Abstract
The general aim of this study was to examine the relation of psychiatric symptom-induced impairment with other common parameters of mental health in children with autism spectrum disorder (ASD). Prevalence rates are used to illustrate the implications of different criteria for caseness. Parents/teachers completed DSM-IV-referenced rating scales for 6–12 year old children with ASD (N = 115), the majority of whom were boys (86 %). Most children were rated by parents (81 %) or teachers (86 %) as being socially or academically impaired by symptoms of at least one psychiatric disorder. The most common impairing conditions (parent/teacher) were attention-deficit/hyperactivity disorder (67 %/71 %), oppositional defiant disorder (35 %/33 %), and anxiety disorder (47 %/34 %), and the combined rates based on either informant were generally much higher. Agreement between symptom cutoff and impairment cutoff was acceptable for most disorders. A larger percentage of youth were impaired by psychiatric symptoms than met symptom cutoff criteria, and the discrepancy between impairment cutoff and clinical cutoff (impairment cutoff plus symptom cutoff) was even greater. Impairment was moderately to highly correlated with both number and severity of symptoms. Parents’ and teachers’ ratings indicated little agreement as to whether a child was impaired. Findings for youth with ASD were similar to non ASD child psychiatry outpatient referrals, but clearly different in several ways from comparable studies of community-based samples.
Similar content being viewed by others
References
Altman, D. G. (1997). Practical statistics for medical research. Boca Raton: Chapman & Hall.
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders: DSM-IV-TR. Washington, DC: Author.
Angold, A., Costello, E. J., Farmer, E. M. Z., Burns, B. J., & Erkanli, A. (1999). Impaired but undiagnosed. Journal of the American Academy of Child and Adolescent Psychiatry, 38, 129–137.
Bird, H. R., Yager, T. J., Steghezza, B., Gould, M. S., Canino, G., & Rubio-Stipec, M. (1990). Impairment in the epidemiological measurement of childhood psychopathology in the community. Journal of the American Academy of Child and Adolescent Psychiatry, 29, 796–803.
Bird, H. R., Davies, M., Fisher, P., Narrow, W. E., Jensen, P. S., Hoven, C., et al. (2000). How specific is specific impairment? Journal of the American Academy of Child and Adolescent Psychiatry, 39, 1182–1189.
Bird, R. H., Canino, G. J., Davies, M., Ramirez, R., Chavez, L., Duarte, C., et al. (2005). The Brief Impairment Scale (BIS): a multidimensional scale of functional impairment for children and adolescent. Journal of the American Academy of Child and Adolescent Psychiatry, 44, 699–707.
Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Mahwah: Lawrence Erlbaum.
De Los Reyes, A. (2011). More than measurement error: discovering meaning behind informant discrepancies in clinical assessments of children and adolescents. Journal of Clinical Child and Adolescent Psychology, 40, 1–9.
DeVincent, C. J., & Gadow, K. D. (2009). Relative clinical utility of three child symptom Inventory-4 scoring algorithms for differentiating children with autism spectrum disorder versus attention-deficit hyperactivity disorder. Autism Research, 2, 312–321.
Drabick, D. A. G., & Gadow, K. D. (2012). Deconstructing oppositional defiant disorder: clinic-based evidence for an anger/irritability phenotype. Journal of the American Academy of Child and Adolescent Psychiatry, 51, 384–393.
Gadow, K. D. (2012). Schizophrenia spectrum and attention-deficit/hyperactivity disorder symptoms in autism spectrum disorder and controls. Journal of the American Academy of Child and Adolescent Psychiatry, 51, 1076–1084.
Gadow, K. D., & DeVincent, C. J. (2012). Comparison of children with autism spectrum disorder with and without schizophrenia spectrum traits: Gender, season of birth, and mental health risk factors. Journal of Autism and Developmental Disorders, 42, 2285–2296.
