment services, guidelines, and treatments for autism. These are typically not provided independently for children with ADHD, Tourette syndrome, communication disorders, or intellectual disabilities, even though the children’s needs overlap significantly.
How will this affect my access to support?
Families often find it difficult to get the help they need. They often say the assessment and support process is confusing, with long wait times and many barriers.
We have previously shown that carers often attend assessment and support services with a wide range of needs but leave many of their needs unaddressed.
Recent national guidelines on child mental health, autism and ADHD call for more integrated support for children. However, most services are not properly configured to do this. To achieve this, driving such system changes will take time.
Why is integrated research necessary?
More integrated research will lead to a more consistent system of support across education, health and disability for all children in need.
For example, research shows that many risk factors (genetic and environmental) are common to all neurodevelopmental conditions. These include extensive overlap in risk genes that are the same across conditions and common environmental factors that influence in utero development, such as the use of certain drugs, stress, and significant immune responses.
Other studies have shown that most children diagnosed with one neurodevelopmental disorder are also diagnosed with other neurodevelopmental disorders.
But gaps remain. For example, we know that certain stimulants are effective for ADHD, but we don’t have much information about how those drugs help children with other neurodevelopmental disorders who have difficulty paying attention.
Unlike what we know about social support for children with autism, there is less research on how the social needs of children with ADHD can be supported.
We should look at children’s needs in a broader perspective.
It is important for families to realize that if their child meets the criteria for one neurodevelopmental condition, it is very likely that they will also meet the criteria for other neurodevelopmental conditions. They likely have many needs related to other conditions.
It is worth contacting clinical services for a wide range of needs beyond diagnosis. This should include developmental, mental and physical health needs.
It is also important to consider that many common interventions have the potential to support all children with neurodevelopmental disorders.
This is an important issue for the government. Considerations are underway to support the needs of people with autism, intellectual disability and ADHD.
The time is now to establish more integrated systems, supports, and strategies for all people with neurodevelopmental disabilities at home, school, play, and work.
