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An Exploratory Study of Self-reported Quality of Life in Children with Autism Spectrum Disorder and Intellectual Disability

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Abstract

We examined the content validity of the Pediatric Quality of Life Inventory™ Young Child Self-report (PedsQL™-YC) in children with autism spectrum disorder (ASD) and intellectual disability and made recommendations for the development of a quality of life (QOL) measure. Ten children, 14 parents, and three teachers were recruited for focus groups and interviews. Focus groups and interviews were conducted to obtain their perceptions about the appropriateness of the PedsQLTM-YC (Phase 1). Based on the results from Phase 1, recommendations for a QOL measure for children with ASD and intellectual disability were made (Phase 2). After piloting a QOL measure by children and subsequent interviews, further refinement was undertaken (Phase 3). Data from Phases 1 and 3 were analysed using thematic and content analyses. Findings suggest that a QOL measure for children with ASD and intellectual disability should be related specifically to the children’s daily life and contexts. Due to the specific cognitive and behavioural characteristics of this population, the wording, response options and presentation style of the existing PedsQL™-YC would need refinement. Questions about social interactions with friends appeared less relevant to children with ASD. These recommendations address the wording and formatting issues needed for a QOL measure for use in children with ASD and intellectual disability identified through qualitative research methods. Further research is needed to include additional or modified questions in the social domain.

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References

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders, fifth edition, DSM-5 (5th ed.). Arlington: American Psychiatric Association.

    Google Scholar 

  • Bell, A. (2007). Designing and testing questionnaires for children. Journal of Research in Nursing, 12(5), 461–469. doi:10.1177/1744987107079616.

    Article  Google Scholar 

  • Carrington, S., Templeton, E., & Papinczak, T. (2003). Adolescents with asperger syndrome and perceptions of friendship. Focus on Autism and Other Developmental Disabilities, 18(4), 211–218. doi:10.1177/10883576030180040201.

    Article  Google Scholar 

  • Centers for Disease Control and Prevention. (2014). Prevalence of autism spectrum disorder among children aged 8 years - autism and developmental disabilities monitoring network, 11 sites, United States, 2010. Morbidity and Mortality Weekly Report. Surveillance Summaries, 63, 1–21.

    Google Scholar 

  • Church, C. C., & Coplan, J. (1995). The high-functioning autistic experience: birth to preteen years. Journal of Pediatric Health Care, 9(1), 22–29.

    Article  Google Scholar 

  • Church, C. C., Alisanski, S., & Amanullah, S. (2000). The social, behavioral, and academic experiences of children with asperger syndrome. Focus on Autism and Other Developmental Disabilities, 15(1), 12–20. doi:10.1177/108835760001500102.

    Article  Google Scholar 

  • Coghill, D., Danckaerts, M., Sonuga-Barke, E., Sergeant, J., & ADHD European Guidelines Group. (2009). Practitioner review: quality of life in child mental health—conceptual challenges and practical choices. Journal of Child Psychology and Psychiatry, 50(5), 544–561. doi:10.1111/j.1469-7610.2009.02008.x.

    Article  Google Scholar 

  • Cremeens, J., Eiser, C., & Blades, M. (2006). Characteristics of health-related self-report measures for children aged three to eight years: a review of the literature. Quality of Life Research, 15(4), 739–754. doi:10.1007/s11136-005-4184-x.

    Article  Google Scholar 

  • Cummins, R. A. (2005). Moving from the quality of life concept to a theory. Journal of Intellectual Disability Research, 49(10), 699–706. doi:10.1111/j.1365-2788.2005.00738.x.

    Article  Google Scholar 

  • Danckaerts, M., Sonuga-Barke, E., Banaschewski, T., Buitelaar, J., Döpfner, M., Hollis, C., et al. (2010). The quality of life of children with attention deficit/hyperactivity disorder: a systematic review. European Child & Adolescent Psychiatry, 19(2), 83–105. doi:10.1007/s00787-009-0046-3.

    Article  Google Scholar 

  • Dey, M., Landolt, M., & Mohler-Kuo, M. (2012). Health-related quality of life among children with mental disorders: a systematic review. Quality of Life Research, 21(10), 1797–1814. doi:10.1007/s11136-012-0109-7.

    Article  Google Scholar 

  • Drotar, D. (2004). Validating measures of pediatric health status, functional status, and health-related quality of life: key methodological challenges and strategies. Ambulatory Pediatrics, 4(4), 358–364.

