Health-Related Quality of Life in Children with Autism Spectrum Disorders: Results from the Autism Treatment Network

  • Karen Kuhlthau
  • Felice Orlich
  • Trevor A. Hall
  • Darryn Sikora
  • Erica A. Kovacs
  • Jennifer Delahaye
  • Traci E. Clemons
original paper

Abstract

We examined data collected as a part of the Autism Treatment Network, a group of 15 autism centers across the United States and Canada. Mean Health-Related Quality of Life (HRQoL) scores of the 286 children assessed were significantly lower than those of healthy populations (according to published norms). When compared to normative data from children with chronic conditions, children with ASD demonstrated worse HRQoL for total, psychosocial, emotional and social functioning, but did not demonstrate differing scores for physical and school functioning. HRQoL was not consistently related to ASD diagnosis or intellectual ability. However, it was consistently related to internalizing and externalizing problems as well as repetitive behaviors, social responsiveness, and adaptive behaviors. Associations among HRQoL and behavioral characteristics suggest that treatments aimed at improvements in these behaviors may improve HRQoL.

Keywords

Autism Quality of life Behavior Adaptive behavior 

Notes

Acknowledgments

We would like to thank Autism Speaks for funding this work and Brian Winklosky, Joyce Shu, and Kirsten Klatka for their help managing the project. We would also like to thank the Autism Treatment Network’s leadership at each of the data collection sites: Diane Treadwell-Deering, MD, Daniel Glaze, MD, Wendy Roberts, MD, Alvin Loh, MD, Patricia Manning-Courtney, MD, Cynthia Molloy, MD, MS, Agnes Whitaker, MD, Reet Sidhu, MD, Lisa Croen, PhD, Pilar Bernal, MD, Rebecca Landa, PhD, Stewart Mostofsky, MD, Margaret Bauman, MD, Martha Herbert, MD, PhD, Robert Steiner, MD, Jill James, PhD, Eldon Schulz, MD, Jill Fussell, MD, Cordelia Robinson, PhD, RN, Ann Reynolds, MD, Susan Hepburn, PhD, Judith Miles, MD, PhD, Stephen Kanne, PhD, Nancy Minshew, MD, Cynthia Johnson, PhD, Benjamin Handen, PhD, Susan Hyman, MD, Tristram Smith, PhD, Wendy Stone, PhD, Beth Malow, MD, Bryan King, MD, Raphael Bernier, PhD.

