Co-occurring Autism Spectrum Disorder and Attention-Deficit/Hyperactivity Disorder in a 12-Year-Old Female: A Case Report and Clinical Insights

Abstract

Background: Autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) frequently co-occur, yielding additive impairments in social communication, executive control, and participation; female presentations are often under-recognized due to subtler phenotypes and compensatory strategies. Objective: To describe the diagnostic reasoning, measurement considerations, and staged management of a school-aged girl with co-occurring ASD and ADHD, emphasizing attention-related measurement bias and a data-driven care pathway. Methods: Case report anchored to the original evaluation epoch (chronological age ≈12 years). Multi-informant and multimethod assessment included clinical interview and observation, Childhood Autism Rating Scale (CARS total), Conners’ Teacher Forms (T-scores from two raters), Portage Guide to Early Education (PGEE; domain current functioning ages), Raven’s Colored Progressive Matrices (CPM), and Learning Disabilities Diagnostic Inventory (LDDI). A coordinated intervention combined ABA-informed behavioral strategies, speech–language therapy with visual systems, individualized education program accommodations, parent-mediated generalization, and psychiatry referral for ADHD pharmacotherapy. Results: CARS total 33 (mild–moderate range) with elevations in social reciprocity/communication; Conners’ profiles showed markedly atypical inattention/hyperactivity across settings; PGEE indicated 5–8-year functional lags across domains; CPM fell <5th percentile under high distractibility; LDDI revealed diffuse academic weakness. Across 17 sessions, on-task duration and routine adherence improved under structured scaffolds; spontaneous reciprocity and generalized attention remained limited. Intellectual-impairment specifier was retained provisionally pending re-evaluation after attention optimization. Conclusion: In ASD–ADHD comorbidity, attention-state effects can depress cognitive/achievement scores and misguide specifiers. A staged approach—optimize attention first, then re-test cognition/adaptation—supports accurate classification and improves educational and therapeutic yield.