Table 4 Practice recommendations for children and adolescents with comorbid ADHD and ASD: non-pharmacological clinical interventions

1. Whenever possible, provide psychoeducation with both the young person and their parents/carers taking a lifespan approach. Follow-up sessions are essential to provide information and support and key points of transition (see text for topics).

2. Ensure that individuals and/or parents/carers have realistic expectations of the child’s abilities and what may be achieved by interventions (both medical and non-medical).

3. Psychoeducational programmes should differ for children and adolescent populations with the latter including issues relating to transition, sexuality and risk.

4. Parent/carer support interventions provide a supportive and contained ‘space’ where service-users can meet and share experiences. The focus is predominantly on the parent/carer with the child being the indirect beneficiary (see text for topics).

5. Acknowledge the difficulties experienced by parents/carers in coping with a child with complex needs on a daily basis by including content that will help the parents/carers to manage their own feelings of isolation, stress, anxiety and depression.

6. Parent/carer-mediated interventions teach parents/carers to deliver behavioural and environmental interventions to their child. The parent/carer is the agent of change and the child is the direct beneficiary (see text for topics).

7. A Functional Behavioural Analysis is an observational technique that systematically records the antecedents, behaviours and consequences of behaviour. It is helpful to provide insight into the triggers of challenging behaviour and factors that maintain the behaviour. In turn, this informs the method and goals of treatment.

8. Cognitive approaches (including cognitive remediation therapy [CRT] and cognitive behavioural therapy [CBT]) are more suitable for young people in adolescence than younger children, although the balance between cognitive and behavioural interventions may need to favour the latter when treating children with ADHD and co-existing ASD (see text for topics).

9. An increased number of sessions may be required with sessions being delivered at a slower pace, of shorter duration and/or including mid-session breaks. Greater structure and adherence to a clear agenda will help to reduce uncertainty and anxiety. Environmental adaptations may be needed to minimise sensory discomfort and distractions (e.g. sensitivity to light, smells and sounds).

10. It is helpful to include parents/carers (and teachers if appropriate) to support the young person to apply techniques learned in therapy across different contexts.

11. In order to avoid disengagement from services, transition planning should occur at least 1 year before a young person moves from child to adult services so that appropriate supports may be identified. A successful transition should involve everyone in the person’s circle of support.

12. All treatment approaches should be integrated into a comprehensive care plan. This should include a Positive Behavioural Support plan, which aims to provide consistency of interventions (including educational) between different caregivers, staff and service-user(s). The care plan should be shared with all relevant parties, with appropriate consent.