Cognitive profiles of Autism, ADHD, and co-occurring presentations in childhood: insights from an online working memory task

Abstract

Access to standardized cognitive assessment remains limited in low- and middle- income countries (LMICs), with direct implications for the identification and support of children with neurodevelopmental disorders. Among these, Autism Spectrum Conditions (ASC) and Attention-deficit/hyperactivity disorder ADHD are highly prevalent and frequently co-occurring yet characterized by distinct cognitive profiles. Online assessment methods represent a promising avenue for scalable, cost-effective screening and research. The present study investigated whether a brief online cognitive task could reliably distinguish performance patterns among children and adolescents with ADHD, ASC, both (ASC + ADHD) and a group of typically developing (TD) peers. Children between the ages of 8 and 14 from diverse regions of Mexico completed a brief online working memory task, where they were required to remember either the identity(N = 61) or the emotional expression (N = 99) of a face. Task completion rates were high, demonstrating the feasibility of remote administration (84.6%). Clinical groups showed expected differences relative to TD peers: the ADHD group was distinguished by poorer overall working memory performance and increased intra-subject variability. The ASC group was selectively impaired in the emotion task. This study demonstrates the feasibility of deploying online cognitive tasks in LMIC contexts, providing a scalable approach to developmental research and early identification and referral. Intra-subject variability is a robust marker for ADHD, while careful future work should continue to disentangle overlapping disorders.