INFLUENCE of Symptom SEVERITY and Adaptive BEHAVIOR Functioning of CHILDREN with AUTISM Spectrum DISORDERS On Parental ADHERENCE to TREATMENT Recommendations

Background: Previous research has suggested a relationship between parental adherence to treatment recommendations for children with autism spectrum disorders (ASD) and diagnosis of the child. Moore and Symons (2009) found that parents of children with Asperger syndrome were less likely than parents of other ASD diagnoses to adhere to behavioral treatment recommendations. It is unclear, however, whether it is the actual diagnosis that influences treatment adherence, or whether this difference is related to other factors such as child’s level of symptom severity and/or current level of adaptive behavior functioning. 

Objectives: This study investigated the roles of symptom severity and adaptive behavior functioning in parents’ adherence to treatment recommendations. We predicted that parents of children who currently exhibit more severe ASD symptoms and/or lower levels of adaptive behavior functioning were more likely to adhere to treatment recommendations than parents with children with milder ASD symptom presentations and/or higher levels of adaptive behavior functioning.

Methods: Ninety-five primary caregivers of individuals with ASD anonymously completed four online questionnaires. All participants were parents of individuals 21-years-old or younger. Accuracy of diagnosis was screened using the Social Communication Questionnaire (SCQ) Lifetime version. The SCQ Current version was used to measure current symptom severity. To measure adaptive behavior functioning, parents completed the Adaptive Behavior Assessment System-Second Edition (ABAS-II). Parents then completed the Parental Adherence Questionnaire, which looked at parental adherence to behavioral and medical treatment recommendations for children with ASD (modified from Moore & Symons, 2009). 

Results: When controlling for parent-reported diagnosis of the child, SCQ Current total score accounted for a significant proportion of variance in parental adherence to both behavioral and medical treatment recommendations (β=.283 and β=.324, p<.05) over and above the effects of diagnosis alone. When only parent-reported diagnosis was used, parental adherence was found to be statistically significant with only behavioral treatment recommendations. Overall level of adaptive behavior functioning was not correlated with parental adherence to either behavioral or medical treatment recommendations (r=.126 and r=.188, p>.05).

Conclusions: These data suggest ASD symptom severity is predictive of parental adherence to both behavioral and medical treatment recommendations over and above diagnosis alone. Therefore, parents of children with milder ASD symptoms, as seen in individuals with a diagnosis of Asperger Syndrome or “high-functioning” autism, are less likely to adhere to treatment recommendations possibly impeding on additional developmental gains of the child. In fact, Saulnier and colleagues (2011) reported that with age, gains in adaptive skills do not develop at the same rate as cognitive skills in children with high IQ, thus stressing the importance for parents to adhere to treatment recommendations for children with higher skills set. Future research should examine whether specific items (rather than summary scores) are more predictive of parental adherence to treatment recommendations.