A Comparison of Psychiatric Problems In Children with Autism, Prader-Willi Syndrome and Age, Gender and IQ Matched Control Group

Background: Comorbid psychiatric disorders complicate the course of both Autistic spectrum disorders (ASD) and Prader-Willi Syndrome (PWS) by affecting detection, therapeutic interventions, and outcome. The better understand of comorbid psychiatric disorders in ASD and PWS may facilitate more specific treatment potentially limiting negative outcomes.

Objectives: to examine comorbid psychiatric problems in a sample of children with ASD and PWS and their parents compared with an age, gender and IQ matched control group and their parents.

Methods: Subjects

Children with genetically confirmed PWS and their parents participating in the First National Irish PWS study were invited to participate. Children with ASD participating in the Irish Autism Genetics Study were also invited to participate: inclusion criteria for the present study were diagnosis of autism based on the Autism Diagnostic Interview-Revised (ADI-R), a diagnosis of autism or autism spectrum disorder based on the Autism Diagnostic Observational Schedule (ADOS). The age, gender and IQ matched control group was collected through Special Schools.

Assessment Instruments

The Child Behavior Checklist 6-18 (CBCL/6-18) was used to assess behavioral/emotional problems in children. Parents reported their own psychological distress using the Brief Symptom Inventory (BSI). Cognitive assessment was based on assessment with the Leiter International Performance Scale-Revised (Leiter-R).

Results:

All groups (PWS, ASD and controls) were comprised of 24 children. In all groups there were 11 (45%) girls and 13 (55%) boys. The groups did not differ significantly on mean age, mean IQ scores, gender, and parents mean age.

Results of the CBCL/6-18 revealed that the majority of parents reported their child with ASD or PWS as having either internalizing (ASD: clinical range-41.6%; borderline range-20.84%; PWS: clinical range-37.5%; borderline range-8.3%) or externalizing problems (ASD: clinical range-8.3%; borderline range-20.3% PWS: clinical range-8.3%; borderline range-16.6%). In the control group more parents reported their children having externalizing (clinical range- 37.5%; borderline range-16.6%) than internalizing problems (clinical range-16.6%; borderline range-4.1%).

Clinically significant difficulties were not reached for any of CBCL DSM orientated subscales in PWS group. Borderline difficulties were detected for the affective, somatic and ADHD CBCL DSM orientated subscales in PWS group with PWS children having significantly more somatic (mean T=63.05 SD=8.33 vs. 52 SD=6.48, P<.05) and affective (mean T=66.22 SD=8.51, vs. 60.08 SD=6.829 P<.05) problems than controls. Almost one third of the ASD group met CBCL DSM criteria for clinically significant ADHD (37.5 %) and anxiety (29.1%) problems.

The presence of BSI T-scores greater than 63 on two or more BSI subscales indicates possible psychopathology. Based on this criterion one third of ASD children’s mothers (33.3%) and fathers (20.8 %) screened positive for psychopathology with obsessive-compulsive and phobic anxiety being most common. Based on the same criterion, 16.6% of PWS fathers and 37.5% of mothers screened positive for psychopathology with depression being most common.

Conclusions:   Both PWS and ASD represent complex neurodevelopmental disorders with multiple areas of disturbances.