Parent-Child Interaction and Global Assessment of Functioning: Measuring Change and Outcome in Adolescents with Autism

Background:

Individuals with autism have difficulties in their relations with other people – both caregivers and peers.  Adolescence can bring special challenges, and co-morbid conditions may exacerbate affected adolescents’ problems with adaptive functioning and quality of life.  It is important to discover whether both in children and adolescents – and in given individuals across this time - these broader problems are more or less severe, depending on individuals’ ability to engage with other people.

Objectives:

The objectives of this study were to investigate a) whether among children and adolescents with autism, limitations in social engagement with caregivers are associated with broader difficulties in adjustment and functioning, and b) whether changes in individuals’ social engagement that take place from childhood to adolescence (changes that my have been fostered by the current participants’ involvement in Relationship Development Intervention) correspond with changes in global functioning over time.

Methods:

We studied 16 families each of which included an adolescent with autism, diagnosed according to the Autism Diagnostic Observation Schedule (ADOS) and the Autism Diagnostic Interview (ADI), who had previously participated in a treatment aimed at fostering communication through parent-child and subsequently child-peer interactions.

The principal measures were of two kinds, each of which was administered when the individuals with autism were in childhood or early adolescence (chronological age = 7 years, range 2 - 13 years) and then later in adolescence (chronological age M = 13 years, range 10 - 17 years: time span between measures for individuals M = 5 years, range 3 – 8 years):

a)      Interactions between the children/adolescents and their parents.  There were two forms of assessment: firstly, videotape analysis of interactions using the Dyadic Coding Scale (Humber & Moss, 2005), and secondly, caregiver-report measures.

b)      Clinical judgments on the Children’s Global Assessment Scale (C-GAS).  These ratings were made by clinicians ‘blind’ to the time that data were collected, taking into account a comprehensive set of measures including formal assessments of cognitive ability, emotional and behavioral symptoms (BASC), adaptive functioning (VABS), clinical features of autism (ADOS and ADI-R).

Results:

Preliminary results suggest that in this sample, caregiver-child relatedness improved over time. This will enable us to determine whether such changes – as well as separate analyses of data at the two time-points of data collection – correspond with global measures on the CGAS.

Conclusions:

Whatever the outcome of this study, it will illustrate the value of methodologically novel approaches to the measurement of change and functioning among individuals with autism – especially in their relations with caregivers – from childhood into adolescence.  It will also provide suggestive evidence on the significance of affected individuals’ capacities to engage with caregivers for broader aspects of their functioning.