Assessing Social, Behavioral and Emotional Functioning in Autism: A Feasibility Pilot Study

Background:

The clinical assessment of global functioning in children with autism is essential in order to identify needs and to arrange therapeutic and educational interventions. Appropriateness of using rapid and cost-effective instruments, as the Strengths and Difficulties Questionnaire (SDQ) and the Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA), needs further evaluation and definition, in particular in children with low-functioning autism.

Objectives:

Through a pilot observational study to describe the trend in different areas (behavior, socialization, emotions) using SDQ and HoNOSCA, and to explore correlation pathways between the two instruments, thus to plan an adequate and wide collaborative study.

Methods:

Ten consecutive new patients with low-functioning autism (age 5-14 years) were enrolled between November 2015 and October 2016. The SDQ is a 25-item questionnaire useful to screen emotional, behavioral and social problems in children aged 4-16 years. Scores for the 5 subscales (emotional symptoms, conduct problems, hyperactivity/inattention, peer problems and prosocial behavior) are classified in “normal”, “borderline” and “abnormal” ranges, according to the original cut-offs. The HoNOSCA is a 15-item clinical assessment scale used as part of the routine outcome monitoring in mental health services, especially in Netherlands, UK, Australia and New Zealand, which measures global functioning in patients aged 3-18 years through 4 different areas: behavioral, impairment, symptoms, social functioning. The SDQ completed by the educators was compared to the results of the global functioning evaluation of the clinician, who has used the HoNOSCA scale. A single psychologist completed the HoNOSCA questionnaire. Associations have been assessed with Pearson linear correlation index and minimum spanning tree algorithm.

Results:

The SDQ subscales with abnormal mean scores were “peer relations” (mean: 5.8, SD: 1.03) and “pro-sociality” (mean: 1.4, SD: 1.4), while in the HoNOSCA the social functioning domain resulted as the most problematic area. Linear correlation matrix between the items of the two instruments showed interesting values of r- index between behavioral score of HoNOSCA and both emotional difficulties (r = 0.71, p 0.02) and peer relationships of SDQ (r = 0.55, p = 0.09), and between social functioning score of HoNOSCA and behavioral problems of SDQ (r = 0.52, p = 0.12). These association were also confirmed by a map projection using the minimum spanning tree method ( fig.1).

Conclusions:

The correlation between SDQ and HoNOSCA can be a simple and efficient way to screen for emotional disorders and behavioral problems in child and adolescents with low-functioning autism. It could help to recognize co-occurring disorders and reduce with appropriate interventions their impact on social functioning and peer relationship domains. However, further more systematic attempts at validation are warranted.