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Children who show traits of autism and attention-deficit/hyperactivity disorder often face elevated risks of emotional and behavioral problems as they grow up, but the social pathways connecting these traits to mental health are complex. A long-term study published in Psychological Medicine suggests that difficulties with classmates, schoolwork, and family members do not simply follow neurodevelopmental traits in a straight line. Instead, day-to-day social struggles and mental health challenges appear to be linked in both directions over time, which may create self-reinforcing cycles as students develop.
Autism spectrum disorder, commonly known as ASD, involves differences in social communication, social interaction, and patterns of behavior or interests. Attention-deficit/hyperactivity disorder, or ADHD, is characterized by ongoing patterns of inattention, hyperactivity, and impulsivity. Both conditions exist on a continuum, meaning that many children display noticeable traits without having an official clinical diagnosis. Even when these traits fall below diagnostic thresholds, children are at elevated risk of emotional distress, including internalizing problems like anxiety and depression, or externalizing problems like anger and disruptive behavior.
Earlier research suggested that everyday hardships may help explain these links. For instance, a 2018 longitudinal study tracking youth from childhood to age 18 found that elevated autistic traits increased the risk of developing depressive symptoms, an association partly explained by social hardships such as bullying. In a similar vein, a 2020 study of adolescents indicated that childhood ADHD symptoms predicted teenage depression in part through academic setbacks and peer problems.
Strained relationships with parents and peers also helped account for the link between attention difficulties and later depression in a 2013 study of two samples of young people, although academic struggles did not independently explain that link in that research.
Because autistic and ADHD traits frequently co-occur in the same individuals, researchers faced a challenge in untangling which specific social hurdles stem uniquely from each set of characteristics. Many previous studies examined either autism or ADHD in isolation, making it difficult to understand how distinct traits relate to social adjustment across different settings.
“In school settings, many children show mild ASD or ADHD traits that do not meet diagnostic criteria, yet they may still experience difficulties with peers, learning, or relationships with adults,” lead author Eriko Hashimoto, a doctoral student in the Graduate School of Humanities and Sciences at Ochanomizu University in Tokyo, told PsyPost. “These children may fall outside formal support systems.”
“However, we still know relatively little about how such traits relate to social adjustment and mental health over time,” Hashimoto explained. “Together with my supervisor and co-author, Professor Hiroyuki Ito, I wanted to address this gap by examining these developmental associations over several years in a large, community-based sample of school-aged children.”
To investigate these questions, Hashimoto, Professor Hiroyuki Ito of the Faculty of Core Research at Ochanomizu University, and their colleagues analyzed data from a large population-based cohort involving all public elementary and junior high schools in a medium-sized municipality in Chubu, Japan. The final analysis included 9,619 students from an initial group of 11,549 enrolled children. Students were surveyed once per school year from fourth through ninth grade, with data from 11 grade cohorts collected between 2012 and 2023. By gathering information from students, their parents, and their homeroom teachers, the authors were able to capture behavioral and emotional patterns across both home and classroom environments.
Parents reported on their children’s autistic tendencies using a shortened version of the Autism Spectrum Screening Questionnaire and assessed ADHD traits using the ADHD Rating Scale-IV. Students completed questionnaires detailing their subjective difficulties in three areas: keeping up with classwork, conflicts with teachers, and arguments with family members. Problems with classmates were evaluated using the peer relationships subscale of the Strengths and Difficulties Questionnaire, combining ratings from students, teachers, and parents into a single composite score.
Mental health outcomes were grouped into two broad categories. Internalizing problems, reflecting inward emotional distress such as anxiety and depression, combined child self-reports on a depression scale with parent and teacher ratings of emotional symptoms. Externalizing problems, capturing outward behavioral difficulties such as hostility and aggression, brought together student self-reports with adult ratings of conduct problems. The researchers used cross-lagged structural equation modeling, an advanced statistical technique that tests whether one variable predicts changes in another variable over time while controlling for student sex and grade level.
