Comparison of Two Screening Instruments for Additional Psychopathology in Children with Autism Spectrum Disorder

Background: High rates of co-occurring psychiatric disorders have consistently been reported in older children, adolescents and adults with autism spectrum disorders.   These rates are four to six times higher than those reported in the general population and higher than those found in the studies with children with intellectual disability. The most commonly co-occurring disorders include anxiety, obsessive compulsive disorder and ADHD.  More recent studies have reported similarly high rates in younger children with autism.  Psychiatric disorders can worsen autism symptoms, interfere with education and reduce benefits of behavioural therapies.  However, in younger children emotional and behavioural problems associated with these disorders are often assumed to be “part of autism” and are not systematically elicited by clinicians at diagnosis. Early identification of comorbid problems is crucial in the management of ASD as the impact of these additional problems can be reduced using a range of evidence-based interventions.  A number of screening instruments are available for use in general populations but few have been validated for use with children with ASD. 

Objectives:

• To explore whether the factor structures previously reported for the Developmental Behaviour Questionnaire (DBC) and the Profile of Neuropsychiatric Symptoms (PONS) in people with intellectual disability and general population samples, are found when used within a community sample of children with ASD.
• To test the validity of the DBC and PONS in relation to DSM-IV diagnoses elicited by a gold standard psychiatric diagnostic interview.
• To assess which questionnaire parent/carers found most suitable for describing their child’s emotional and behavioural problems.

Methods: The DBC and PONS were completed by parent/carers of 227 children with ASD, aged 4-9 years old. Intellectual ability and autism symptomatology were also assessed. DSM-IV psychiatric diagnoses were elicited for a stratified subsample of 101 children using the Preschool Age Psychiatric Assessment (PAPA).

Results: Exploratory factor analysis (EFA) of the DBC generated a 5-factor solution accounting for 53% of the total variance; the 5 factors were similar to the disruptive/antisocial, self-absorbed, communication, anxiety and social relating subscales previously reported.  EFA of the PONS generated a 4-factor solution accounting for 93% of the total variance, broadly mapping onto the domains of neurodevelopmental disability, behaviour and emotional dysregulation, psychoses and personality dysfunction, anxiety and depression as previously reported.  The relationship between the questionnaire measures and DSM-IV diagnoses as measured by the PAPA, will be presented using receiver operator characteristics (ROC) analysis and logistic regression.

61% of parents said they preferred the DBC to the PONS, 38% preferred the PONS and 1% expressed no preference.

Conclusions: The factor structures of the DBC and the PONS are similar in this ASD population to those already reported in other populations. The ROC analyses will determine the validity of both questionnaires in measuring additional psychopathology in young children with ASD, and thus point to whether either instrument could be recommended as part of the routine care of children with ASD at/following diagnosis.