Journal of Autism and Developmental Disorders

, Volume 49, Issue 2, pp 729–737 | Cite as

Exploring Traits of Autism and Their Impact on Functional Disability in Children with Somatic Symptom Disorder

  • Kyoko HattaEmail author
  • Mariko Hosozawa
  • Kyoko Tanaka
  • Toshiaki Shimizu
Original Paper


Subclinical traits of autism were measured in children with somatic symptom disorder (SSD, n = 28) and compared with age-matched controls (n = 26) using the Autism Spectrum Quotient (AQ) children’s version. The KINDLR quality of life questionnaire was used to assess functional disability. Although there was no significant group difference in total traits of autism, SSD group had significantly greater difficulty in attention switching domain. Logistic regression analysis confirmed attention switching and age were associated with increased likelihood of SSD. In SSD group, difficulty in attention switching significantly negatively correlated with total, family, and friends quality of life scores. In conclusion, assessment and treatment targeting difficulties in attention switching could be useful when dealing with children with SSD.


Somatic symptom disorder Autism Spectrum Quotient Autism spectrum disorder Autistic traits Attention switching 



We are grateful to Dr Seigo Shiga, Masato Kantake, Takahiro Kudo, and Tamiko Usui who contributed to data collection. The authors would like to thank Dr Shuko Nojiri for her guidance regarding the statistical analysis.

Author Contributions

KH, MH, and KT developed the study concept. KH and MH collected the data. KH performed the analyses. KH drafted the paper, MH revised the paper and KT and TS provided critical advice. All authors approved the final version of the paper for submission.

Compliance with Ethical Standards

Conflict of interest

The authors have no conflict of interest relevant to this article to disclose.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

10803_2018_3751_MOESM1_ESM.pptx (40 kb)
Supplementary material 1 (PPTX 40 KB)