References

  1. Achenbach, T. M., & Rescorla, L. A. (2000). Manual for ASEBA school-age forms and profiles. Burlington, VT: University of Vermont, Research Center for Children, Youth, and Families.Google Scholar
  2. Allik, H., Larsson, J. O., & Smedje, H. (2006). Insomnia in school-age children with asperger syndrome or high-functioning autism. BMC Psychiatry, 6, 18.CrossRefPubMedGoogle Scholar
  3. American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders fourth edition text revision. Washington, D.C.: American Psychiatric Association.CrossRefGoogle Scholar
  4. Anderson, A., Moore, D. W., Godfrey, R., & Fletcher-Flinn, C. M. (2004). Social skills assessment of children with autism in free-play situations. Autism: The International Journal of Research and Practice, 8(4), 369–385.Google Scholar
  5. Bastiaansen, D., Koot, H. M., Bongers, I. L., Varni, J. W., & Verhulst, F. C. (2004a). Measuring quality of life in children referred for psychiatric problems: Psychometric properties of the PedsQL 4.0 generic core scales. Quality of Life Research : An International Journal of Quality of Life Aspects of Treatment. Care and Rehabilitation, 13(2), 489–495.Google Scholar
  6. Bastiaansen, D., Koot, H. M., Ferdinand, R. F., & Verhulst, F. C. (2004b). Quality of life in children with psychiatric disorders: Self-, parent, and clinician report. Journal of the American Academy of Child and Adolescent Psychiatry, 43(2), 221–230.CrossRefPubMedGoogle Scholar
  7. Bauminger, N., & Kasari, C. (2000). Loneliness and friendship in high-functioning children with autism. Child Development, 71(2), 447–456.CrossRefPubMedGoogle Scholar
  8. Bauminger, N., & Shulman, C. (2003). The development and maintenance of friendship in high-functioning children with autism: Maternal perceptions. Autism: The International Journal of Research and Practice, 7(1), 81–97.Google Scholar
  9. Bauminger, N., Shulman, C., & Agam, G. (2003). Peer interaction and loneliness in high-functioning children with autism. Journal of Autism and Developmental Disorders, 33(5), 489–507.CrossRefPubMedGoogle Scholar
  10. Bodfish, J. W., Symons, F., & Lewis, M. (1999). The repetitive behavior scales: A test manual. Morgantown, NC: Western Carolina Center Research Reports.Google Scholar
  11. Bodfish, J. W., Symons, F. J., Parker, D. E., & Lewis, M. H. (2000). Varieties of repetitive behavior in autism: Comparisons to mental retardation. Journal of Autism and Developmental Disorders, 30(3), 237–243.CrossRefPubMedGoogle Scholar
  12. Bolte, S., & Poustka, F. (2003). The recognition of facial affect in autistic and schizophrenic subjects and their first-degree relatives. Psychological Medicine, 33(5), 907–915.CrossRefPubMedGoogle Scholar
  13. Colgan, S. E., Lanter, E., McComish, C., Watson, L. R., Crais, E. R., & Baranek, G. T. (2006). Analysis of social interaction gestures in infants with autism. Child Neuropsychology: A Journal on Normal and Abnormal Development in Childhood and Adolescence, 12(4–5), 307–319.Google Scholar
  14. Constantino, J. N. (2005). Social responsiveness scale. Los Angeles, CA: Western Psychological Services.Google Scholar
  15. Constantino, J. N., Davis, S. A., Todd, R. D., Schindler, M. K., Gross, M. M., Brophy, S. L., et al. (2003). Validation of a brief quantitative measure of autistic traits: comparison of the Social Responsiveness Scale with the Autism Diagnostic Interview-Revised. Journal of Autism and Developmental Disorders, 33, 427–433.CrossRefPubMedGoogle Scholar
  16. Constantino, J. N., & Todd, R. D. (2005). Intergenerational transmission of subthreshold autistic traits in the general population. Biological Psychiatry, 57(6), 655–660.CrossRefPubMedGoogle Scholar
  17. Cotton, S., & Richdale, A. (2006). Brief report: Parental descriptions of sleep problems in children with autism, down syndrome, and prader-willi syndrome. Research in Developmental Disabilities, 27(2), 151–161.CrossRefPubMedGoogle Scholar
  18. Dekker, M. C., Koot, H. M., van der Ende, J., & Verhulst, F. C. (2002a). Emotional and behavioral problems in children and adolescents with and without intellectual disability. Journal of Child Psychology and Psychiatry and Allied Disciplines, 43(8), 1087–1098.CrossRefGoogle Scholar
  19. Dekker, M. C., Nunn, R., & Koot, H. M. (2002b). Psychometric properties of the revised developmental behaviour checklist scales in Dutch children with intellectual disability. Journal of Intellectual Disability Research: JIDR, 46(Pt 1), 61–75.CrossRefPubMedGoogle Scholar
  20. Donovan, A. M. (1988). Family stress and ways of coping with adolescents who have handicaps: Maternal perceptions. American Journal of Mental Retardation: AJMR, 92(6), 502–509.PubMedGoogle Scholar
  21. Fayers, P. M., & Machin, D. (2007). Quality of life: The assessment, analysis and interpretation of patient-reported outcomes (2nd ed. ed.). West Sussex, England: John Wiley and Sons Ltd.Google Scholar
  22. Gabriels, R. L., Cuccaro, M. L., Hill, D. E., Ivers, B. J., & Goldson, E. (2005). Repetitive behaviors in autism: Relationships with associated clinical features. Research in Developmental Disabilities, 26(2), 169–181.CrossRefPubMedGoogle Scholar
  23. Gross, T. F. (2004). The perception of four basic emotions in human and nonhuman faces by children with autism and other developmental disabilities. Journal of Abnormal Child Psychology, 32(5), 469–480.CrossRefPubMedGoogle Scholar
