Remarkably little research has considered the long-term impact of abuse and maltreatment in childhood, on the development of social communication. Patterns of autistic-like behaviours appear to be evident amongst children who have been exposed to profound and prolonged institutional deprivation. This has been referred to as ‘quasi-autism’ in the literature. Within this group, the features that originally appeared to be consistent with autism were shown to diminish somewhat with age, but a number of atypical features remained. Despite well documented deficits, the parameters for ‘quasi-autism’ are far from clear-cut. This study aims to further understand the concept of ‘quasi-autism’ by comparing children who have experienced early maltreatment to children diagnosed with Autism Spectrum Disorder (ASD). In this way the social communication impairments displayed by maltreated children can be more accurately conceptualised.
Objectives:
To investigate whether early maltreatment and abuse influence the development of social communication skills and contribute to the development of features consistent with ASD. If yes, are these features similar to those children who have not experienced such early adversity but do have a diagnosis of autism?
Methods:
12 maltreated children (mean age 11.25 years, mean verbal IQ 82.5) were identified through a national attachment and trauma clinic and assessed for ASD symptomatology (using the 3Di and ADOS) and additional co-morbidities (using the Strengths and Difficulties Questionnaire-SDQ). These children were then matched on verbal IQ and age to a sample of children who had received a clinic consensus diagnosis of high functioning ASD (mean age 11.3 years, mean verbal IQ 84.5). All participants were in mainstream school and had fluent language.
Results:
Using standardised diagnostic measures, no significant differences between the two groups were found. However, a number of non-significant trends were suggested by the data. Although matched on verbal IQ, compared to those with a history of maltreatment (mean=79.7, SD=10.4) the children with ASD (mean=87.9, SD=18.4) demonstrated a trend of higher performance IQ. Parents and carers also reported a trend that children with ASD (mean=2.18, SD=2.18) exhibited greater levels of repetitive, stereotypic behaviours than the maltreatment children (mean=1.70, SD=1.41 ). However, using SDQ scores children in the maltreated group (mean=2.90, SD=2.91) were reported to exhibit greater internalising difficulties compared to the ASD group (mean=5.64, SD=3.50). When examining specific 3Di items, children in the maltreated group were significantly more likely to display indiscriminate familiarity (p<0.05), whereas children with ASD exhibited a trend of greater levels of wariness on meeting a stranger.
Conclusions:
In this preliminary study, using fine-grained diagnostic instruments (3Di, ADOS and WISC IV), the two groups in our sample did not show large differences. However our data does not preclude the possibility that these groups show subtle but measurable cognitive and behavioural differences. As we continue to increase our sample size we aim to test our hypotheses that children with 'quasi-autism' difficulties can be distinguished from children with ASD, on the following:
- Lower repetitive behaviour
- Less sensory sensitivity
- Lower non-verbal reasoning skills
- Greater social disinhibition
- Greater internalising difficulties
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