Associations of Health Related Quality of Life and Adaptive Skills Functioning in Children Diagnosed with ASD:Implications for Treatment Planning

Background: Although it is a relatively new area of investigation, research has shown that children diagnosed with Autism Spectrum Disorder (ASD) evidence poorer Heath Related Quality of Life (HRQoL) when compared to children without ASD. Research has also preliminarily indicated that children with ASD experience a multitude of psychosocial effects (e.g., family stress, internalizing and externalizing emotional/behavioral distress, etc.) and physical health effects (e.g., higher rates of sleep problems, gastrointestinal problems, etc.). However, the association between adaptive skill functioning and HRQoL among children diagnosed with ASD has not been directly examined within this pediatric population.

Objectives: The objective of this study was to statistically explore the associations of HRQoL and adaptive skill functioning in a population of children diagnosed with ASD.

Methods: This study examined HRQoL associations of children with ASD using the Pediatric Quality of Life Inventory 4.0 (PedsQL) with adaptive skill functioning using the Vineland Adaptive Behavior Scales, Second Edition (VABS-II). This study examined whether adaptive functioning (overall and in specific domains of behavior) is positively associated with HRQoL. Data were collected at an autism specialty clinic located at a regional academic medical center (the Oregon Health and Science University [OHSU] site of the Autism Treatment Network [ATN]). Data on 155 diagnosed children (87% male; mean age: 7 years; range: 5-12 years) were available. Study participants had confirmed ASD diagnoses according to DSM-IV-TR criteria and supported by administration of the ADOS-G.

Results: Mean PedsQL scores were 34.11 (SD=15.30) for the total, 9.11 (SD=7.00) for the physical functioning domain, and 24.93 (SD=10.93) for the psychosocial domain. Mean VABS-II standard scores were 68.12 (SD=14.59) for the overall composite, 67.70 (SD=11.20) for the socialization domain, 74.37 (SD=16.16) for the daily living skills domain, and 71.53 (SD=17.22) for the communication domain. When total PedsQL scores were predicted it was found that VABS-II overall scores were not a significant predictor when age was not included; however, the VABS-II overall scores did predict total PedsQL scores when age was included (Beta = -0.23, p < .01). Outcomes on the ADOS were never a significant predictor for HRQoL or adaptive skills functioning.

Conclusions: Adjusted regression models showed an association between adaptive skill functioning and HRQoL, with poorer adaptive skill functioning problems being associated with poorer HRQoL. These findings suggest that treatments focused on developing adaptive skills in children diagnosed with ASD may improve overall HRQoL. Follow-up analyses will examine how the variables are distributed and whether a linear relationship best characterizes the associations. Implications for clinical practice in the context of outcomes driven healthcare will be discussed.