“Typical Teen” or “Typical ASD”?: Changes in Self- and Parent-Report of Co-Occurring Conditions for Adolescents with ASD Following a Social Skills Intervention

Background:  Discrepancies between adolescent and caregiver reports of symptoms and impact in a wide range of behavioral and physical health concerns is well documented. It is not well understood whether discrepancies also exist for adolescent and caregiver report of co-occurring conditions associated with Autism Spectrum Disorder (ASD).  Observed discrepancies could illuminate challenges faced by families and adolescents with ASD during a developmental stage marked by shifting roles.

Objectives:  This study examined agreement between self and caregiver assessment of co-occurring conditions for adolescents with ASD participating in a social skills intervention.  Additionally, changes in agreement patterns over time were examined to determine the impact of active intervention on self and caregiver assessment of needs.

Methods:  Thirty-six adolescents with a confirmed diagnosis of ASD between the ages of 13- and 18-years-old (M = 14.61, SD = 1.36) completed a 12-week social skills intervention. 81% were male and 97% were Caucasian. Verbal IQ was estimated using the Kaufman Brief Intelligence Scale, Second Edition (KBIT 2; M = 104.33, SD = 18.85). Exclusionary criteria included verbal IQ below 70. Participants and caregivers completed the Strengths and Difficulties Questionnaire (SDQ) to assess for comorbidities at pre- and post-intervention, as well as at three-month follow-up.

Results:  Paired-sample t-tests were completed to compare self- and parent-report of comorbidities at the three assessment points. Self- and caregiver-report of the adolescent’s level of anxiety was not significantly different at pre-, post-intervention, or at three-month follow-up. At pre- and post-intervention, self- and caregiver-report of the adolescent’s behavioral difficulties also did not differ. However, at the three-month follow up, caregivers reported significantly less behavioral difficulties (t = -2.81, p < .01). In regards to symptoms of hyperactivity/impulsivity, caregivers rated the adolescent’s symptoms as significantly higher at pre-intervention (t = 3.58, p < .01); at post-intervention and at three-month follow-up, ratings did not significantly differ. In terms of peer difficulties, at every time point caregiver report rated the adolescents’ behavior as significant higher than self-report (t = 4.78, p < .001; t = 2.65, p < .05; t = 5.20, p < .001). Finally, in the area of total difficulties, adolescents and their caregivers did not differ in their report of symptoms at pre-intervention and post-intervention; at three-month follow-up adolescents reported having significantly less total difficulties as compared to caregivers (t = 2.89, p < .01).

Conclusions:  Consistency between self and caregiver report was noted at post intervention and follow-up for anxiety and hyperactivity/impulsivity reflecting good agreement between assessment of internal and external symptoms.  The most significant and consistent discrepancies between self- and caregiver-report were observed for relationship and social interaction challenges, most notably with peer difficulties. Adolescents and their caregivers also had significant discrepancies on assessment of behavior and total problems at the three-month follow-up.  Further investigation is warranted to determine whether these discrepancies are reflective of self-assessment challenges faced by adolescents with ASD or are more indicative of perceptual differences in the adolescent-caregiver relationship.