    Article  Google Scholar 

  • Eiser, C., & Morse, R. (2001). Quality-of-life measures in chronic diseases of childhood. Health Technology Assessment, 5(4), 1–157. doi:10.3310/hta5040.

    Article  Google Scholar 

  • Elo, S., & Kyngäs, H. (2008). The qualitative content analysis process. Journal of Advanced Nursing, 62(1), 107–115. doi:10.1111/j.1365-2648.2007.04569.x.

    Article  Google Scholar 

  • Elsabbagh, M., Divan, G., Koh, Y.-J., Kim, Y. S., Kauchali, S., Marcín, C., et al. (2012). Global prevalence of autism and other pervasive developmental disorders. Autism Research, 5(3), 160–179. doi:10.1002/aur.239.

    Article  Google Scholar 

  • Farley, M. A., McMahon, W. M., Fombonne, E., Jenson, W. R., Miller, J., Gardner, M., et al. (2009). Twenty-year outcome for individuals with autism and average or near-average cognitive abilities. Autism Research, 2(2), 109–118. doi:10.1002/aur.69.

    Article  Google Scholar 

  • Filipek, P., Accardo, P., Baranek, G., Cook, E., Jr., Dawson, G., Gordon, B., et al. (1999). The screening and diagnosis of autistic spectrum disorders. Journal of Autism and Developmental Disorders, 29(6), 439–484. doi:10.1023/a:1021943802493.

    Article  Google Scholar 

  • Happe, F. G. E. (1993). Communicative competence and theory of mind in autism: a test of relevance theory. Cognition, 48(2), 101–119.

    Article  Google Scholar 

  • Hill, E., Berthoz, S., & Frith, U. (2004). Brief report: cognitive processing of own emotions in individuals with autistic spectrum disorder and in their relatives. Journal of Autism and Developmental Disorders, 34(2), 229–235. doi:10.1023/b:jadd.0000022613.41399.14.

    Article  Google Scholar 

  • Hinckson, E. A., Dickinson, A., Water, T., Sands, M., & Penman, L. (2013). Physical activity, dietary habits and overall health in overweight and obese children and youth with intellectual disability or autism. Research in Developmental Disabilities, 34(4), 1170–1178. doi:10.1016/j.ridd.2012.12.006.

    Article  Google Scholar 

  • Hinde, R. A. (1995). A suggested structure for a science of relationships. Personal Relationships, 2(1), 1–15. doi:10.1111/j.1475-6811.1995.tb00074.x.

    Article  Google Scholar 

  • Hobson, R. P. (2012). Autism, literal language and concrete thinking: some developmental considerations. Metaphor and Symbol, 27(1), 4–21. doi:10.1080/10926488.2012.638814.

    Article  Google Scholar 

  • Iarocci, G., & McDonald, J. (2006). Sensory integration and the perceptual experience of persons with autism. Journal of Autism and Developmental Disorders, 36(1), 77–90. doi:10.1007/s10803-005-0044-3.

    Article  Google Scholar 

  • Ikeda, E., Hinckson, E. A., & Krägeloh, C. (2014). Assessment of quality of life in children and youth with autism spectrum disorders: a critical review. Quality of Life Research, 23(4), 1069–1085. doi:10.1007/s11136-013-0591-6.

    Article  Google Scholar 

  • Jennes-Coussens, M., Magill-Evans, J., & Koning, C. (2006). The quality of life of young men with Asperger syndrome: a brief report. Autism, 10(4), 403–414. doi:10.1177/1362361306064432.

    Article  Google Scholar 

  • Kamp-Becker, I., Schroder, J., Remschmidt, H., & Bachmann, C. J. (2010). Health-related quality of life in adolescents and young adults with high functioning autism-spectrum disorder. GMS Psycho Social Medicine, 7, doi:10.3205/psm000065.

  • Kuhlthau, K., Orlich, F., Hall, T., Sikora, D., Kovacs, E., Delahaye, J., et al. (2010). Health-related quality of life in children with autism spectrum disorders: results from the Autism Treatment Network. Journal of Autism and Developmental Disorders, 40(6), 721–729. doi:10.1007/s10803-009-0921-2.

    Article  Google Scholar 

  • Limbers, C., Heffer, R., & Varni, J. W. (2009). Health-related quality of life and cognitive functioning from the perspective of parents of school-aged children with Asperger’s syndrome utilizing the PedsQL. Journal of Autism and Developmental Disorders, 39(11), 1529–1541. doi:10.1007/s10803-009-0777-5.

