Associations Among Adaptive Behavior, Cognition, and ASD Status Among Young, Underserved Children

Background: People with ASD often experience impairments in adaptive behavior, regardless of intellectual ability. Typically, IQ is higher than measures of adaptive behavior would predict in the general population. This association has not been explicitly examined among traditionally under-resourced children. Adaptive behavior is typically assessed based on caregiver report whereas intellectual functioning is measured by a trained professional. While there has been some investigation of the relationships among adaptive behavior, IQ and ASD status, little is known about the relationship of these indices among low income or racial/ethnically diverse young children. Quantifying these relationships among populations with known disparities in accessing healthcare may help explain some of these disparities. That is, if these families rate adaptive behavior higher relative to IQ, it may result in missed diagnosis of ASD because parent level of concern may not be high enough to trigger a formal diagnostic referral.

Objectives: To examine the associations among adaptive behavior, cognitive functioning and ASD status among young children from low income, racial/ethnic minority or limited English proficiency families.

Methods: Young children referred for developmental evaluation (at-risk group) and those who screened positive on ASD screening tools from a general population received evaluations including ADOS-2, cognitive functioning (Mullen Scales of Early Development) and adaptive behavior (Adaptive Behavior Assessment Scale-2) measures. Both groups were from low-income, ethnic/racial minority or limited English proficiency families.

Results: Among the 288 at-risk children, adaptive behavior and cognitive functioning were positively associated and adaptive behavior was significantly higher than cognitive score. ASD status was negatively associated with both composite adaptive behavior scores and composite cognitive scores. Neither cognitive score nor adaptive behavior was associated with parent primary language or ethnicity.

Among the 179 children from the general population who screened at-risk for autism, adaptive behavior and cognitive functioning were also positively associated, and adaptive behavior score was significantly higher than cognitive score. ASD status was not associated with adaptive behavior, but was negatively associated with cognitive score. Neither cognitive score nor adaptive behavior was associated with primary language or ethnicity.

Conclusions: Adaptive behavior, cognitive functioning and ASD status are correlated for young underserved children already identified as at-risk for ASD. When identified through population based-screening, the same relationships hold, except that parent-reported adaptive behavior scores are not significantly associated with ASD status. In both at risk and population-based underserved groups, parent-reported adaptive behavior was significantly higher than measured cognitive functioning. This differs from previous ASD research which more typically finds IQ to be higher than parent-reported adaptive behavior. It is noteworthy that within this underserved population of young children, parent ethnicity and primary language were unrelated to the adaptive behavior or cognitive functioning of the child. Implications for screening and diagnosis will be discussed.