Parental Concerns, Socioeconomic Status and the Risk of Autism Spectrum Conditions in a Population-Based Study

Background: Epidemiological studies consistently find an association between Autism Spectrum Conditions (ASC) and high socioeconomic status (SES) in families. We hypothesized that parents with high SES might have more concerns about their children with ASC. So far, limited research has investigated the association between parental concern, socioeconomic status and the risk of having ASC.

Objectives: To investigate whether higher levels of parental concern about autistic symptoms predict higher risk of meeting ASC criteria; To investigate whether the SES of parents plays a role in any association between parental concern and risk of having ASC.

Methods: A total number of 11,635 screening packs were distributed to 5-10 year-old children in 136 schools in Cambridgeshire. Parental concern was examined by using the Social Difficulty Questionnaire (SDQ). The socioeconomic status of parents was generated using the self-coded National Statistics Socio-economic Classification (NS-SEC). The ASC status of children was investigated through assessments using ADOS and ADI-R and clinical diagnosis. The variables for investigating associations and possible confounders were extracted for analysis, including parental concern question score, SES, age of the child, sex, maternal age at birth, father’s age at birth, maternal age at leaving education, father’s age at leaving education, birth order and the number of children in the family. The associations between levels of parental concern (none/minor/strong) and SES, as well as the other variables were tested (Chi-squared). The association between parental concern, SES and the risk of ASC was examined by adjusting all the other variables in the model using unconditional logistic regression.

Results: The SES, age of the child, sex and maternal age at leaving education were associated with parental concern. Parents with higher SES reported higher levels of concern (Chi-square=11.8; p=0.02). However, a higher SES was not associated with the risk of having ASC (p=0.50). Sex was found to be associated with both parental concern and the risk of ASC, and both were included in the final model. After adjusting for potential confounders, the odds of children meeting ASC criteria whose parents had reported strong parental concern were 8.5 times (odds ratio: 8.5; 95%CI: 4.5, 16.2; p<0.001) the odds of children having ASC whose parents reported minor concern. No child met ASC criteria where parents expressed no concerns. 

Conclusions: Parents with higher social class express more concerns than those from lower social classes. However, the concerns reported by parents in higher SES did not appear to be specific for ASC as there was no relationship between ASC and SES. Parental concern itself was strongly associated with a child meeting ASC criteria. The higher the degree of parental concern over their child in terms of emotions, concentration, behaviour or getting on with others, the more likely it is that the child will have ASC, independently of potential confounders. Conversely this study shows that where there is no parental concern expressed a child is extremely unlikely to meet diagnostic criteria. These findings should be of value in discussions related to which measures at what times are helpful in identifying children with ASC.