Parent and Teacher Perceptions of ASD Severity and Comorbid Emotional and Behavioral Symptoms: Differences for Children with Regressive Onset

Background:  Developmental  regression, or a loss of previously acquired skills, is reported in ~30% of children with ASD (Barger et al., 2013).  While evidence supports important phenotypic differences between children with or without a history of regression (ASD+regression) (Bernabei et al., 2007; Goin-Kochel et al., 2014), less is known about whether they differ on indices of ASD symptomatology or emotional/behavioral (EB) functioning. Most comparisons between children with ASD±regression rely on parent-reported data, yet teacher perceptions may inform understanding setting-specific differences in symptom manifestation and subsequent treatment planning.  Moreover, if children with ASD±regression are distinguished based on teacher reports (i.e., “blinded” to child’s regression status), then this adds further evidence attesting to the association between early skill losses and child outcomes.

Objectives:  To examine potential differences between children with ASD±regression on parent and teacher ratings of children’s (a) core ASD symptoms, and (b) emotional/behavioral symptoms.  

Methods:  Data were analyzed from children (N=2695, 86.6% male, M age=9.0 years) in the Simons Simplex Collection (Version 15.1).  Regression status was ascertained via the Autism Diagnostic Interview—Revised and operationalized as language and/or social-engagement losses at <36 months. EB symptomatology was measured via the co-normed Child Behavior Checklist (CBCL; parents) and Teacher Report Form (TRF; teachers). ASD symptoms were measured with the (a) Social Communication Questionnaire—Lifetime version (SCQ-L; parents) and Current version (SCQ-C; teachers); and (b) Social Responsiveness Scale(SRS; parents and teachers).  Separate one-way analysis of variance (ANOVA; with Bonferroni correction α=.005) were conducted to explore differences in parent and teacher ratings on these measures, by regression status.

Results:  In this sample, 27.4% experienced language and/or social-engagement skill loss. ANOVA results indicated a significant effect (p<.0001) of skill loss for all parent ratings across EB (CBCL INT, EXT, TOT) and core ASD symptoms (SCQ-L, SRS-P). Children with regression were rated by parents as having significantly lower CBCL scores but higher SCQ and SRS scores.  For teachers, their ratings of children with regression were lower only on the TRF INT composite than for children without loss, F(1)=8.17, p<.005.  However, consistent with findings on parent ratings, teacher ratings of core ASD symptoms were significantly higher for children with regression (SCQ-C and SRS-T, p<.0001). 

Conclusions:  Parent and teacher ratings of children's symptoms often differ (Reyes & Kazdin, 2005), particularly for children with ASD (Kanne et al., 2009).  Our findings suggest that early skill loss (i.e., before 36 months) is associated with later phenotypic differences as reported by both parents and teachers.  Specifically, both informant groups reported significantly greater severity in core ASD symptoms, per the SCQ and SRS, for children with regression.  However, while all emotional/behavioral symptoms rated by parents were significantly different by regression status, teachers’ ratings only differed for internalizing problems.  Overall, our findings suggest that children with developmental regression present differently across settings, even as they age, which may have implications for early treatment planning and ongoing support.