Gadow, K. D., & Drabick, D. A. G. (2012). Anger and irritability symptoms among youth with ODD: Cross-informant versus source-exclusive syndromes. Journal of Abnormal Child Psychology, 40, 1073–1085.
Gadow, K. D., & Sprafkin, J. (2005). Child and Adolescent Symptom Inventory–4R. Stony Brook: Checkmate Plus.
Gadow, K. D., & Sprafkin, J. (2011). The Symptom Inventories: An annotated bibliography. Stony Brook, NY: Checkmate Plus. www.checkmateplus.com.
Gadow, K. D., DeVincent, C. J., Pomeroy, J., & Azizian, A. (2005). Comparison of DSM-IV symptoms in elementary school-age children with PDD versus clinic and community samples. Autism, 9, 392–415.
Gadow, K. D., DeVincent, C. J., & Pomeroy, J. (2006). ADHD symptom subtypes in children with pervasive developmental disorder. Journal of Autism and Developmental Disorders, 36, 271–283.
Gadow, K. D., Schwartz, J., DeVincent, C., Strong, G., & Cuva, S. (2008). Clinical utility of autism spectrum disorder scoring algorithms for the child symptom Inventory. Journal of Autism and Developmental Disorders, 38, 419–427.
Gadow, K. D., Angelidou, K., Chernoff, M., Williams, P. L., Heston, J., Hodge, J., et al. (2012a). Longitudinal study of emerging mental health concerns in youth perinatally-infected with HIV and peer comparisons. Journal of Developmental and Behavioral Pediatrics, 33, 456–468.
Gadow, K. D., Guttmann-Steinmetz, S., Rieffe, C., & DeVincent, C. J. (2012b). Depression symptoms in boys with autism spectrum disorder and comparison samples. Journal of Autism and Developmental Disorders, 42, 1353–1363.
Gadow, K.D., Kaat, A.J., & Lecavalier, L. (in press). Relation of symptom-induced impairment with other psychiatric illness parameters in clinic-referred youth. Journal of Child Psychology and Psychiatry.
Gathje, R. A., Lewandowski, L. J., & Gordon, M. (2008). The role of impairment in the diagnosis of ADHD. Journal of Attention Disorders, 11, 529–537.
Gordon, M., Antshel, K., Faraone, S., Barkley, R., Lewandowski, L., Hudziak, J. J., et al. (2006). Symptoms versus impairment: the case for respecting DSM-IV’s criterion D. Journal of Attention Disorders, 9, 465–475.
Guttmann-Steinmetz, S., Gadow, K. D., DeVincent, C. J., & Crowell, J. (2010). Anxiety symptoms in boys with autism spectrum disorder, attention-deficit hyperactivity disorder, or chronic multiple tic disorder and community controls. Journal of Autism and Developmental Disorders, 40, 1006–1016.
Kraemer, H. C., Kupfer, D. J., Clarke, D. E., Narrow, W. E., & Regier, D. A. (2012). DSM-5: how reliable is reliable enough? The American Journal of Psychiatry, 169, 13–15.
Lecavalier, L., Leone, S., & Wiltz, J. (2006). The impact of behaviour problems on caregiver stress in young people with autism spectrum disorders. Journal of Intellectual Disability Research, 50, 172–183.
Lecavalier, L., Gadow, K. D., DeVincent, C. J., & Edwards, M. C. (2009). Validation of DSM-IV model of psychiatric syndromes in children with autism spectrum disorders. Journal of Autism and Developmental Disorders, 39, 278–289.
Leyfer, O. T., Folstein, S. E., Bacalman, S., Davis, N. O., Dinh, E., Morgan, J., et al. (2006). Comorbid psychiatric disorders in children with autism: Interview development and rates of disorders. Journal of Autism and Developmental Disorders, 36, 849–861.
Lord, C., Risi, S., Lambrecht, L., Cook, E. H., Leventhal, B. L., DiLavore, P. C., et al. (2000). The Autism Diagnostic Observation Schedule—Generic: a standard measure of social and communication deficits associated with the spectrum of autism. Journal of Autism and Developmental Disorders, 30, 205–223.