    Article  Google Scholar 

  • Limbers, C., Ripperger-Suhler, J., Heffer, R. W., & Varni, J. W. (2011). Patient-reported pediatric quality of life inventory™ 4.0 generic core scales in pediatric patients with attention-deficit/hyperactivity disorder and comorbid psychiatric disorders: Feasibility, reliability, and validity. Value in Health, 14(4), 521–530. doi:10.1016/j.jval.2010.10.031.

    Article  Google Scholar 

  • McIntyre, L. L., Kraemer, B. R., Blacher, J., & Simmerman, S. (2004). Quality of life for young adults with severe intellectual disability: mothers’ thoughts and reflections. Journal of Intellectual and Developmental Disability, 29(2), 131–146. doi:10.1080/13668250410001709485.

    Article  Google Scholar 

  • Ministry of Health. (2011). Health indicators for New Zealanders with intellectual disability.

  • Morgan, D. L. (1996). Focus groups. Annual Review of Sociology, 22, 129–152. doi:10.2307/2083427.

    Article  Google Scholar 

  • Neergaard, M., Olesen, F., Andersen, R., & Sondergaard, J. (2009). Qualitative description: the poor cousin of health research? BMC Medical Research Methodology, 9(52), 1–5.

    Google Scholar 

  • Ozonoff, S., Pennington, B. F., & Rogers, S. J. (1991). Executive function deficits in high-functioning autistic individuals: relationship to theory of mind. Journal of Child Psychology and Psychiatry, 32(7), 1081–1105. doi:10.1111/j.1469-7610.1991.tb00351.x.

    Article  Google Scholar 

  • Potvin, M.-C., Snider, L., Prelock, P. A., Wood-Dauphinee, S., & Kehayia, E. (2013). Health-related quality of life in children with high-functioning autism. Autism. doi:10.1177/1362361313509730.

    Google Scholar 

  • Powell, R. A., & Single, H. M. (1996). Focus groups. International Journal for Quality in Health Care, 8(5), 499–504. doi:10.1093/intqhc/8.5.499.

    Article  Google Scholar 

  • Ravens-Sieberer, U., Erhart, M., Wille, N., Wetzel, R., Nickel, J., & Bullinger, M. (2006). Generic health-related quality-of-life assessment in children and adolescents: methodological considerations. PharmacoEconomics, 24(12), 1199–1220.

    Article  Google Scholar 

  • Riley, A. W. (2004). Evidence that school-age children can self-report on their health. Ambulatory Pediatrics, 4(4), 371–376. doi:10.1367/A03-178R.1.

    Article  Google Scholar 

  • Ropar, D., & Peebles, D. (2007). Sorting preference in children with autism: the dominance of concrete features. Journal of Autism and Developmental Disorders, 37(2), 270–280. doi:10.1007/s10803-006-0166-2.

    Article  Google Scholar 

  • Rosa, P. A. D., Catricalà, E., Vigliocco, G., & Cappa, S. F. (2010). Beyond the abstract-concrete dichotomy: mode of acquisition, concreteness, imageability, familiarity, age of acquisition, context availability, and abstractness norms for a set of 417 Italian words. Behavior Research Methods, 42(4), 1042–1048. doi:10.3758/BRM.42.4.1042.

    Article  Google Scholar 

  • Sandelowski, M. (2000). Whatever happened to qualitative description? Research in Nursing and Health, 23(4), 334–340. doi:10.1002/1098-240X(200008)23:4<334::AID-NUR9>3.0.CO;2-G.

    Article  Google Scholar 

  • Schalock, R. L. (2004). The concept of quality of life: what we know and do not know. Journal of Intellectual Disability Research, 48(3), 203–216. doi:10.1111/j.1365-2788.2003.00558.x.

    Article  Google Scholar 

  • Shaffer, D. R., & Kipp, K. (2007). Infancy. In Developmental psychology: childhood and adolescence (7th ed., pp. 159–193, Vol. Book, Whole). Belmont, CA: Thomson Wadsworth.

  • Sheldrick, R. C., Neger, E. N., Shipman, D., & Perrin, E. C. (2012). Quality of life of adolescents with autism spectrum disorders: concordance among adolescents’ self-reports, parents’ reports, and parents’ proxy reports. Quality of Life Research, 21(1), 53–57. doi:10.1007/s11136-011-9916-5.

    Article  Google Scholar 

  • Shipman, D. L., Sheldrick, R. C., & Perrin, E. C. (2011). Quality of life in adolescents with autism spectrum disorders: reliability and validity of self-reports. Journal of Developmental and Behavioral Pediatrics, 32(2), 85–89. doi:10.1097/DBP.0b013e318203e558.

