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The Structure of Co-Occurring Depression in Youth with ASD Living in Residential Care
Children with Autism Spectrum Disorders (ASD) more often exhibit co-occurring psychiatric conditions than not (Rosen et al., 2018). Frequently, ASD youth experience depression symptoms (Ghaziuddin et al., 2002). Some individuals with ASD express profound symptom presentation, requiring comprehensive care within inpatient or residential settings (Croen et al., 2006; Siegel at al., 2015). Individuals with ASD in these settings are underrepresented in the overall ASD literature, as well as the comorbidity literature more specifically (Lerner et al., 2018). There is evidence, though, that youth in in-patient settings display significant and observable challenges such as self-injury and suicidality (Siegel, 2018; Cassidy et al., 2014); this may indicate that inpatient youth experience significant difficulties related to depression, even though these observable challenges are not necessarily conceptualized as such. Youth in psychiatric inpatient settings experience co-occurring psychiatric symptoms differently than those in the community (Mandell, 2008; Siegel et al., 2018), suggesting that symptom presentation in ASD may be dependent on treatment setting. Though research regarding inpatient populations is emerging, symptom presentation in a residential setting remains to be explored. Though there may be similarities between the settings, residential settings are typically long term, while in-patient settings are frequently acute. Therefore, symptom presentation in residential settings is likely to vary from in-patient or community settings.
Objectives: To determine how ASD youth in a residential setting experience depression symptomology.
Methods:
Data were collected via the Child and Adolescent Symptom Inventory (CASI-5; Gadow & Sprafkin, 2013) from teachers of 146 youth (Mage = 15.27, SDage = 3.12; 119 male) in state-funded residential facilities across New York state. Participants had severe intellectual (IQ ≤ 70) and adaptive (MVineland = 43.25, SDVineland = 14.11) difficulties. An exploratory factor analysis (EFA) of the CASI-5 depression scale using Maximum Likelihood estimation and Geomin rotation was conducted.
Results:
The EFA supported a 5-factor model of depression symptoms, which accounted for 72.2% of item variance (Table 1). The factors were, anhedonia/difficulty concentrating, /verbally mediated symptoms, low energy level, suicidality and functional changes (Table 2).
Conclusions: Whereas outpatient and non-treatment seeking youth have depression symptoms that form only one or two factors (Bitsika et al.,2016; Lecavalier, Gadow, Devincent, Houts, & Edwards, 2011; Uljarević et al., 2017), these residential samples evince depression symptoms that consist of five factors. These results indicate that ASD youth in residential settings may experience multi-faceted symptomology compared to inpatient and outpatient ASD youth. Obtained factors, such as functional changes related to depression (i.e., change in activity level, sleep, appetite etc.), and anhedonia and fatigue (acts unhappy or sad, shows little enjoyment in pleasurable activities), may be less verbally mediated, and therefore more easily observed and coherently identified in patients with lower verbal abilities (Righi et al., 2017, Siegel et al., 2018), such as those receiving residential care. Understanding this population’s symptom presentation will inform and guide treatment practices for this understudied population, as it may be useful for treatments to be targeted to these multi-faceted and specific symptom domains, rather than to discrete diagnostic categories.