Emotional and Behavioural Problems in Children with Neurodevelopmental Disorders: Using Cross-Disorder Phenotypes to Identify Informative Subgroups
Objectives: To use the phenotypes of emotional and behavioural problems to identify informative subgroups of children across conventional NDD diagnostic categories (ASD/ADHD/OCD).
Methods: The sample consisted of 784 children with NDDs (319 ASD, 329 ADHD, 136 OCD; 74.9% males; mean age: 10.7 years) participating in the Province of Ontario Neurodevelopmental Disorders (POND) Network project. To identify subgroups, data on the Child Behavior Checklist (CBCL 6-18) syndrome scales – Anxious/Depressed, Withdrawn/Depressed, Somatic Complaints, Social Problems, Thought Problems, Attention Problems, Rule-Breaking Behavior, and Aggressive Behavior – were used in Hierarchical Clustering analysis. The optimal number of clusters was selected using the scree-plot criterion. Derived clusters were characterized using sex ratio, the child’s age, social communication deficits (Social Communication Questionnaire; SCQ), obsessive compulsive behaviours (Toronto Obsessive Compulsive Rating Scale; TOCS) and adaptive behaviours (Adaptive Behavior Assessment System; ABAS-2)
Results: A 2–cluster solution provided the best fit to the data. Compared to those in Cluster 1, children in Cluster 2 (43% of sample) scored higher (within borderline or clinical range) on all CBCL syndrome scales (p< .001 for all) and total problems score (mean: 71.6 compared to 57.4; p<.001). The two clusters did not differ in terms of sex ratio or the child’s age. The proportion of children from each primary diagnostic category in Cluster 2 was 45.5% of ASD, 45.9% of ADHD, and 30.1% of OCD. Within Cluster 2, children with ASD scored higher on the SCQ (mean ASD: 22.2 > ADHD: 10.2 and OCD: 7.7; p<.001) and had the lowest scores on the ABAS (mean ASD: 60.7 < ADHD: 75.7 and OCD: 80.1; p<.001). Children with OCD had the highest scores on the TOCS (mean OCD: 20.6 > ASD: -11.6 > ADHD: -19.9; p<.001).
Conclusions: Study findings suggest that emotional and behavioural problems are useful phenotypes for the identification of informative subgroups of children with NDDs that may benefit from cross-disorder treatments. At the same time, notable within-subgroup variability suggests that primary diagnostic categories (ASD/ADHD/OCD) provide useful information on unique phenotypes (e.g., social communication deficits, obsessive compulsive behaviors, and adaptive behaviors) requiring disorder-specific treatments. This work has the potential to inform research on the shared and unique aetiologies in NDDs.
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