    Article  Google Scholar 

  • Simonoff, E., Pickles, A., Charman, T., Chandler, S., Loucas, T., & Baird, G. (2008). Psychiatric disorders in children with autism spectrum disorders: prevalence, comorbidity, and associated factors in a population-derived sample. Journal of the American Academy of Child and Adolescent Psychiatry, 47(8), 921–929. doi:10.1097/CHI.0b013e318179964f.

    Article  Google Scholar 

  • Travis, L. L. S. M. (1998). Social deficits and interpersonal relationships in autism. Mental Retardation and Developmental Disabilities Research Reviews, 4(2), 65–72.

    Article  Google Scholar 

  • United Nations Chidren’s Fund. (2005). The convention on the rights of the child: Participation rights.

  • Upton, P., Lawford, J., & Eiser, C. (2008). Parent–child agreement across child health-related quality of life instruments: a review of the literature. Quality of Life Research, 17(6), 895–913. doi:10.1007/s11136-008-9350-5.

    Article  Google Scholar 

  • van Manen, M. (1990). Hermeneutic phenomenological reflection. In Researching lived experience: Human science for an action sensitive pedagogy (pp. 77–110, Vol. Report). Ontario, Canada: The State University of New York.

  • Varni, J. W., Seid, M., & Kurtin, P. S. (2001). PedsQLTM 4.0: reliability and validity of the pediatric quality of life InventoryTM version 4.0 generic core scales in healthy and patient populations. Medical Care, 39(8), 800–812. doi:10.1097/00005650-200108000-00006.

    Article  Google Scholar 

  • Varni, J. W., Burwinkle, T. M., Seid, M., & Skarr, D. (2003). The PedsQL™ 4.0 as a pediatric population health measure: feasibility, reliability, and validity. Ambulatory Pediatrics, 3(6), 329–341. doi:10.1367/1539-4409(2003)003<0329:tpaapp>2.0.co;2.

    Article  Google Scholar 

  • Varni, J. W., Burwinkle, T. M., & Lane, M. M. (2005). Health-related quality of life measurement in pediatric clinical practice: an appraisal and precept for future research and application. Health and Quality of Life Outcomes, 3(34), 1–9. doi:10.1186/1477-7525-3-34.

    Google Scholar 

  • Varni, J. W., Limbers, C., & Burwinkle, T. M. (2007). How young can children reliably and validly self-report their health-related quality of life?: An analysis of 8,591 children across age subgroups with the PedsQL 4.0 Generic Core Scales. Health and Quality of Life Outcomes, 5(1), doi:10.1186/1477-7525-5-1.

  • Varni, J. W., Handen, B. L., Corey-Lisle, P. K., Guo, Z., Manos, G., Ammerman, D. K., et al. (2012). Effect of Aripiprazole 2 to 15 mg/d on health-related quality of life in the treatment of irritability associated with autistic disorder in children: A post hoc analysis of two controlled trials. Clinical Therapeutics, 34(4), 980–992. doi:10.1016/j.clinthera.2012.02.023.

    Article  Google Scholar 

  • White, F. A., Hayes, B. K., & Livesey, D. J. (2010a). Perceptual development. In Developmental psychology: from infancy to adulthood (2nd ed., pp. 82–110, Vol. Book, Whole). Frenchs Forest, Australia: Pearson Australia.

  • White, F. A., Hayes, B. K., & Livesey, D. J. (2010b). Stages of cognitive development: Piaget and beyond Piagetian approaches. In Developmental psychology: from infancy to adulthood (2nd ed., pp. 111–146, Vol. Book, Whole). Frenchs Forest, Australia: Pearson Australia.

  • WHOQOL Group. (1995). The world health organization quality of life assessment (WHOQOL): position paper from the world health organization. Social Science and Medicine, 41(10), 1403–1409. doi:10.1016/0277-9536(95)00112-K.

    Article  Google Scholar 

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Acknowledgments

This research was funded by the National Institute for Public Health and Mental Health Research, Auckland University of Technology. The authors would like to thank James W. Varni for reviewing this article.

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Correspondence to Erika Ikeda.

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Ikeda, E., Krägeloh, C., Water, T. et al. An Exploratory Study of Self-reported Quality of Life in Children with Autism Spectrum Disorder and Intellectual Disability. Child Ind Res 9, 133–153 (2016). https://doi.org/10.1007/s12187-015-9307-5

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