Why Is Quality of Life Reduced in Individuals with Autism Spectrum Conditions? Investigating the Impact of Core Symptoms and Psychiatric Comorbidities on Quality of Life in the EU-AIMS LEAP Cohort.
Objectives: Thus, this study aimed to investigate the role of ASC core symptoms and psychiatric comorbidities in QoL across multiple domains, in a large and diverse sample of individuals with ASCs.
Methods: 445 individuals with ASCs and 302 individuals without ASC (with/without mild intellectual disabilities), aged 6-30 years, were recruited to EU-AIMS LEAP (Charman et al., 2017; Loth et al., 2017). ASC core symptoms were assessed using the Social Responsiveness Scale-2nd Edition (SRS-2) and Repetitive Behaviour Scale-Revised (RBS-R); co-occurring psychiatric symptoms were assessed using the Development and Well Being Assessement. To measure QoL; 1) Across all participants, parent-report Columbia Impairment Scale (CIS) was administered; 2) In children (6-11 years), we also administered parent-report Child Health and Illness Profile (CHIP-CE), which indexes Satisfaction, Comfort, Resilience, Risk Avoidance & Achievement; 3) Participants 12-30 years completed self-report CIS and/or WHOQOL-BREF. The latter measure indexes Overall QoL, Physical Health, Psychological Health, Social Relationships & Environment. Within the ASC group we performed stepwise multiple regression for each domain of QoL as the dependent variable, and the following independent variables; demographics (age, IQ, sex, testing site), core symptomatology (SRS-2, RBS-R), and comorbid symptomatology (anxiety, depression, ADHD).
Results: In accordance with previous research, the ASC group scored significantly lower on QoL measures than Controls, with effect sizes from r=0.17-0.61. See Figure 1 for correlations.
CIS-Parent. Social-communication deficits accounted for 31.1% unique variance, with depression contributing a further 6.1%, and repetitive behaviours 1.8%.
CIS-Self. Social-communication deficits explained 29.1% variance, and anxiety explained a further 2.5%.
WHOQOL-BREF. Depression was the only variable significantly accounting for variance in; Overall QoL (29.1%), Physical Health (23.1%), and Social Relationships (47.2%). Social-communication deficits were the only symptom significantly explaining variance on Psychological (36.5%) and Environment (26.9%) domains.
CHIP-CE. For the Satisfaction domain, the best-fitting model included social-communication deficits (11.4% unique variance) and anxiety (5.1% unique variance). The same was true for the Comfort domain, however this time anxiety (20.1%) explained more variance than social-communication deficits (4.1%). Depression alone significantly accounted for 7.1% unique variance on the Resilience domain. Finally, the best-fitting model for Risk Avoidance included ADHD (17.5% unique variance) and sex (6.1%). The model for Achievement also featured ADHD (20.4% unique variance), as well as IQ (12.7%) and depression (5.8%).
Conclusions: These findings emphasise how QoL in ASCs is a multi-faceted construct, with diverse underpinnings, influenced by core and comorbid symptoms. Through better understanding the contributions of diverse symptoms on various domains of QoL, in different individuals with ASCs, we may identify how interventions can be targeted to improve QoL.