Restrictions on in-person assessments during the COVID-19 pandemic were a challenge for an adult autism diagnostic service receiving over 600 referrals annually. The service sought to adapt the Autism Diagnostic Observation Schedule (ADOS-2) for online administration.

To investigate whether an online adaptation of the ADOS-2 performed comparably to the in-person ADOS-2. To obtain qualitative feedback from patients and clinicians regarding experiences of the online alternative.

Online ADOS-2 assessments were completed for 163 referred individuals. A matched-comparison group comprised 198 individuals seen for an in-person ADOS-2 assessment prior to COVID-19 restrictions. A two-way analysis of variance (ANOVA) was run to explore any effect of assessment type (online or in-person ADOS-2) and gender on total ADOS score. Qualitative feedback was collected from 46 patients and 8 clinicians involved in diagnostic decision-making after the online ADOS-2 assessment.

A two-way ANOVA found no significant effect of assessment type or gender and no assessment type × gender interaction effect on total ADOS score. Qualitative feedback suggested that only 27% of patients would have preferred an in-person assessment. Nearly all clinicians reported gains from offering an online alternative.

This is the first study to examine an online adaptation of ADOS-2 within an adult autism diagnostic service. It performed comparably to the in-person ADOS-2, making it a viable alternative when in-person assessments are not possible. As this clinic group has high rates of comorbid mental health difficulties, we encourage further work to determine whether online assessment approaches generalise to other services to increase options for patients and efficiencies for service delivery.

The National Autism Service for Adults receives over 600 referrals annually and with an extensive waitlist, COVID-19 restrictions on in-person assessments were a challenge for service delivery. We aimed to adapt the Autism Diagnostic Observation Schedule (ADOS) for online delivery and investigate whether it is comparable to the in-person ADOS in predicting Autism Spectrum Disorder (ASD) diagnostic outcome. We also aimed to obtain qualitative feedback from service users and clinicians regarding experiences of the online ADOS.

A working group of staff who administer ADOS and representatives from psychiatry, psychology and management reached consensus that an online version of ADOS module 4 was feasible based on experience that a lot information required for coding is obtained verbally and some tasks were adaptable for online delivery. After the pilot, it was agreed all algorithm items could be coded except ‘unusual eye-contact’. Subsequently, 163 service users attended an online ADOS between August 2020 and February 2021. A matched-comparison group consisted of 198 service users seen for an in-person ADOS between May 2014 and February 2020. Algorithm scores were recorded and ASD diagnosis was made by a trained clinician. Qualitative feedback regarding the online ADOS was collected from 46 service users and 11 clinicians.

The working group agreed the online and in-person ADOS were closely matched regarding administration and coding. Mean scores for service users who received an ASD diagnosis were comparable for the online and in-person ADOS groups (7 and 8 respectively). This was also shown for those who were not diagnosed with ASD (3 and 4 respectively). A two-sample t-test showed no significant difference in total scores between the online and in-person ADOS (p = 0.38). Qualitative feedback suggested good service user and clinician satisfaction; only 27% of service users indicated they would have preferred an in-person assessment; 88% of clinicians reported there were gains from offering an online alternative. Although the online and in-person ADOS perform similarly, clinicians reported relying more on qualitative reports over scores from the online version to inform diagnostic decision.

To our knowledge, this is the first study to examine using an online ADOS within an adult diagnostic service. Due to its comparable performance, the online-ADOS is a viable alternative option for service delivery when in-person assessments are not possible. As this clinic group has high rates of comorbid mental health difficulties, the applicability of online assessments could generalise to other services and have an impact beyond the pandemic.

We investigated whether adults with attention-deficit/hyperactivity disorder (ADHD) show pseudoneglect—preferential allocation of attention to the left visual field (LVF) and a resulting slowing of mean reaction times (MRTs) in the right visual field (RVF), characteristic of neurotypical (NT) individuals —and whether lateralization of attention is modulated by presentation speed and incentives.

Fast Task, a four-choice reaction-time task where stimuli were presented in LVF or RVF, was used to investigate differences in MRT and reaction time variability (RTV) in adults with ADHD (n = 43) and NT adults (n = 46) between a slow/no-incentive and fast/incentive condition. In the lateralization analyses, pseudoneglect was assessed based on MRT, which was calculated separately for the LVF and RVF for each condition and each study participant.

Adults with ADHD had overall slower MRT and increased RTV relative to NT. MRT and RTV improved under the fast/incentive condition. Both groups showed RVF-slowing with no between-group or between-conditions differences in RVF-slowing.

Adults with ADHD exhibited pseudoneglect, a NT pattern of lateralization of attention, which was not attenuated by presentation speed and incentives.

Adults with attention deficit hyperactivity disorder (ADHD) frequently suffer from sleep problems and report high levels of daytime sleepiness compared to neurotypical controls, which has detrimental effect on quality of life.

We evaluated daytime sleepiness in adults with ADHD compared to neurotypical controls using an observer-rated sleepiness protocol during the Sustained Attention Response Task as well as electroencephalogram (EEG) slowing, a quantitative electroencephalographic measure collected during a short period of wakeful rest.

We found that adults with ADHD were significantly sleepier than neurotypical controls during the cognitive task and that this on-task sleepiness contributed to cognitive performance deficits usually attributed to symptoms of ADHD. EEG slowing predicted severity of ADHD symptoms and diagnostic status, and was also related to daytime sleepiness. Frontal EEG slowing as well as increased frontal delta were especially prominent in adults with ADHD. We have validated and adapted an objective observer-rated measure for assessing on-task sleepiness that will contribute to future sleep research in psychology and psychiatry.

These findings indicate that the cognitive performance deficits routinely attributed to ADHD and often conceptualized as cognitive endophenotypes of ADHD are largely due to on-task sleepiness and not exclusively due to ADHD symptom severity. Daytime sleepiness plays a major role in cognitive functioning of adults with ADHD.

Recent studies point to overlap between neuropsychiatric disorders in symptomatology and genetic aetiology.

To systematically investigate genomics overlap between childhood and adult attention-deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD) and major depressive disorder (MDD).

Analysis of whole-genome blood gene expression and genetic risk scores of 318 individuals. Participants included individuals affected with adult ADHD (n = 93), childhood ADHD (n = 17), MDD (n = 63), ASD (n = 51), childhood dual diagnosis of ADHD–ASD (n = 16) and healthy controls (n = 78).

Weighted gene co-expression analysis results reveal disorder-specific signatures for childhood ADHD and MDD, and also highlight two immune-related gene co-expression modules correlating inversely with MDD and adult ADHD disease status. We find no significant relationship between polygenic risk scores and gene expression signatures.

Our results reveal disorder overlap and specificity at the genetic and gene expression level. They suggest new pathways contributing to distinct pathophysiology in psychiatric disorders and shed light on potential shared genomic risk factors.