Associated Psychiatric Conditions, Problem Behavior, and Adaptive Functioning in Adolescents with ASD

Background: In addition to the core social, communication and behavioral features of ASD, up to 80% of adolescents with ASD may suffer from additional psychiatric conditions and problem behaviors, which can further impair functioning. Researchers have reported exacerbation of associated symptoms and behavioral deterioration in one third to one half of children with ASD around the time of puberty and early adolescence. Because ASDs alone can be quite debilitating, associated symptoms are often not the primary focus of diagnosis or treatment. However, such symptoms can exacerbate impairments in individuals with ASD and may be treatable with behavioral and pharmacological interventions.

Objectives: Investigate whether 13-15 year olds with ASD have higher levels of psychiatric conditions and lower adaptive functioning compared with adolescents with typical development. Describe the relationship between level of cognitive functioning and associated conditions in this sample. Explore the relationship between pubertal onset and levels of associated conditions in adolescents with ASD.

Methods: 27 adolescents with ASD and 26 adolescents with typical development between 13-15 years of age were assessed for psychiatric conditions, problem behavior and adaptive functioning.  Parent report of associated psychiatric conditions was obtained using the Child Behavior Checklist, problem behavior using the Aberrant Behavior Checklist and adaptive functioning using the Vineland Adaptive Behavior Scales.  The Differential Ability Scales II was used to directly assess cognitive ability in both groups. Pubertal development was assessed using the Tanner Scale of Sexual Maturity.

Results: Parent report of psychiatric conditions indicates that adolescents with ASD have increased internalizing and externalizing symptoms, increased problem behavior and decreased adaptive functioning compared with typically developing adolescents.  In addition, the relationship between level of cognitive function and associated psychiatric conditions, problem behavior and adaptive functioning will be investigated.  The role of pubertal development will be discussed.

Conclusions: Research on associated conditions and adaptive functioning in adolescents is needed to increase awareness of the range of psychiatric conditions and adaptive functioning challenges facing adolescents with ASD.  This awareness should be used to guide clinical assessment procedures in this age group and provide more effective intervention to adolescents with ASD.