  1. American Psychiatric Association. (2013). Diagnostic and statistical manual mental disorders DSM-5 (5th edn.). Washington, DC: American Psychiatric Association.CrossRefGoogle Scholar
  2. Auyeung, B., Baron-Cohen, S., Wheelwright, S., & Allison, C. (2008). The autism spectrum quotient: Children’s version (AQ-Child). Journal of Autism and Developmental Disorders, 38, 1230–1240. Scholar
  3. Baron-Cohen, S., Hoekstra, R. A., Knickmeyer, R., & Wheelwright, S. (2006). The Autism-Spectrum Quotient (AQ)—adolescent version. Journal of Autism and Developmental Disorders, 36, 343–350. Scholar
  4. Baron-Cohen, S., Wheelwright, S., Skinner, R., Martin, J., & Clubley, E. (2001). The autism-spectrum quotient (AQ): Evidence from Asperger syndrome/high-functioning autism, males and females, scientists and mathematicians. Journal of autism and developmental disorders, 31, 5–17.CrossRefGoogle Scholar
  5. Beck, J. E. (2008). A developmental perspective on functional somatic symptoms. Journal of pediatric psychology, 33, 547–562. Scholar
  6. Bishop, S. L., Richler, J., Cain, A. C., & Lord, C. (2007). Predictors of perceived negative impact in mothers of children with autism spectrum disorder. American journal of mental retardation: AJMR, 112, 450–461.;2.CrossRefGoogle Scholar
  7. Black, K. R., et al. (2017). Linking anxiety and insistence on sameness in autistic children: The role of sensory hypersensitivity. Journal of Autism and Developmental Disorders, 47, 2459–2470. Scholar
  8. Bujoreanu, S., Randall, E., Thomson, K., & Ibeziako, P. (2014). Characteristics of medically hospitalized pediatric patients with somatoform diagnoses. Hospital Pediatrics, 4, 283–290. Scholar
  9. Campo, J. V., et al. (2004). Recurrent abdominal pain, anxiety, and depression in primary care. Pediatrics, 113, 817–824.CrossRefGoogle Scholar
  10. Cerutti, R., Presaghi, F., Spensieri, V., Valastro, C., & Guidetti, V. (2016). The potential impact of internet and mobile use on headache and other somatic symptoms in adolescence. A population-based cross-sectional study. Headache, 56, 1161–1170. Scholar
  11. Cerutti, R., Spensieri, V., Valastro, C., Presaghi, F., Canitano, R., & Guidetti, V. (2017). A comprehensive approach to understand somatic symptoms and their impact on emotional and psychosocial functioning in children. PLoS ONE, 12, e0171867. Scholar
  12. Chang, L. (2011). The role of stress on physiologic responses and clinical symptoms in irritable bowel syndrome. Gastroenterology, 140, 761–765. Scholar
  13. Chitkara, D. K., van Tilburg, M. A., Blois-Martin, N., & Whitehead, W. E. (2008). Early life risk factors that contribute to irritable bowel syndrome in adults: A systematic review. The American Journal of Gastroenterology, 103, 765–774. (quiz 775)CrossRefGoogle Scholar
  14. Corbett, B. A., Schupp, C. W., Levine, S., & Mendoza, S. (2009). Comparing cortisol, stress, and sensory sensitivity in children with autism. Autism Research: Official Journal of the International Society for Autism Research, 2, 39–49. Scholar
  15. Cozzi, G., et al. (2017). Somatic symptom disorder was common in children and adolescents attending an emergency department complaining of pain. Acta Paediatrica (Oslo, Norway: 1992), 106, 586–593. Scholar
  16. Craig, F., Lamanna, A. L., Margari, F., Matera, E., Simone, M., & Margari, L. (2015). Overlap between autism spectrum disorders and attention deficit hyperactivity disorder: Searching for distinctive/common clinical features. Autism Research: Official Journal of the International Society for Autism Research, 8, 328–337. Scholar
  17. De Pauw, S. S., Mervielde, I., Van Leeuwen, K. G., & De Clercq, B. J. (2011). How temperament and personality contribute to the maladjustment of children with autism. Journal of Autism and Developmental Disorders, 41, 196–212. Scholar
  18. Durand, V. M., & Carr, E. G. (1987). Social influences on “self-stimulatory” behavior: Analysis and treatment application. Journal of Applied Behavior Analysis, 20, 119–132. Scholar
  19. Emich-Widera, E., Kazek, B., Szwed-Bialozyt, B., Kopyta, I., & Kostorz, A. (2012). Headaches as somatoform disorders in children and adolescents. Mental Illness, 4, e9. Scholar
