Adaptive behaviors and related factors in children and adolescents with autism spectrum disorder: Report from ELENA cohort

for the ELENA study group

doi:10.1016/j.jpsychires.2023.05.013

Adaptive behaviors and related factors in children and adolescents with autism spectrum disorder: Report from ELENA cohort

for the ELENA study group

Research output: Contribution to journal › Article › peer-review

Abstract

There are strong individual differences in adaptive behaviors (AB) in autism spectrum disorder (ASD) with conflicting results in literature about specific patterns and related factors. The present study aims to describe AB and identify related factors in terms of clinical and socio-familial characteristics in 875 children and adolescents with ASD in the multiregional ELENA cohort in France. Results showed that AB in children and adolescents with ASD were lower than in typically developing subjects, regardless of age group. AB were associated with clinical (gender, age at diagnosis, IQ, ASD severity, psychiatric comorbidities, motor and language skills, challenging behaviors), interventional (school attendance, special interventions) and familial characteristics (age, educational and socio-economic status of parents, household status, number of siblings). There is a need of interventions focusing on improvement of AB, tailored to children's characteristics.

Original language	English
Pages (from-to)	43-54
Number of pages	12
Journal	Journal of Psychiatric Research
Volume	163
DOIs	https://doi.org/10.1016/j.jpsychires.2023.05.013
State	Published - Jul 2023

Keywords

Adaptive behaviors
Autism spectrum disorder
Children
VABS-II

Access to Document

10.1016/j.jpsychires.2023.05.013

Cite this

@article{a84762bbbdb248118ffda4cb9bbf904b,

title = "Adaptive behaviors and related factors in children and adolescents with autism spectrum disorder: Report from ELENA cohort",

abstract = "There are strong individual differences in adaptive behaviors (AB) in autism spectrum disorder (ASD) with conflicting results in literature about specific patterns and related factors. The present study aims to describe AB and identify related factors in terms of clinical and socio-familial characteristics in 875 children and adolescents with ASD in the multiregional ELENA cohort in France. Results showed that AB in children and adolescents with ASD were lower than in typically developing subjects, regardless of age group. AB were associated with clinical (gender, age at diagnosis, IQ, ASD severity, psychiatric comorbidities, motor and language skills, challenging behaviors), interventional (school attendance, special interventions) and familial characteristics (age, educational and socio-economic status of parents, household status, number of siblings). There is a need of interventions focusing on improvement of AB, tailored to children's characteristics.",

keywords = "Adaptive behaviors, Autism spectrum disorder, Children, VABS-II",

author = "{for the ELENA study group} and Ela Miniarikova and Lee Audras-Torrent and Mathilde Berard and Marianne Peries and Picot, {Marie Christine} and Kerim Munir and Amaria Baghdadli and Catherine Chabaux and Clarisse Chatel and David Cohen and Emmanuel Damville and Geoffray, {Marie Maude} and Ludovic Gicquel and Renaud Jardri and Thierry Maffre and Alexandre Novo and Roxane Odoyer and Oreve, {Marie Jo{\"e}lle} and Didier P{\'e}risse and Fran{\c c}ois Poinso and Julien Pottelette and Laurence Robel and Catherine Rolland and Marie Schoenberger and Sandrine Soni{\'e} and Mario Speranza and St{\'e}phanie Vesp{\'e}rini",

