IMPACT of Multiple Comorbid Emotional and Behavioral Conditions on Youth with Autism and Their Families

Thursday, May 11, 2017: 5:30 PM-7:00 PM
Golden Gate Ballroom (Marriott Marquis Hotel)
K. N. Medeiros1,2 and M. O. Mazurek1, (1)Health Psychology, University of Missouri, Columbia, MO, (2)Thompson Center for Autism and Neurodevelopmental Disorders, Columbia, MO

Comorbid emotional and behavioral problems are very common in children and adults with autism (Levy et al., 2010), and several studies have highlighted the effects of comorbid conditions on school performance, adaptive skills, and peer relationships (Storch et al., 2012). These additional complications also place strain on the entire family as well as the individual with autism (Kerns et al., 2015). The literature in this area includes a wide variety of methods and assessment tools and sample characteristics. Prior research has been limited by narrow samples, limited outcome constructs, and a lack of attention toward child- or family-level variables that may influence the impact of comorbid conditions.


The purpose of this project was to determine whether comorbid emotional and behavioral problems significantly impact children with autism over and above child and family characteristics. Our primary hypothesis was that emotional and behavioral comorbidities in youth with autism would be associated with greater functional impact for the child, more difficulty accessing services, greater family impact, and greater transitional needs.


Using the 2009-2010 National Survey of Children with Special Health Care Needs (NSCSHCD), we examined 3,055 cases of children and adolescents with autism (ages 2 to 17) who had varying numbers of comorbid conditions (i.e., ADHD, depression, anxiety, or behavior problems). For continuous dependent variables, hierarchical linear regressions were executed, with child-level variables entered in the first block (age, intellectual disability, and developmental delay), family-level variables entered in the second block (income, education, and respondent relationship), and number of comorbidities entered in the third block. For dichotomous dependent variables, the same three block method was used in hierarchical logistic regression analyses. We reported effects sizes for significant predictors with an odds ratio greater than 1.


Multiple comorbid conditions did have a significant impact on elements of child functioning (i.e., daily activities and school attendance), difficulties and frustrations accessing services for multiple reasons, and family impact (mental health need, more hours of care) in youth with autism. These effects were observed over and above the effects of child age, intellectual disability, developmental delay, family income, family education, and respondent relationship. Child and family characteristics were also important predictors for outcomes in child functioning, family impact, and transitional needs.


These findings are important for families, practitioners, paraprofessionals, and educators of youth with autism. Addressing the compounding effects of comorbid emotional and behavioral conditions may improve services and supports for youth with autism and their families.


Kerns, C., … Herrington, J. (2015). Not to be overshadowed or overlooked: Functional impairments associated with comorbid anxiety disorders in youth with ASD. Beh Ther 46,29-39.

Levy, S., … Rice, C. (2010). Autism spectrum disorder and comorbid developmental, psychiatric, and medical conditions among children in multiple populations of the United States. J. Dev Behavioral Pediatrics, 31, 267-275.

Storch, E., …Wood, J. (2012). Peer victimization in youth with autism spectrum disorders and comorbid anxiety: Relations with psychopathology and loneliness. J Dev Physical Disabilities, 24, 575-590.