Influence of Depressive Symptoms on Adaptive Functioning in Children with ASD

Background: Individuals with autism spectrum disorder (ASD) often present with impairments in adaptive functioning. Individuals with ASD also present with greater rates of co-morbid psychiatric disorders, such as depression, that further impact their daily living skills. Prior work has demonstrated that certain domains of adaptive functioning in ASD are more affected in the presence of co-morbid psychopathology relative to ASD alone. Despite the high co-morbidity of depressive symptoms in children with ASD, few studies have investigated how depressive symptoms impact their adaptive functioning. Understanding the impact of depressive symptoms on adaptive functioning in children with ASD has implications for targeted assessment and clinical intervention in this population.

Objectives: To investigate the impact of depressive symptoms on adaptive functioning in children with ASD.

Methods: 114 children with ASD (29 females, mean age=12.82, mean IQ=102.07) and 66 children with typical development (TD; 31 females, mean age=13.14, mean IQ=107.13) between 5-18 years-old participated in the study. Participants’ scores on the depression subscale of Child and Adolescent Symptom Inventory – Fifth Edition were used as a measure of depressive symptoms. Caregiver report on the Vineland Adaptive Behaviour Scales - Second Edition was used to measure participants’ adaptive functioning. ASD diagnoses were confirmed according to gold-standard research criteria (ADOS + ADI-R, DSM-5). Intellectual ability was measured with the Differential Ability Scales - Second Edition.

Results: Independent sample t-tests indicated that children with ASD demonstrated significantly lower T scores than TD children across all domains of adaptive functioning (socialization: t(173)=-12.28, p<.001; daily living skills: t(173)=-7.57, p<.001; communication: t(173)=-8.66, p<.001; adaptive behaviour composite: t(171)=-12.43, p<.001). The same test showed that children with ASD (M=65.44) also had significantly higher depressive symptoms compared to TD children (M=51.44; t(122)=4.58, p<.001). Given selective observation of difficulties with adaptive functioning and increased depressive symptoms in children with ASD, stepwise multiple regression analyses were conducted in children with ASD in order to examine the relationship between their depressive symptoms and adaptive functioning. Age, IQ, gender and depressive symptoms were independent variables. T scores of adaptive behaviour composite and each domain of adaptive functioning were entered as dependent variables. After controlling for IQ, age and gender, the addition of depressive symptoms as a predictor resulted in significantly improved model strength for the socialization domain (ΔR² =.09-.21, p=.003,) and adaptive behaviour composite (ΔR²=.10-.16, p=.038). Higher depressive symptoms predicted lower T scores in the socialization domain (β = -.0.36, p=.003), as well as lower adaptive behaviour composite (β = -.25, p=.038) in children with ASD.

Conclusions: The presence of depressive symptoms was associated with increased impairment in the socialization domain of adaptive functioning in children with ASD. In contrast, it was not related to the communication or daily living skills domain. This effect was independent of ASD children’s IQ, age and gender. These findings highlight the importance of depression in impacting social function in ASD and emphasize the value of assessing depression in understanding social ability and planning treatment in children with ASD.