Parental Perspectives on Psychiatric Comorbidity in Preschoolers With Autism Spectrum Disorders Receiving Publicly Funded Mental Health Services

Abstract

An increased prevalence of psychiatric comorbidity (PC) in individuals with Autism Spectrum Disorders (ASD) is consistently reported. While several studies have examined PC in school-aged children, adolescents and adults with ASD, investigations on PC in preschoolers are less common. In this study, we explore the prevalence and the type of PC in a sample of 989 preschoolers with ASD through the DSM-Oriented Scales (DOS) of the Child Behavior Checklist (CBCL 1½-5) and their possible links with the core features of ASD and cognitive functioning. Results indicated that 37.8% of the sample had at least one PC in addition to ASD; these subjects displayed significantly higher Total score (p = 0.02) and Social Affect score (p = 0.003) on the ADOS-based calibrated severity scores (CSS), as well as lower (p ≤ 0.0001) performance IQ (pIQ) compared to ASD individuals without PC. As far as the specific DOS, Affective Problems (AP) were detected in 23.4% of the whole sample, ADHD Problems (ADHD) in 17.3%, Anxiety Problems (AXP) in 16.7%, and Oppositional Problems (OP) in 7.9%. These different comorbidities were isolated in 195 subjects (Mono-comorbid group: 19.7% of the whole sample), while 179 subjects (18.1% of the whole sample) had two or more types of PC (Multi-comorbid group). One-way ANOVA revealed that subjects with multi-comorbidity have statistically significant lower pIQ and higher Total score and Social Affect score on CSS-ADOS. Specific differences for each type of comorbidity and gender differences were also discussed. Taken together, results indicate a considerable presence of PC in preschoolers with ASD that should be accurately considered during the assessment and diagnosis process in order to plan a tailored intervention based not only on core symptoms of ASD, but also on comorbid psychiatric condition since preschool age.

Sex Differences in Autism Spectrum Disorder: An Investigation on Core Symptoms and Psychiatric Comorbidity in Preschoolers

“…A total of 107 females matched to 107 males one by one for chronological age (±6 months) and non-verbal IQ (±6 points) were examined. All the participants were selected from an initial sample of 989 preschoolers with and without non-verbal IQ impairment (mean age, 44.0 months; SD, 13.8 months; range, 16–75 months) examined in the preliminary analysis section of this study and investigated in depth in previously published research (Muratori et al, 2019 ).…”

“…In this study, we adopted the borderline clinical elevation cutoff score ( T score ≥60 for summary scales and T score ≥65 for DOS), according to previous studies on screening (Muratori et al, 2011 ; Narzisi et al, 2013 ; Rescorla et al, 2015 ) and PC (Llanes et al, 2018 ; Muratori et al, 2019 ) in young children with ASD.…”

“…A large part of previous studies used the Child Behavior Checklist (CBCL) (Achenbach and Rescorla, 2000 , 2001 ) to investigate PC, highlighting the utility of this tool to assess associated emotional and behavioral symptoms in children and adolescents with ASD (Guerrera et al, 2019 ; Muratori et al, 2019 ). A recent systematic review observed age-related sex differences in ASD in comparison with TD peers.…”

A Scoping Review of Anxiety in Young Children with Autism Spectrum Disorder

“…When using the parent‐report CBCL, the overall anxiety prevalence across five studies ranged from 16.7 to 31.8% [Iao, Yu, & Wu, 2020; Johnson, DeMand, & Shui, 2015; Muratori et al, 2019; Snow & Lecavalier, 2011; Vasa et al, 2013]. Two of these studies reported a greater prevalence of anxiety compared to an ON group (26 vs. 17%, Iao et al, 2020; 31.8 vs. 22.1%, Snow & Lecavalier, 2011).…”

“…Studies including a broader age of children (e.g., 4–18 years) were included only if age‐specific subgroup analyses were conducted with children under 6 years when examining prevalence, correlates, and treatment. Seven studies included children with an age range up to 8 years because the mean age of children in these studies was under 6 years old [Driscoll et al, 2020; Goldman et al, 2011; Keen, Adams, Simpson, Den Houting, & Roberts, 2019; Lei, Sukhodolsky, Abdullahi, Braconnier, & Ventola, 2017; Muratori et al, 2019; Sukhodolsky et al, 2020; Wilson, Manangan, Dauterman, & Davis, 2014]. (b) ASD and either co‐occurring anxiety symptoms or disorders were present in the child and the methods to assess ASD and anxiety were explicitly reported.…”