Mandell, D. S., Morales, K. H., Marcus, S. C., Stahmer, A. C., Doshi, J., & Polsky, D. E. (2012). Psychotropic medication use among Medicaid-enrolled children with autism spectrum disorders. Pediatrics, 121, 441–448.
Rapee, R. M., Bőgels, S. M., van der Sluis, C. M., Craske, M. G., & Ollendick, T. (2012). Annual research review: conceptualising functional impairment in children and adolescents. Journal of Child Psychology and Psychiatry, 53, 454–468.
Rommelse, N. N. J., Geurts, H. M., Franke, B., Buitelaar, J. K., & Hartman, C. A. (2011). A review on cognitive and brain endophenotypes that may be common in autism spectrum disorder and attention-deficit/hyperactivity disorder and facilitate the search for pleiotropic genes. Neuroscience and Biobehavioral Reviews, 35, 1363–1396.
Shaffer, D., Gould, M. S., Brasic, J., Ambrosini, P., Fisher, P., Bird, H., et al. (1984). A children’s global assessment scale (CGAS). Archives of General Psychiatry, 40, 228–231.
Shaffer, D., Fisher, P., Lucas, C. P., Dulcan, M. K., & Schwab-Stone, M. E. (2000). NIMH Diagnostic Interview Schedule for Children Version IV (NIMH DISC-IV): description, differences from previous versions, and reliability of some common diagnoses. Journal of the American Academy of Child and Adolescent Psychiatry, 39, 28–38.
Siegel, M., & Beaulieu, A. A. (2012). Psychotropic medications in children with autism spectrum disorders: a systematic review and synthesis for evidence-based practice. Journal of Autism and Developmental Disorders, 42, 1592–1605.
Simonoff, E., Pickles, A., Charman, T., Chandler, S., Loucas, T., & Baird, G. (2008). Psychiatric disorders in children with autism spectrum disorders: Prevalence, comorbidity, and associated factors in a population-derived sample. Journal of the American Academy of Child and Adolescent Psychiatry, 47, 921–929.
Sprafkin, J., Steinberg, E.A., Gadow, K.D., & Drabick, D.A.G. (2013). Agreement among categorical, dimensional, and impairment criteria for ADHD and common comorbidities. Journal of Attention Disorders. Published online February 11, 2013.
Sverd, J. (2003). Psychiatric disorders in individuals with pervasive developmental disorder. Journal of Psychiatric Practice, 9, 111–127.
Szatmari, P., Archer, L., Fisman, S., & Steiner, D. L. (1994). Parent and teacher agreement in the assessment of pervasive developmental disorders. Journal of Autism and Developmental Disorders, 24, 703–717.
Wagner, A., Lecavalier, L., Arnold, L. E., Aman, M. G., Scahill, L., Stigler, K. A., et al. (2007). Developmental Disabilities Modification of Children’s Global Assessment Scale (DD-CGAS). Biological Psychiatry, 61, 504–511.
Witwer, A. N., & Lecavalier, L. (2010). Validity of comorbid psychiatric disorders in youngsters with autism spectrum disorders. Journal of Developmental and Physical Disabilities, 22, 367–380.
Acknowledgement
This study was supported, in part, by the Matt and Debra Cody Center for Autism and Developmental Disabilities. The authors thank Dr. Carla DeVincent, PhD, Stony Brook University (Radiology), for managing data entry, Dr. John Pomeroy, MD, Stony Brook University (Pediatrics) for supervising the diagnostic evaluations, and three anonymous reviewers for their helpful suggestions.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Kaat, A.J., Gadow, K.D. & Lecavalier, L. Psychiatric Symptom Impairment in Children with Autism Spectrum Disorders. J Abnorm Child Psychol 41, 959–969 (2013). https://doi.org/10.1007/s10802-013-9739-7
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10802-013-9739-7