The analysis produced standardized coefficients, which express how strongly one measure predicted later changes in another. By the guidelines the authors used for this kind of analysis, values around 0.03 count as small, 0.07 as medium, and 0.12 as large.
The findings indicated distinct developmental patterns for autistic and ADHD traits. Autistic traits showed consistent links over time with subsequent peer difficulties, showing standardized coefficients between 0.146 and 0.190 across grade transitions, which fall in the large range. Autistic traits were also linked with later internalizing problems, with small-to-medium coefficients ranging from 0.068 to 0.097. In contrast, autistic traits were not consistently associated with later academic struggles or conflict with teachers.
ADHD traits showed a different pattern of associations. Elevated ADHD traits were linked to subsequent externalizing problems, with coefficients between 0.064 and 0.118, with the strongest associations appearing during late elementary school. ADHD traits were also associated with higher levels of academic difficulties over time, particularly in fourth and fifth grade, but showed weak and mostly inconsistent links to later internalizing problems directly. Instead, academic difficulties themselves predicted later internalizing symptoms during elementary school, suggesting that learning struggles may act as an intermediate pathway linking attention difficulties to emotional distress.
Rather than revealing one-way effects, the analyses indicated notable bidirectional processes. For instance, while peer problems predicted increases in subsequent internalizing symptoms, higher levels of internalizing symptoms were also associated with worsening peer problems over time. Similarly, externalizing behaviors predicted more frequent conflicts with teachers and parents in later years, and those strained adult relationships were linked with subsequent increases in behavioral difficulties. Academic problems consistently predicted greater family conflict in the following year, with coefficients ranging from 0.105 to 0.163.
The social environment also appeared to feed back into parent ratings of neurodevelopmental traits. Experiencing peer problems was linked to higher reported autistic traits in later grades, with coefficients up to 0.164. In an analogous manner, elevated externalizing behaviors predicted higher reported ADHD traits in subsequent waves. These patterns suggest that neurodevelopmental traits may not be fixed and could shift with a child’s social experiences, though they could also reflect changes in how parents perceive and rate their children’s traits once problems emerge.
“One important message is that ASD and ADHD traits showed different patterns of association with later difficulties,” Hashimoto said. “These findings highlight the importance of considering not only children’s individual characteristics but also the social environments in which they develop.”
These findings align with prior research into how childhood difficulties unfold over time. The results are consistent with a study covered by PsyPost in 2026, which found that childhood ADHD traits were linked to greater psychological distress in midlife, partly through experiences of social exclusion in adulthood, though that research followed individuals into adulthood while the current study tracked youth through junior high school.
The observed connections also touch upon research covered by PsyPost in 2025 linking ADHD symptoms to emotional problems across development, though that earlier project pointed to shared genetic factors, based on twin data, as an underlying driver rather than school-based social pathways.
As with all research, there are some caveats to consider. “This study does not demonstrate causality,” Hashimoto noted. “The findings show temporal associations, not proof that one factor directly causes another.”
“It is also important to emphasize that children with elevated ASD or ADHD traits are highly diverse; our results describe group-level patterns and should not be interpreted as predictions for any individual child,” she pointed out. “In addition, we examined ASD and ADHD traits dimensionally in a general school population rather than focusing specifically on children with clinical diagnoses.”
There are a few other things to keep in mind. Many of the associations, including most links between the traits and later mental health problems, were small to medium in size. Also, the questionnaire used to evaluate autism primarily captured a relatively narrow set of characteristics, focusing mainly on Asperger-type social and behavioral traits rather than the full spectrum.
Future research could build on these findings by incorporating direct observational measures alongside questionnaires and testing whether supportive social settings can buffer these links. The authors suggest that early support for academic organization, peer relationship skills, and positive communication between families and schools might help interrupt these cycles, though the study did not test any interventions.
The study, “Longitudinal associations among autism and ADHD traits, social maladjustment, and mental health in school-aged children,” was authored by Eriko Hashimoto, Hiroyuki Ito, Megumi Hamada, Takahiro Nakajima, Nobuya Takayanagi, Mitsunori Myogan, Yasuo Murayama, and Masatsugu Tsujii.