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From Early Childhood to Adolescence: Persistence and Impact of Emotional and Behavioural Problems in ASD
High rates of co-occurring psychiatric disorders have been reported in adolescents and adults with autism spectrum disorder (ASD), and recent studies have also shown high rates of emotional and behavioural problems (EBPs) in young children with ASD. These problems can have a significant impact on the individual’s ability to cope with daily life, over and above their core ASD symptoms. While additional psychiatric problems have been shown to persist in older children with ASD, far less is known about the stability and impact of EBPs in young children with ASD. This study seeks to address this issue using a three time-point community cohort with repeated measures.
Objectives:
As part of the Improving Autism Mental Health (IAMHealth; www.iamhealth.kcl.net) research programme, we aimed to: (1) assess the stability of EBPs across three time-points from early childhood to adolescence; (2) consider the association between early EBPs and later outcomes such as adaptive functioning.
Methods:
Participants were part of the QUEST cohort, a community-based sample of children with a diagnosis of ASD. Children were assessed at a mean age of 6-years 9-months (time 1, total n=277), 13-years 5-months (time 2, total n=211), and 15-years 4-months (time 3, total n=207). Parent/carers completed the Developmental Behaviour Questionnaire at time 1 and 2, and the Strengths and Difficulties Questionnaire at times 2 and 3 as a measure of their child’s EBPs. Children’s IQ was assessed at time 1, and (on a stratified subsample) at time 2. The Adaptive Behaviour Assessment System (ABAS-II) was completed at time 2, and psychiatric outcomes were assessed at time 3. This study focuses on 185 participants with data at all 3 time-points.
Results:
Parent reports of EBPs showed an overall decrease in total scores from time 1 to time 2 (t=4.18, p<.0001), but no significant difference was found between scores at time 2 and time 3. However, for those with high levels of EBPs at time 1, these problems persisted through to adolescence: 74% of those above the clinical cut-off on the DBC at time 1, remained above cut-off at time 2 (X2 (1) = 27.0, p<.001); and of these, 81% scored in the high/very high range on the SDQ at time 3. Furthermore, higher levels of EBPs at time 1 were associated with poorer adaptive functioning at time 2, independent of IQ (β = -.19, (SE .08, p=.014).
Conclusions:
Within this community sample of children with ASD, we found a high level of EBPs in early childhood, with 76% scoring above the clinical cut-off on the DBC. For the majority, these EBPs persisted into late childhood and adolescence and were associated with lower adaptive functioning. These findings highlight the importance of identifying co-existing EBPs in children with ASD at an early stage, to enable timely interventions to be put in place, potentially reducing impact on the individual and their families.