Supportive School Services for Youth with ASD and Their Relation to ASD Symptoms, Intellectual Functioning, and Co-Occurring Psychiatric Symptoms

Background: It is often presumed that greater ASD symptom severity necessitates more intensive supportive school-based services (SSS; e.g., Goin-Kochel et al., 2007). However, ASD symptoms vary in presentation of severity by context, highlighting the need for multiple perspectives to understand complexity of symptom presentation (Lerner et al., 2017). Nonetheless, little research has taken a multi-informant perspective on symptom severity in relation to SSS. In addition, the contribution of intellectual functioning and psychiatric comorbidity to SSS has been relatively understudied (Narendorf et al., 2011; White et al., 2007), though ~32% of youth with ASD have intellectual disability (Christensen et al., 2016), and ~70% have co-occurring psychiatric conditions (Simonoff et al., 2008). Moreover, no study has examined the relation of ASD severity, intellectual functioning, and psychiatric comorbidity in tandem to parse their relative and joint contributions to SSS delivery.

Objectives: Examined the relative contributions of parent, teacher, and clinician ratings of ASD symptom severity and psychiatric comorbidity, and IQ, in relation to SSS for ASD youth.

Methods: 283 youth (233 males) ages 6-18 (M_age = 10.5) with ASD were assessed with parent and teacher versions of the Child and Adolescent Symptom Inventory-4R (Gadow & Sprafkin, 2005), and clinical evaluation via the ADOS, to index co-occurring psychiatric and ASD symptom severity. FSIQ scores were obtained from case record review. Parents reported on SSS; Presence of common SSS refers to receipt of ≥1 of three SSS ASD youth most commonly use (Goin-Kochel, et al., 2007; speech/language, occupational therapy, social skills training). Total SSS includes both common SSS and any other SSS (e.g., adaptive physical education, counseling, etc.). Frequency of services refers to average weekly SSS receipt.

Results: Parent, teacher, and clinician ratings of ASD severity correlated with common ASD and total SSS frequency (see Table 1). Importantly, when controlling for all 3 sources of severity and age, only clinical evaluation related to common SSS presence (OR = 1.19, p < .01), whereas both clinical evaluation and teacher-report of ASD severity related to common (both B = .04, p < .05) and total SSS frequency (B_{Clinical Evaluation} = .07, p < .001; B_{Teacher-report =} .02, p < .05).

IQ was negatively associated with common and total SSS frequency, whereas parent-reported internalizing symptoms were negatively correlated with common SSS frequency (Table 1). After accounting for IQ and psychiatric comorbidity, clinical evaluation related only to total SSS frequency (B = .04, p < .05), whereas teacher-report related only to common SSS frequency (B = .03, p < .05). Moreover, lower IQ predicted higher frequency of common (B = -.02, p < .01) and total SSS (B = -.01, p < .05), while parent-reported externalizing symptoms predicted lower likelihood of common SSS presence (OR = .93, p < .01).

Conclusions: Overall, clinical evaluation and teacher-report of ASD severity showed the strongest and most consistent associations with SSS frequency. Results highlight the importance of indexing ASD severity via multiple sources, and accounting for intellectual functioning and psychiatric comorbidity, when examining correlates of SSS for youth with ASD.