Parent and Teacher Perceptions of Emotional and Behavioral Problems in Children with ASD: Effects of Child Age and IQ

Background:   Youth with autism spectrum disorder (ASD) frequently experience comorbid emotional and behavioral problems, which may exacerbate ASD core symptoms.  The Child Behavior Checklist (CBCL) often is used to capture parent-report of emotional and behavioral problems in youth with ASD.  Yet such difficulties also manifest in school and impact programming/intervention decisions.  Fewer studies focus on teacher-report of these symptoms, though the Teacher Report Form (TRF), a companion instrument to the CBCL, is available.  Importantly, parent and teacher perceptions of problems may differ, including low (Internalizing scales) to moderate (Externalizing scales) CBCL-TRF agreement (Kanne et al., 2009). Effects of child age and IQ on parent-teacher reports of emotional and behavioral problems are equivocal.  For example, prevalence of parent-reported anxiety and depression may increase with age and IQ (Mayes et al., 2011; van Steensel et al., 2011), while age and/or IQ may have little relationship with parent-reported externalizing behaviors (i.e., aggression) (Farmer & Aman, 2011; Kaat & Lecavalier, 2013). However, teacher-report of aggression may be higher for younger children with lower IQ (McTiernan et. al., 2011). 

Objectives:  To investigate a) cross-setting prevalence of clinically significant emotional and behavioral problems of youths with ASD (parent-, teacher-report); b) relationships between parent- teacher ratings; c) child age-related differences in ratings, while controlling for IQ. 

Methods:   Data from the Simons Simplex Collection (SSC) were analyzed (N=2760; age range 4.0-17.9 years [M=9.03, SD=3.57]). CBCL and TRF Composite scores (Internalizing; Externalizing) and syndrome scales were examined from preschool (ages 1.5-5; N=323) and school age forms (ages 6-18; N=903).  Descriptive analyses characterized the type and prevalence of cross-setting emotional and behavioral problems; correlational analyses examined parent-teacher agreement.  Dependent-samples t-tests examined differences between parent- and teacher-ratings.  Forthcoming analysis includes one-way multivariate analysis of covariance (MANCOVA) to examine age-related CBCL-TRF differences while adjusting for IQ (covariate). 

Results:   Findings indicated more CBCL parent-ratings within the clinically-significant range (t≥64) for Internalizing (preschool: 36.0%, school-age: 38.4%) than Externalizing (preschool: 24.7%, school-age: 22.3%).  Correlational analyses revealed low-to-moderate positive relationships between parent-teacher (e.g., CBCL-TRF) Internalizing and Externalizing scores, with higher correlations for Externalizing (preschool: r(321)=.27, p<.01; school age: r(900)=.36, p<.01) than for Internalizing (preschool: r(321)=.22, p<.01; school age: r(901)=.27, p<.01).  Overall, CBCL-TRF syndrome scale correlations were higher for school-agers (range: r=.16 to r=.38) than for preschoolers(range: r=.07 to r=.33).  Dependent samples t-tests indicated significant differences between parent- and teacher-ratings for Externalizing, but not Internalizing, in both preschoolers [t(322)=-2.22, p<.05, r=.27] and school-agers [t(901)=-4.82, p<.001, r=.36]. 

Conclusions: Preliminary analyses indicate differences in symptom manifestation across age-groups (preschoolers, school age) and between settings (home and school).  We expect these findings to be further elucidated by exploring differences in CBCL-TRF scores by age-of-child (in years), adjusting for IQ scores (forthcoming MANCOVA).  Parent-teacher agreement was higher for Externalizing than Internalizing symptoms for both age groups, with teacher-reported Externalizing behaviors significantly higher than parent-reported. These initial findings suggest differences in setting-specific demands or in peer-group comparisons.  Both parent- and teacher-report of comorbid emotional and behavioral problems yield important information for supporting the cross-setting needs of youth with ASD.