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Depressive and Anxiety Symptom Trajectories From School Age Through Young Adulthood in Samples With Autism Spectrum Disorder and Developmental Delay

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Objective

The objectives of this study were to model growth in anxiety and depressive symptoms from late school age through young adulthood in individuals with autism spectrum disorder (ASD) and controls with developmental delay (DD), and to assess relationships among internalizing growth patterns, participant characteristics, baseline predictors, and distal outcomes.

Method

Data were collected between ages 6 and 24 years in 165 participants (n = 109 with ASD; n = 56 with nonspectrum DD), most of whom received diagnostic evaluations in both childhood and early adulthood. Questionnaires were collected approximately every 3 to 6 months between ages 9 and 24 years. Parent-rated Child Behavior Checklist (CBCL), Adult Behavior Checklist (ABCL), and Developmental Behaviour Checklist anxiety- and depression-related subscale distributions were modeled with mixed-effects Poisson models, covarying diagnosis, age, verbal IQ (VIQ), gender, and significant 2- and 3-way interactions.

Results

Anxiety was positively associated with VIQ, and controlling for VIQ, both anxiety and depressive symptoms were greater in ASD than nonspectrum participants. Female gender predicted greater increases over time in anxiety and depressive symptoms for both diagnostic groups. Lower maternal education was associated with increasing internalizing symptoms in a subset of less verbal individuals with ASD. In exploratory post hoc analyses, internalizing symptoms were associated with poorer emotional regulation in school age, and with lower life satisfaction and greater social difficulties in early adulthood.

Conclusion

Findings support previous claims that individuals with ASD are at particular risk for affect- and anxiety-specific problems. Although symptom levels in females increase at a faster rate throughout adolescence, males with ASD appear to have elevated levels of depressive symptoms in school age that are maintained into young adulthood.

Section snippets

Predictors and Outcome of Affective Distress in Populations With DD

Shattuck et al.14 and Gray et al.15 found that lower IQ was associated with greater emotional and behavioral problems in ASD. The impact of socioeconomic status (SES) on depression in ASD is unclear, with findings that lower SES predicts emotional problems at age 16 years,25 is not associated with emotional problems,15 predicts less improvement over time,11 and is associated with overall level of psychopathology but not with changes over time.26 Gender is another important covariate due to the

Participants and Procedures

Our sample included 165 participants with data collected between the ages of 6 and 24 years. Of these, 148 had between 2 and 7 repeat iterations of the parent-rated CBCL and/or ABCL (n = 99 with ASD; n = 49 with heterogeneous nonspectrum disorders or early delays). A subset of 44 less verbal participants, all of whom had ASD and 32 with 2 to 4 iterations of repeat data, were also included in analyses of the DBC. Table 1 provides a sample description by diagnostic cohort.

There was great

ASEBA Anxiety Subscale

A linear growth model was preferable to a quadratic growth model in the ASEBA Anxiety subscale (BIClinear = 1,779.6 versus BICquadratic = 1,812.3). We observed main effects of both VIQ and diagnosis: higher VIQ was associated with higher levels of anxiety (γˆ = 1.005, 95% CI = 1.001, 1.009), and ASD was associated with higher levels of anxiety than NSDD (γˆ = 1.392, 95% CI = 1.010, 1.885). In the competition for variance, the effect of higher VIQ was ultimately quite small, whereas ASD

Discussion

We modeled growth in anxiety and depressive symptoms from school age through young adulthood in participants with ASD and NSDD, focusing on differences in trajectory across diagnostic groups and by VIQ and gender. We found that VIQ was a positive predictor of anxiety but not depressive symptoms in the CBCL/ABCL models. Both anxiety and depressive symptoms tended to begin and remain higher in ASD compared to NSDD. For both types of symptoms in both diagnostic groups, females showed greater

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  • Cited by (0)

    Clinical guidance is available at the end of this article.

    This work was supported by funding from the National Institute of Mental Health (T32-MH18921; R01-MH57167; R01-MH066469; R01-MH081873-01A1; K01-MH103500-01A1).

    Dr. Brunwasser served as the statistical expert for this research.

    Disclosure: Dr. Gotham has received royalties from the publisher of the Autism Diagnostic Observation Schedule-2 (ADOS-2). Dr. Lord has received royalties from the publisher of the Autism Diagnostic Interview-Revised (ADI-R) and the Autism Diagnostic Observation Schedule (ADOS; ADOS-2). These measures were used for establishing diagnosis in this sample and were not primary to outcome in this paper; further, Drs. Lord and Gotham donate to charity all royalties from clinics and projects in which they are involved. Dr. Brunwasser reports no biomedical financial interests or potential conflicts of interest.

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