Functional connectivity patterns differ as a function of co-occurring attentional problems in preschoolers with autism.

This research looked at young children with autism (ages 1.5-5 years) to see how attention problems affect their brain and development. Children with autism who also had attention difficulties showed different brain connection patterns and struggled more with daily skills compared to children with autism but fewer attention problems. These differences appeared very early, even before doctors can officially diagnose ADHD. This suggests attention problems in autism start early and may need different support approaches.

This study examined 122 children aged 1.5-5 years with and without autism spectrum disorder (ASD) to investigate how co-occurring attention problems affect brain connectivity and development. Children with ASD and elevated attention problems showed significantly reduced functional connectivity within and between brain networks responsible for executive function, language, and attention regulation, compared to children with ASD but lower attention problems. Despite similar autism symptom severity, those with attention problems demonstrated poorer adaptive and developmental skills across multiple domains. These findings suggest that attention difficulties in autism emerge very early in development and are associated with distinct brain connectivity patterns before ADHD can be formally diagnosed.

Early identification of attention problems in young children with autism may be crucial for targeted interventions. Functional connectivity differences suggest executive function supports should be considered in early intervention planning. Co-occurring conditions require attention in both research and clinical practice from early developmental stages.

Study design not specified in abstract. Cross-sectional data cannot establish causality or developmental trajectories. Limited information about assessment methods for measuring attention problems. Sample characteristics beyond age and ASD status not fully described.

Symptoms of attention-deficit/hyperactivity disorder (ADHD) are common in children with autism spectrum disorder (ASD), and are associated with greater developmental challenges, poorer clinical outcomes, and alterations in functional connectivity (FC) of the brain. However, despite the consensus that ASD and other neurodevelopmental conditions emerge early in life, little is known about the trajectories of brain and behavioral development during the first years of life in children with ASD and co-occurring attention problems (AP). In a sample of 122 young children (ages 1.5-5 years) with and without ASD, we examined whether toddlers and preschoolers with ASD and co-occurring AP already differ from peers with ASD without co-occurring AP on adaptive and developmental skills, ASD symptoms, and FC of the frontoparietal and salience networks, which have been previously linked to ADHD symptoms in older children with ASD and ADHD. Results of general linear model analyses revealed lower developmental and adaptive skills across multiple domains in children with ASD and elevated AP compared with their peers with lower AP, despite equivalent levels of ASD symptoms.

Further, children with ASD and elevated AP showed reduced FC within the frontoparietal network (p = .027), between the frontoparietal and language networks (p = .004), and the frontoparietal and default mode networks (p = .046) in comparison to their peers with lower AP. No group differences in FC of the salience network were observed (all p > .05). These findings provide evidence that neurodevelopmental and behavioral differences in children with ASD and co-occurring AP emerge very early in life, before a reliable diagnosis of ADHD is typically made. Specifically, these results demonstrate that early inattention symptoms are associated with unique connectivity patterns in executive circuitry as early as the first years of life in toddlers and preschoolers with ASD, likely contributing to the phenotypic and neural heterogeneity recognized in autism.

Thus, our results underscore the importance of considering co-occurring conditions early in developmental research and clinical care, as further understanding these trajectories can inform early interventions during the critical time period when they have the greatest potential for positive impact.