Emotional and behavioural problems in young children with autism spectrum disorder

Abstract

AIM To assess the frequency, pervasiveness, associated features, and persistence of emotional and behavioural problems in a community sample of young children with autism spectrum disorder (ASD).METHOD Parents (n=277) and teachers (n=228) of 4-to 8-year-olds completed the Developmental Behaviour Checklist (DBC). Intellectual ability and autism symptomatology were also assessed. A subsample repeated the DBC.RESULTS Three-quarters of the cohort scored above the clinical cut-off on the Developmental Behaviour Checklist Primary Carer Version (DBC-P) questionnaire; almost two-thirds of these scored above cut-off on the Developmental Behaviour Checklist Teacher Version (DBC-T) questionnaire. In 81%, problems persisted above threshold 14 months later. Higher DBC-P scores were associated with greater autism symptomatology, higher deprivation index, parental unemployment, and more children in the home but not with parental education or ethnicity, or child's age or sex. Children with IQ>70 scored higher for disruptive behaviour, depression, and anxiety symptoms; those with IQ<70 scored higher for self-absorption and hyperactivity. INTERPRETATIONThe DBC identifies a range of additional behaviour problems that are common in ASD and which could be the focus for specific intervention. The results highlight the potential benefit of systematic screening for co-existing problems.Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by impairments in reciprocal social interaction, communication, and repetitive, stereotyped interests and behaviours. 1 Recent estimates suggest a prevalence rate of over 1%. 2 ASD is associated with high comorbidity and significant costs to individuals, families, and services. 3 Emotional and behavioural problems in ASD are frequent, 4 and rates of social anxiety, attentiondeficit-hyperactivity disorder and oppositional disorder are elevated compared both with the general population 5 and with children with intellectual disability. [6][7][8] Functional problems in sleeping, eating, and toileting are also increased. High rates of behavioural and emotional disturbance are evident from pre-school onwards 9 and many children have two or more comorbid problems. 10,11 In non-ASD populations with and without intellectual disability, prevalence and types of emotional and behavioural difficulties are associated with age, sex, IQ, ethnic group, and social disadvantage. 5,7 In ASD these factors are less clearly linked to psychiatric co-morbidity 6,11 although the type of difficulty does vary with IQ, age, and sex. 6 Psychiatric disorders also have a high prevalence in adults 12 and, together with functional problems, can have as great an adverse impact as core ASD symptoms. There is, nevertheless, a range of evidence-based interventions that could reduce the effects of these problems. 13 Hence systematic assessment of emotional/behavioural difficulties by clinicians is crucial. This paper describes the use of parent and teacher questionnaires to assess comorbid emotional and behavioural ...

Autism spectrum disorder: advances in diagnosis and evaluation

“…Clinicians must actively ask about signs and symptoms of these conditions, although management is generally similar to that for children without ASD. Co-occurring mental health conditions, such as anxiety and depression,221222223 and behavioral disorders such as ADHD,224225 also have important effects on health related quality of life 226. Here again, clinicians should specifically ask about symptoms of co-occurring mental health conditions and behavioral disorders, recognizing that specialized assessment, which takes into account communication challenges and symptom overlap, may be needed.…”

Association Between Autistic Traits in Preschool Children and Later Emotional/Behavioral Outcomes

“…Salazar et al (2015) reported that in a group of 101 children diagnosed with ASD at age 5–9 over 90% had at least one comorbid psychiatric disorder. Another recent study found that in a community sample of children with ASD aged 4–8 years old three-quarters had parent-reported emotional/behavioral problems, while two-thirds of these children who parents reported as being above the clinical cut-off for emotional/behavioral problems also had teacher-reported problems, as assessed by the Developmental Behavior Checklist (DBC; Einfeld and Tonge 2002) (Chandler et al 2016). Preschool children with ASD as young as 2–4 years old have also been found to have increased levels of emotional/behavioral symptoms as assessed by the Child Behavior Checklist (CBCL; Achenbach and Rescorla 2000) (Georgiades et al 2011).…”

Emotion Regulation and Emotional Distress in Autism Spectrum Disorder: Foundations and Considerations for Future Research

“…Atypical or impaired ER has been implicated in the development and maintenance of most, if not all, psychiatric disorders (Berking & Wupperman, 2012). Yet, ER has been relatively neglected in ASD research until recently, which is surprising given the prominence of aberrant emotional functioning for so many individuals with ASD (e.g., Chandler et al, 2015). …”