Prevalence of Emotional and Behavioural Disorders in Young Children with Autistic Disorder in Jamaica

Prevalence of Emotional and Behavioural Disorders in Young Children with Autistic Disorder in Jamaica 

Background: Children with Autistic Disorder are known to have more co-morbid emotional and behavioral disorders (EBD) than their typically developing peers.  This has resulted in intervention strategies designed to reduce withdrawn behavior, aggressive behavior and attention problems, in particular.  There may be cultural differences in the EBD that children with autistic disorder manifest.  There is little available information on the prevalence of EBD in children diagnosed with autistic disorder in developing countries, including Jamaica.

Objectives: The objective of this study is to determine the prevalence of co-morbid  emotional and behavioural disorders in young children diagnosed with autistic disorder in Jamaica.  

Methods: The Jamaica Autism Database (JAD) contains 500 children diagnosed at Jamaica’s main referral centre for autism, the University Hospital of the West Indies (UHWI), since 1999. Ninety two (92) children between the ages of 11/2 and 5 years, who were diagnosed with autistic disorder, using DSM IV criteria , a standardised tool, the Childhood Autism Rating Scale (CARS), and who had  the Child Behavior Checklist 11/2-5 years parent report and the Teacher Report Form completed were included in this study. These forms require adults to rate 99 individual behaviours as being absent, present but not frequently occurring and present but frequently occurring.   Cross informant syndromes for the following EBDs were derived for both forms: Emotionally Reactive, Anxious/Depressed, Somatic Complaints, Withdrawn, Attention Problems, and Aggressive Behavior. The parent report also includes a Sleep Problem syndrome.  Children’s syndrome scores are subsequently rated as being in the non-clinical range, the borderline clinically significant range and the clinically significant range.  In this study, the latter two categories were combined m resulting in two ratings: not clinically significant or clinically significant.

Results: There were 77 males (83.7%), the mean age of the population was 4.5 years (SD 1.7). Less than 20% of parents or teachers reported behaviours consistent with Emotional Reactivity, Anxiety/Depression, Somatic Complaints, Affective Problems and Anxiety.  Parents reported sleep problems in 12.8%.  Both parents and teachers reported similar, relatively high prevalence of Withdrawn Behaviour (47.6%, 43.5%), Attention Problems (39.1%, 40.2%), Aggressive Behaviour (29.3%, 23.8%) and Oppositional Defiant Problems (28.3%, 20.7%).  Discrepancy between parent and teacher reports occurred only for ADHD, with prevalence of 11.7% and 33.7%, respectively. Pervasive Developmental Problems, of which autistic disorder is the most common, was reported at 64.1% by parents and 50% by teachers.

Conclusions: Parents and teachers report similar prevalence of EBD in young Jamaican children with autism.  Similar to findings reported in the literature from the USA, Withdrawn Behaviour, Attention Problems and Aggression are the most prevalent of the EBDs in young children with autism.  Clinicians should enquire of  symptoms of these disorders when a diagnosis of autism is being considered, to ensure holistic care of the child..