My key AHA for this article are, the results showed children with ASD +ADHD have impaired preparatory processes compared to children with ASD-only, and further that children with ASD-only allocate more cognitive resources to prepare for the upcoming stimulus compared to children with ASD +ADHD and TD children. I think these results may explain that the function of preparatory processes of children with ASD-only helps them to be hyperfocused on the task than other group of children sometimes. 

Besides, the results also showed that task performance was impaired in both ADHD groups (ADHD-only and ASD+ADHD). These may link back to the preparatory processes, as if the function of helping to focus on task have impairment, it will direct affect the task performance. For TD children, even though their preparatory processes were not as well as children with ASD-only, but they can make themselves to focus on task, and this is what children with ASD and ADHD are hardly to do so.

Overall, this study provided more evidence on brain functioning to explain the performance of children with ASD, ADHD and ASD+ADHD.

ASD begins in prenatal life. ASD it is clinically detectable and highly diagnostically stable by 14 months of age.  
Most ASD risk genes are expressed prenatally in many ASD-relevant brain regions and fall into two categories: broadly expressed regulatory genes that are expressed in the brain and other organs, and brain-specific genes.

[Refer to Figure 1 above] Recent computational, cell-line model, animal model, clinical, genetic, and postmortem findings show that ASD is a highly heritable, multistage, multiprocess, progressive brain-wide disorder of prenatal and early postnatal development, with prenatal subtypes leading to clinical outcome heterogeneity.

It is critical to discover how these ASD prenatal processes are mechanistically linked with early-age ASD neural and clinical features.

 (1) differences in the neurophysiological correlates of attention and inhibition in strictly defined cases of ASD and ADHD and 

(2) whether these markers were shared or distinct in co-morbid ASD +ADHD, using an event-related potential (ERP) paradigm that has been used in previous studies of ADHD

The ERP allows sensitive measurement of distinct temporal stages in overt and covert cognitive processing.

-          Abnormal inhibitory processing was found in children with ADHD group

-          Problems in shifting from one response to another was found in children with ASD group

-          Presence of compensatory strategy/ alternative mechanism (in preparing for upcoming stimulus) to strengthen inhibitory control found in children with ASD group

Children with ASD have behavioural difficulties in the ability to flexibly shift to different cognitive demands (Hill, 2004) and disengage attention. Children with ADHD display neurophysiological abnormalities in attentional orienting, inhibitory processing and behavioural deficits in task performance, suggestive of specific deficits compared to ASD, along with widespread attentional dyscontrol

Findings from group differences for diagnostic status and correlations between quantitative trait measures converge to suggest unique deficits across the two disorders. For the majority of findings, children with co-morbid ASD +ADHD display deficits of both disorders suggestive of an additive co-occurrence, rather than a separate condition with a distinct pattern of deficits.

The findings indicate that there may be specific neuronal abnormalities in attention for ASD and ADHD, and suggest an additive model of ASD +ADHD. This complements and extends cognitive findings and suggests that previous inconsistent findings in the literature may be due to misspecification in group allocation. Along with accumulating evidence of co-occurring ADHD and ASD, this supports the adoption of a broader view of the psychopathology (the scientific study of mental illness or disorders) when assessing the underlying pathophysiology (the study of abnormal changes in body functions that are the causes, consequences, or concomitants of disease processes).

As I was reading this article, it reminds me of teachers who often flagged out children with poor eye contact and focus to be suspected of ASD while some others also noticed attentional concerns in children with autism. Some of these differences in difficulties faced in children with one or the other disorder only may be subtle (and confusing), but this article, although novel, may be able to help educators put in place more appropriate strategies to support students with either ASD or ADHD instead of using general strategies for both conditions (which often ends up not being effective for one or both groups of students). This study again brings up the importance of supporting children by their needs and not so much of their conditions – if we understand the needs of the children well, we will be able to support them better.

Definition of domains of parenting style dimensions :
a.      acceptance versus rejection; 

b.      psychological control versus autonomy;

c.      firm control versus lax control

Current study is a comparison of parenting style of 3 groups of children : TD (Typically developed), ANX (Anxiety), ASD (Autism).

Findings are :
a. parents of children with anxiety reported experiences of heightened anxiety themselves compared with parents of children with ASD and TD children, although this was not associated with any domains of parenting style.
b. parents of children with ASD reported greater levels of depressive symptoms than parents of children with anxiety, and parents of TD children to a lesser degree. However, the depressive symptoms was not associated with parenting style.

The children’s behavioural symptoms play the most dominant role in shaping parenting behaviour.

Recommendations :
a. direct intervention on maladaptive behaviour or teach parents how to manage.
b. need to provide additional parental support when working with parents of children with ASD.
c. identify critical time window for interventions. Around the time of their child receiving ASD diagnosis seem to benefit parent and child. 

I agree with the authors that more research needs to be done, as they had quite a small sample size. Not only that if there were significant impairments for those with ASD+DS it would mean that we would need to tailor the EI services to have a mixture of those from DS and from ASD for this group of kids, more Evidence Based Practice needs to be done to find out what works. Not only that, but they also need to be identified at a younger age similar to those with ASD to work on their social communication needs.

For children with ASD: 

#There are abnormalities in the allocation of resources to process faces and structural encoding of faces; 

#Deficits in the processing of negative emotions as indexed by emotion recognition; 

#Reduced differentiation between fear and neutral expression.

For children with ADHD: 

#Reduced differentiation of happy faces compared to neutral faces -> deficits towards positive stimuli; 

#Reduced differentiation of fearful faces compared to neutral faces -> deficits in recognising threat-related expressions

#In addition to a deficit in an executive function network, multiple neural pathways contribute to ADHD and abnormalities.

#Children with ADHD have unique deficits in evaluating emotion's meaning and context, regardless of comorbid ASD diagnoses.

*Children with ASD exhibit alterations at the structural encoding stage, whereas children with ADHD display abnormalities during the contextual processing stage. In the comorbid ASD + ADHD group, both disorders present distinct deficits.

*Objective neural measures of emotion processing can be used to understand the pathophysiology of complex overlapping disorders better.

It is interesting to know the differences between ASD and ADHD in recognizing emotions.