Adaptive Functioning and Illness/Injury Coping in Children and Adolescents with Autism Spectrum Disorder

Background: In children and adolescents (youth) with autism spectrum disorder (ASD), adaptive skills are often less well-developed than predicted by age and estimated IQ. Although social and communicative behaviours are the adaptive functioning domains typically most affected in ASD, daily living skills – including self-care, health, and safety behaviours – can also be compromised. Prior to this study, none had examined how the adaptive functioning of youth with ASD relates to illness/injury coping behaviours.

Objectives: We sought to better understand the relationship between adaptive functioning and illness/injury coping strategies in youth with ASD.

Methods: Participants were 24 youth with ASD (21 male), 24 age-, sex-, and IQ-matched typically developing (TD) youth (19 male), aged 10 to 17 years, and one parent for each ASD and TD participant (22 and 24 female, respectively). The Adaptive Behavior Assessment System – Second Edition (ABAS-II) was used to assess youth adaptive functioning. A semi-structured interview was administered to youth in order to assess illness/injury knowledge, both generally (e.g., illness/injury causality, symptom recognition, treatment, prevention) and in relation to specific ailments (e.g., cold, concussion, meningitis). Parent and self-reports of illness/injury coping were obtained using vignettes depicting characters with various ailments. The ailments consisted of illnesses, symptoms, and injuries that were balanced in terms of seriousness and frequency of occurrence, as determined by ratings from health care providers. Parents were asked to answer open- and closed-ended questions about how their children would cope with each condition.

Results: ABAS-II scaled scores were lower in the ASD group than in the TD group for all composite and subscales, including the Practical composite, which focuses on daily living skills and incorporates Health and Safety and Self-care subscales. There were no significant between-group differences in general or specific illness knowledge. Parents of youth with ASD described their children as displaying less active coping than their TD peers (60% vs. 93%, respectively), both with respect to general (e.g., information-, help-, and support-seeking) and specific (e.g., seeking out over-the-counter medications and ointments, requesting a physician visit) strategies. Youth with ASD were also reported to engage in more passive (e.g., emotionality, self-isolation) coping when ill/injured, compared to their TD peers (42% and 25%, respectively). Notably, use of specific active coping strategies was highly positively correlated with the Practical composite of the ABAS-II (r = .54). However, no relationship was found between use of general active coping strategies and the ABAS-II Practical composite (r = -.12).

Conclusions: Despite similarity in age, estimated IQ, and illness knowledge, youth with ASD and their TD peers demonstrated different illness coping patterns. Not surprisingly, youth with ASD who struggled more with daily living skills were reported to demonstrate fewer active coping strategies when ill/injured. However, this difference was restricted to specific and not general coping behaviours. Our results support the notion that personal care when ill falls within the broader construct of daily living skills, but suggest that actively seeking caregivers for assistance when ill/injured may be a particularly important behaviour to monitor in youth with ASD.