  24. Gurney, J. G., McPheeters, M. L., & Davis, M. M. (2006). Parental report of health conditions and health care use among children with and without autism: National survey of children’s health. Archives of Pediatrics and Adolescent Medicine, 160(8), 825–830.CrossRefPubMedGoogle Scholar
  25. Hill, E., Berthoz, S., & Frith, U. (2004). Brief report: Cognitive processing of own emotions in individuals with autistic spectrum disorder and in their relatives. Journal of Autism and Developmental Disorders, 34(2), 229–235.CrossRefPubMedGoogle Scholar
  26. Hobson, R. P., & Lee, A. (1998). Hello and goodbye: A study of social engagement in autism. Journal of Autism and Developmental Disorders, 28(2), 117–127.CrossRefPubMedGoogle Scholar
  27. Klassen, A. F., Miller, A., & Fine, S. (2004). Health-related quality of life in children and adolescents who have a diagnosis of attention-deficit/hyperactivity disorder. Pediatrics, 114(5), e541–e547.CrossRefPubMedGoogle Scholar
  28. Lord, C., Risi, S., Lambrecht, L., Cook, E. H., Jr, 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(3), 205–223.CrossRefPubMedGoogle Scholar
  29. Lord, C., Rutter, M., & Le Couteur, A. (2003). Autism diagnostic interview-revised. Los Angeles, CA: Western Psychological Services.Google Scholar
  30. McGovern, C. W., & Sigman, M. (2005). Continuity and change from early childhood to adolescence in autism. Journal of Child Psychology and Psychiatry and Allied Disciplines, 46(4), 401–408.CrossRefGoogle Scholar
  31. Mullen, E. M. (1997). Mullen scales of early learning. Los Angeles: Western Psychological Services.Google Scholar
  32. Oyane, N. M., & Bjorvatn, B. (2005). Sleep disturbances in adolescents and young adults with autism and asperger syndrome. Autism: The International Journal of Research and Practice, 9(1), 83–94.Google Scholar
  33. Roid, G. H. (2003). Stanford binet intelligence scales (5th ed.). Itasca, IL: Riverside Publishing.Google Scholar
  34. Sparrow, S. S., Balla, D., & Cicchetti, D. V. (1984). Vineland adaptive behavior scales (Survey). Circle Pines, MN: American Guidance Service.Google Scholar
  35. Sparrow, S. S., Cicchetti, D. V., & Balla, D. (2005). The vineland II adaptive behavior scales. Circle Pines, MN: American Guidance Service.Google Scholar
  36. Storch, E. A., Merlo, L. J., Lack, C., Milsom, V. A., Geffken, G. R., Goodman, W. K., et al. (2007). Quality of life in youth with tourette’s syndrome and chronic tic disorder. Journal of Clinical Child and Adolescent Psychology: The Official Journal for the Society of Clinical Child and Adolescent Psychology, American Psychological Association, Division 53, 36(2), 217–227.Google Scholar
  37. Teunisse, J. P., & de Gelder, B. (2001). Impaired categorical perception of facial expressions in high-functioning adolescents with autism. Child Neuropsychology: A Journal on Normal and Abnormal Development in Childhood and Adolescence, 7(1), 1–14.Google Scholar
  38. Varni, J. W. (1998). Pediatric quality of life inventory version 4.0. Lyon, France: Mapi Research Institute.Google Scholar
  39. Varni, J. W., & Burwinkle, T. M. (2006). The PedsQL as a patient-reported outcome in children and adolescents with attention-Deficit/Hyperactivity disorder: A population-based study. Health and Quality of Life Outcomes, 4, 26.CrossRefPubMedGoogle Scholar
  40. Varni, J. W., Burwinkle, T. M., Seid, M., & Skarr, D. (2003). The PedsQL 4.0 as a pediatric population health measure: Feasibility, reliability, and validity. Ambulatory Pediatrics: The Official Journal of the Ambulatory Pediatric Association, 3(6), 329–341.Google Scholar
  41. Varni, J. W., Seid, M., & Kurtin, P. S. (2001). PedsQL 4.0: Reliability and validity of the pediatric quality of life inventory version 4.0 generic core scales in healthy and patient populations. Medical Care, 39(8), 800–812.CrossRefPubMedGoogle Scholar
  42. Wallander, J. L., Dekker, M. C., & Koot, H. M. (2006). Risk factors for psychopathology in children with intellectual disability: A prospective longitudinal population-based study. Journal of Intellectual Disability Research: JIDR, 50(Pt 4), 259–268.CrossRefPubMedGoogle Scholar
  43. Williams, G., Sears, L. L., & Allard, A. (2004). Sleep problems in children with autism. Journal of Sleep Research, 13(3), 265–268.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Karen Kuhlthau
    • 1
    • 2
  • Felice Orlich
    • 3
    • 4
  • Trevor A. Hall
    • 5
    • 6
  • Darryn Sikora
    • 6
  • Erica A. Kovacs
    • 7
  • Jennifer Delahaye
    • 1
  • Traci E. Clemons
    • 8
  1. 1.Center for Child and Adolescent Health PolicyMassachusetts General HospitalBostonUSA
  2. 2.Department of PediatricsHarvard Medical SchoolBostonUSA
  3. 3.Department of Psychiatry and Behavioral SciencesUniversity of WashingtonSeattleUSA
  4. 4.Autism ProgramSeattle Children’s HospitalSeattleUSA
  5. 5.Warm Springs Autism Diagnostic & Treatment CenterPortlandUSA
  6. 6.Oregon Health & Science UniversityPortlandUSA
  7. 7.Columbia Developmental Neuropsychiatry Program, Division of Child and Adolescent PsychiatryColumbia University Medical CenterNew YorkUSA
  8. 8.The EMMES CorporationPotomacUSA

Personalised recommendations