  20. 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, 169–181. Scholar
  21. Gotham, K., et al. (2013). Exploring the relationship between anxiety and insistence on sameness in autism spectrum disorders. Autism Research: Official Journal of the International Society for Autism Research, 6, 33–41. Scholar
  22. Guidetti, V., Faedda, N., & Siniatchkin, M. (2016). Migraine in childhood: Biobehavioural or psychosomatic disorder? The Journal of Headache and Pain, 17, 82. Scholar
  23. Harrop, C., McBee, M., & Boyd, B. A. (2016). How are child restricted and repetitive behaviors associated with caregiver stress over time? A parallel process multilevel growth model. Journal of Autism and Developmental Disorders, 46, 1773–1783. Scholar
  24. Hoekstra, R. A., Bartels, M., Cath, D. C., & Boomsma, D. I. (2008). Factor structure, reliability and criterion validity of the Autism-Spectrum Quotient (AQ): A study in Dutch population and patient groups. Journal of Autism and Developmental Disorders, 38, 1555–1566. Scholar
  25. Ilola, A. M., Lempinen, L., Huttunen, J., Ristkari, T., & Sourander, A. (2016). Bullying and victimisation are common in four-year-old children and are associated with somatic symptoms and conduct and peer problems. Acta Paediatrica (Oslo, Norway: 1992), 105, 522–528. Scholar
  26. Kimura, M., Chisaki, K., Yamaguchi, H., & Ikuno, T. (2006). Underlying developmental disorders in patients who visited the outoatient psychosomatic clinic of the development of pediatrics. Japanese Journal of Psychosomatic Medicine, 46, 309–317.Google Scholar
  27. Kiriyama, M. (2008). High-functioning pervasive developmental disorders presenting in school non-attendees in adolescence. Kawasaki Medical Journal, 34, 57–68.Google Scholar
  28. Kojima, N., et al. (2009). Exercise-induced asthma is associated with impaired quality of life among children with asthma in Japan. Allergology International, 58, 187–192. Scholar
  29. Korterink, J. J., Diederen, K., Benninga, M. A., & Tabbers, M. M. (2015). Epidemiology of pediatric functional abdominal pain disorders: A meta-analysis. PLoS ONE, 10, e0126982. Scholar
  30. Landa, A., Peterson, B. S., & Fallon, B. A. (2012). Somatoform pain: A developmental theory and translational research review. Psychosomatic Medicine 74, 717–727. Scholar
  31. 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: JIDR, 50, 172–183. Scholar
  32. Lee, S., Odom, S. L., Loftin, R. L. (2007). Stereotypic behavior and social isolation in autism. Journal of Positive Behavior Interaction and Support, 9, 67–79.CrossRefGoogle Scholar
  33. Leekam, S. R., Prior, M. R., & Uljarevic, M. (2011). Restricted and repetitive behaviors in autism spectrum disorders: A review of research in the last decade. Psychological Bulletin, 137, 562–593. Scholar
  34. Loftin, R. L., Odom, S. L., & Lantz, J. F. (2008). Social interaction and repetitive motor behaviors. Journal of Autism and Developmental Disorders, 38, 1124–1135. Scholar
  35. Malas, N., Donohue, L., Cook, R. J., Leber, S. M., & Kullgren, K. A. (2018). Pediatric somatic symptom and related disorders: Primary care provider perspectives. Clinical Pediatrics, 57, 377–388. Scholar
  36. Matsuzaki, K., Nemoto, Y., & Shibata, R. (2007). A study of the Kiddo-KINDL (Questionnaire for Measuring Health-Related Quality of Life in Children, Revised Version for 13 to 1-year-olds) in Japan. The Journal of the Japan Pediatric Society, 111, 1404–1410.Google Scholar
  37. Maunder, R. G., & Hunter, J. J. (2001). Attachment and psychosomatic medicine: Developmental contributions to stress and disease. Psychosomatic Medicine, 63, 556–567.CrossRefGoogle Scholar
  38. McKillop, H. N., & Banez, G. A. (2016). A broad consideration of risk factors in pediatric chronic pain: Where to Go from here? Children (Basel, Switzerland). Scholar
  39. Mercier, C., Mottron, L., & Belleville, S. (2000). A psychosocial study on restricted interests in high functioning persons with pervasive developmental disorders. Autism 4, 406–425.CrossRefGoogle Scholar
  40. Molnar, B. E., Buka, S. L., & Kessler, R. C. (2001). Child sexual abuse and subsequent psychopathology: Results from the National Comorbidity Survey. American Journal of Public Health, 91, 753–760.CrossRefGoogle Scholar
