Depression in Children with Autism Spectrum Disorders: Measurement and Associations.

Background: Children with autism spectrum disorders (ASD) are acknowledged to have an elevated risk of developing depression compared with their typically developing peers. Despite this, depression is poorly understood and often underdiagnosed in this group. The lack of reliable and valid measures of depression in this population are likely a factor in this. There is emerging evidence of a relationship between depression and a variety of psychological constructs, including traits of ASD although the mechanisms underlying these relationships is as yet unclear.

Objectives: This multi-phased study aimed to further the conceptual understanding of depression in children with ASD. Firstly we aimed to explore the latent factor structure of a well-used measure of childhood depression in a sample of children with ASD. Following this, we aimed to assess the psychometric properties of the measure as well as its acceptability to parents of children with ASD. Finally, the study aimed to explore the direct and indirect relationships between sensory hyposensitivity, restricted and repetitive behaviours and depression in children with ASD.

Methods: Participants were parents of 127 children with ASD without comorbid intellectual disability and 11 parents attended the focus groups for consultation regarding the depression measure. Participants were recruited from two autism research databases in the United Kingdom. Polychoric exploratory factor analysis was used to explore the factor structure of the Children’s Depression Inventory (2^nd Edition) in a sample of parents of children with ASD. Participants from both datasets were included as they were found not to differ significantly from one another across a range of key characteristics. The psychometric properties of the emergent factor structure were assessed and the model fit was tested by confirmatory factor analysis using structural equational modelling. Hayes (2009) mediation models were then used to explore the direct and indirect relationships between depression and traits of ASD.

Results: The results supported a unifactorial depression scale, with the removal of three of the original seventeen items. This scale evidenced promising reliability and validation however further adaptation is advised based on consultation with parents and poor model fit highlighted during confirmatory factor analysis. Mediation analyses highlighted significant and previously unreported direct and indirect relationships between sensory hyposensitivity, restricted and repetitive behaviours and depression.

Conclusions: These findings constitute the first steps in the creation of a psychometrically robust measure of depression in children with ASD. This can have clinical utility in terms of improved screening for depression in a population whereby it is currently often missed. The potential roles of sensory processing and restricted and repetitive behaviours in the prediction and maintenance of depression offer new avenues for future research and clinical intervention.