In a groundbreaking study published in BMC Psychiatry in 2025, researchers have unveiled new insights into the complex diagnostic interplay between adult Attention Deficit Hyperactivity Disorder (ADHD), Autism Spectrum Disorder (ASD), and their frequent co-occurrence. By leveraging self-reported symptom assessments combined with rigorous clinical evaluations, this research delves deeply into the nuanced symptom profiles that define these neurodevelopmental conditions, emphasizing the role of affective lability—a fluctuating emotional state—previously underexplored in this context.
The diagnostic challenge of distinguishing between ADHD, ASD, and their co-occurrence in adults has long posed a clinical conundrum. These conditions not only share overlapping features but also diverge significantly in emotional, cognitive, and behavioral presentations. Traditionally, clinicians have relied heavily on behavioral observations and clinical interviews guided by the DSM-5 criteria. However, the value of self-reported symptom scales as complementary diagnostic tools has gained momentum, particularly in enhancing precision and personal insight prior to formal assessment.
This investigation recruited 300 adults, excluding those with intellectual developmental disorders, implementing a multidisciplinary consensus diagnostic approach. Participants included individuals diagnosed with ADHD (174), ASD (68), and those with both ADHD and ASD (58). Prior to their clinical assessments, these adults completed a battery of psychometrically validated questionnaires via an online platform, targeting distinct symptom dimensions relevant to their suspected diagnoses.
Key instruments utilized in this research were the modified Barkley Adult ADHD Rating Scale (BAARS IV) for assessing ADHD-related symptoms, the Autism Spectrum Quotient (AQ) alongside the Empathy Quotient (EQ) to evaluate autism spectrum traits and empathy levels respectively, and the Affective Lability Scale (ALS) designed to quantify mood instability. By comparing total and subscale scores across diagnostic groups, the researchers aimed to elucidate distinctive symptom constellations aiding differentiation.
The most striking revelation was that individuals with ADHD and those with comorbid ADHD + ASD exhibited significantly elevated affective lability scores relative to those diagnosed solely with ASD. This finding challenges prior assumptions that emotional dysregulation, while common across psychiatric disorders, lacks specificity in distinguishing ADHD within clinical populations. Instead, it underscores affective lability as a critical emotional dimension warranting systematic evaluation during adult ADHD assessments.
Logistic regression models further refined the discriminatory power of these scales. Differentiation between ASD and ADHD + ASD was particularly influenced by current BAARS IV scores and EQ totals, highlighting current ADHD symptom burden and empathetic capacity as pivotal features. When segregating pure ADHD from the comorbid condition, a combination of the ALS anger subscale, past BAARS IV scores, and AQ totals proved most informative, suggesting that historical ADHD symptom severity and autism trait intensity, alongside emotional reactivity, provide valuable diagnostic clues.
Distinguishing ADHD from ASD was similarly nuanced; here, past BAARS IV scores coupled with current inattention levels, AQ, and EQ scores collectively enhanced diagnostic accuracy. These findings suggest that a temporal perspective on symptom evolution, combined with empathy assessments and autism trait quantification, can clarify the often ambiguous clinical presentations where ADHD and ASD traits overlap.
The implications of this research extend beyond mere diagnostic categorization. By emphasizing emotional dimensions such as affective lability within neurodevelopmental frameworks, clinicians are encouraged to adopt a more holistic approach. Understanding mood variability alongside core cognitive and social deficits can generate richer clinical portraits, thus informing tailored therapeutic interventions and potentially improving long-term outcomes.
In light of these insights, the study advocates for integrating targeted self-report questionnaires into standard adult neurodevelopmental assessment protocols. Such an approach not only empowers patients by directly involving them in the diagnostic process but also augments clinicians’ ability to make nuanced distinctions in complex clinical cases, ultimately fostering more personalized care pathways.
Moreover, the use of online platforms for pre-assessment data collection highlights an advancing digital trend in psychiatry, promoting accessibility and efficiency. This methodological innovation also facilitates large-scale data acquisition, which is indispensable for advancing evidence-based practice in neuropsychiatric diagnostics.
While the study focused on adults without intellectual disability, future research might expand these paradigms to include wider demographic and clinical spectra, investigating how affective lability interacts with cognitive impairments or other psychiatric comorbidities. Such exploration could further unravel the multifaceted tapestry of neurodevelopmental disorders and inform more comprehensive clinical strategies.
The comprehensive nature of this research underscores the necessity of moving beyond categorical diagnoses towards dimensional and integrative models that capture the breadth of human neurodiversity. Understanding the interplay between attention, social cognition, and emotional regulation not only refines diagnostic clarity but also paves the way for innovations in treatment modalities.
Ultimately, this study marks a pivotal step in redefining adult neurodevelopmental assessment, illuminating the vital role of emotional fluctuation in teasing apart overlapping disorders. As clinicians and researchers heed these findings, we can anticipate heightened diagnostic precision, enhanced patient engagement, and, importantly, improved quality of life for those navigating the complexities of ADHD, ASD, and their intersection.
Subject of Research: Adult self-reported symptoms and affective lability in differentiating ADHD, ASD, and their co-occurrence.
Article Title: Self-reported symptoms of attention deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD), and affective lability in discriminating adult ADHD, ASD and their co-occurrence.
Article References:
Pehlivanidis, A., Kouklari, E. C., Kalantzi, E. et al. Self-reported symptoms of attention deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD), and affective lability in discriminating adult ADHD, ASD and their co-occurrence. BMC Psychiatry 25, 391 (2025). https://doi.org/10.1186/s12888-025-06841-0
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