  41. Nadig, A., Lee, I., Singh, L., Bosshart, K., & Ozonoff, S. (2010). How does the topic of conversation affect verbal exchange and eye gaze? A comparison between typical development and high-functioning autism. Neuropsychologia, 48, 2730–2739. Scholar
  42. Nansel, T. R., Overpeck, M., Pilla, R. S., Ruan, W. J., Simons-Morton, B., & Scheidt, P. (2001). Bullying behaviors among US youth: Prevalence and association with psychosocial adjustment. JAMA, 285, 2094–2100.CrossRefGoogle Scholar
  43. Natalucci, G., Faedda, N., Calderoni, D., Cerutti, R., Verdecchia, P., & Guidetti, V. (2018). Headache and alexithymia in children and adolescents: What is the connection? Frontiers in Psychology, 9, 48. Scholar
  44. Nitahara, Y., Tachibana, Y., Koeda, T., & Okuyama, M. (2015). Kirituseicyousetusyougai no haikei ni jiheisyousupekutoramu wo mitometa 1 rei. Japanese Journal of Clinical Psychiatry, 44, 1289–1292.Google Scholar
  45. Ravens-Sieberer, U., & Bullinger, M. (1998). Assessing health-related quality of life in chronically ill children with the German KINDL: First psychometric and content analytical results. Quality of Life Research: An International Journal of Quality of Life Aspects of Treatment, Care and Rehabilitation, 7, 399–407.CrossRefGoogle Scholar
  46. Shibata, R., Nemoto, Y., & Matuzaki, K. (2003). A Study of the Kid-KINDL questionnaire for measuring quality of life in elementary school children in Japan. The Journal of the Japan Pediatric Society, 107, 1514–1520.Google Scholar
  47. Shiokawa, H., & Momoi, M. (2002). Psychosomatic and behaviral problems in children with Asperger disorder. Journal of Japanese Society of Psychosomatic Pediatrics, 10, 128–133.Google Scholar
  48. Sifneos, P. E. (1973). The prevalence of ‘alexithymic’ characteristics in psychosomatic patients. Psychotherapy and psychosomatics, 22, 255–262.CrossRefGoogle Scholar
  49. Surdea-Blaga, T., Baban, A., & Dumitrascu, D. L. (2012). Psychosocial determinants of irritable bowel syndrome. World Journal of Gastroenterology, 18, 616–626. Scholar
  50. Tanaka, Y., Ichikawa, H., & Ono, K. (2016). ADHD-RS hyoka sukeiru no nihonngobann hyojyunnka ni mukete. Clinical Psychiatry, 58, 317–326.Google Scholar
  51. Uljarevic, M., & Evans, D. W. (2017). Relationship between repetitive behaviour and fear across normative development, autism spectrum disorder, and down syndrome. Autism research: Official journal of the International Society for Autism Research, 10, 502–507. Scholar
  52. Wakabayashi, A., Baron-Cohen, S., Wheelwright, S., & Tojo, Y. (2006). The Autism-Spectrum Quotient (AQ) in Japan: A cross-cultural comparison. Journal of Autism and Developmental Disorders, 36, 263–270. Scholar
  53. Wakabayashi, A., et al. (2007). The Autism-Spectrum Quotient (AQ) Children's version in Japan: A crosscultural comparison. Journal of Autism and Developmental Disorders, 37, 491–500. Scholar
  54. Wallace, G. L., et al. (2016). Real-world executive functions in adults with autism spectrum disorder: Profiles of impairment and associations with adaptive functioning and co-morbid anxiety and depression. Journal of Autism and Developmental Disorders, 46, 1071–1083. Scholar
  55. White, S. W., Oswald, D., Ollendick, T., & Scahill, L. (2009). Anxiety in children and adolescents with autism spectrum disorders. Clinical Psychology Review, 29, 216–229. Scholar
  56. Yacob, D., et al. (2013). Prevalence of pain-predominant functional gastrointestinal disorders and somatic symptoms in patients with anxiety or depressive disorders. The Journal of pediatrics, 163, 767–770. Scholar
  57. Yerys, B. E., et al. (2017). Evaluation of the ADHD rating scale in youth with Autism. Journal of Autism and Developmental Disorders, 47, 90–100. Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Kyoko Hatta
    • 1
    Email author
  • Mariko Hosozawa
    • 1
  • Kyoko Tanaka
    • 2
  • Toshiaki Shimizu
    • 1
  1. 1.Department of Pediatrics and Adolescent MedicineJuntendo University Graduate School of MedicineTokyoJapan
  2. 2.Department of Psychosocial MedicineNational Center for Child Health and DevelopmentTokyoJapan

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