Emotional and Behavioral Problems in Youth with Autism: High Prevalence and Impact on Functioning.
Eric Fombonne, Lisa A Croen, Joanna E Bulkley and 5 others
PMID 34693924WHAT IT FOUND
Caregivers reported that children with autism had more emotional and behavioral problems and more daily-life impairment than children with asthma or no condition.
Behavior problems contributed to impairment about as much as autism symptoms.
Key findings
01Children with autism had higher total behavior-problem scores and higher parent-reported impairment than children with asthma or no condition, and than U.S. population norms.
02Impairment showed the largest group difference, and hyperactivity symptoms separated the autism group from the comparison groups more strongly than conduct or emotional symptoms.
03Within the autism group, autism symptoms and emotional/behavioral problems together explained 52.5% of impairment variance, and after accounting for their overlap each accounted for about 50%.
STILL TO COME
How it was doneWhat they foundWhat it means for OTs
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What it does not show
The design was cross-sectional, so it cannot show that emotional and behavioral problems caused impairment or that treating them would improve functioning. Only 1,707 of 6,533 contacted families consented (26.1%), and participation bias may have occurred. SDQ completion was lower for families of children with autism (83.7%) than for families of children with asthma (87.6%) or controls (89.7%), so the analyzed group may not represent all eligible families. Most children were male (79.4%), so girls may be underrepresented. All outcomes were parent or guardian report; children were not assessed directly and no school-based measure was available. The study could not assess language skills or intellectual level, which can affect behavior and functioning. Asthma was used as the chronic-condition comparison, but conditions affecting the central nervous system may be more relevant for some questions. Familial, school and community factors that may influence impairment were not measured.
Declared interests
The authors reported no conflicts of interest.
The easy way to misread this
Do not conclude that treating emotional and behavioral problems will reduce impairment. This was an observational survey at one time point, and it did not test any intervention.