note = "Funding Information: In addition, interventions or support received by children with ASD, or by their parents, appeared to be protective of the child's AB (Baghdadli et al., 2012; Bal et al., 2015; Remington et al., 2007). Also, this protective effect for AB may be related to the possibility of attending school irrespective of regular or special education settings (Rattaz et al., 2020).The second objective of our study was to identify the factors related to AB in ASD. We found a relationship with child's gender for young children, as also described by Ratto et al. (2018), with boys having higher communication and daily living skills than girls. Consistent with multiple studies (Chang et al., 2013; Chatham et al., 2018; Klin et al., 2007; Pathak et al., 2019; Perry et al., 2009; Puig et al., 2013; Ray-Subramanian et al., 2011), we also found a positive association with IQ regardless of age group affiliation. These finding need to be expanded by longitudinal studies to explore adaptive trajectories according to IQ, previous studies suggesting that children with co-occurring ASD and ID had low-growth adaptive trajectories (Baghdadli et al., 2012; 2018) and that children without ID had better adaptive trajectories (Darrou et al., 2010; Szatmari et al., 2015). Nevertheless, clinicians need to provide age-appropriate interventions for people with ASD and without ID, who also need support to adapt socially in emotional relationships or take responsibility for their own health (Cheak-Zamora et al., 2019; Rock and Becker, 2021). In contrast, we found a weak association between ASD severity and adaptive skills in both young and latency age children (Frost et al., 2017; Liss et al., 2001; Perry et al., 2009). A strong and negative association between ASD severity and AB for communication and socialization was observed only for adolescents. It can be supposed that it was the consequence of the effect of less commonly available early intensive interventions and supports for older adolescents compared to the younger children. The increase in social constraints with age, may also explain our result of an association between ASD severity and socialization skills found in adolescents. In our sample, behavioral problems occurrence was negatively associated with adaptive skills, regardless of the age group. This can be interpreted into the light of the finding of better adaptive skills in our sample for children without psychiatric comorbidities as reported by previous studies (Kraper et al., 2017; Scandurra et al., 2019). In our sample, comorbidity type and child's age influenced this association. For young children and adolescents, affective problems were comorbidities with the greatest negative impact on adaptive skills. This implies promoting interventions focusing on socio-affective dimension, such as parent-mediated social communication therapy (Aldred and Green, 2019). The association described in the literature between higher language skills during childhood and better AB was contrasted in our sample. Early language skills were positively related to all areas of AB for children but not for adolescents. Relations between language skills and AB were also found for young children, which should be interpreted with caution due to the lack of precision in language assessment at this stage. In agreement with other studies, motor skills were positively associated in our sample with daily living skills regardless of age group (Bremer and Cairney, 2018; MacDonald et al., 2013). A recent longitudinal study (Travers et al., 2017) highlighted that motor skills were associated to AB beyond adolescence, with an increasing negative impact of motor difficulties on daily skills until adulthood, which implies specific support over time.In our sample, children receiving special interventions had overall lower AB than those who did not. Longitudinal studies are needed, as some studies showed that children who received specialized interventions had positive adaptive trajectories (Baghdadli et al., 2012; Bal et al., 2015; Remington et al., 2007). Also, young children and children attending regular or special class mostly had better AB than those out of school, in agreement with Rattaz et al. study (2020), which also underlined the influence of school attendance on psychiatric disorders such as anxiety. This result implies the use of supports and interventions targeting AB from the earliest years of life in order to promote school inclusion in children with ASD.In our sample children with ASD who had higher communication and socialization skills, regardless of age group, had parents with higher educational levels, as previously described (Ibrahim, 2020). In adolescents, daily living skills were also associated with higher mothers' educational level. It can be assumed that parents with higher educational level also have better material and educational resources to support their children at home towards better adaptation outcomes. In our sample, communication skills were positively correlated with SES both in young children and latency age children. However, daily living skills and socialization were strongly and positively associated with SES only in young children, supporting previous findings that children from lower SES families were at risk for weaker AB and mostly in early age (Aishworiya et al., 2021). Consequently, there is a challenge to promote access to care and education for children from socially deprived families. In our sample, the parental age at diagnosis was not related to the children's AB, except for adolescents, where socialization skills were positively related to mothers' age. This result is in contradiction with literature where higher parental age was a risk factor for ASD incidence and severity (Idring et al., 2014; Lyall et al., 2020; Sandin et al., 2016; Wu et al., 2017). Higher AB were found in families where children were living with two parents notably for young children and latency age children, the contrary was found in adolescents. We suppose that the parental support for developing daily AB is promising notably in the early development.This work was supported by the French Health Ministry (DGOS) PHRCN 2013 [Grant number 1: 13-0232] and the Caisse Nationale de Solidarit{\'e} pour l'Autonomie (CNSA) [Grant number 2: 030,319]. The CHU of Montpellier (AOI) provided additional support. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Funding Information: We warmly thank the contributing families, the ELENA staff (C{\'e}cile Rattaz, Florine Dellapiazza, No{\'e}mie Fourgassi{\'e}, Laura Fragey, Marion Sevens, Julie Loubersac, C{\'e}cile Michelon, and La{\"e}titia Ferrando) and the ELENA study group. We also express gratitude to the Caisse Nationale de Solidarit{\'e} pour l{\textquoteright}Autonomie (CNSA) and the French Health Ministry (DGOS) for funding this research. Funding Information: This work was supported by the French Health Ministry ( DGOS ) PHRCN 2013 [Grant number 1: 13-0232 ] and the Caisse Nationale de Solidarit{\'e} pour l{\textquoteright}Autonomie (CNSA) [Grant number 2: 030,319 ]. The CHU of Montpellier (AOI) provided additional support. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Publisher Copyright: {\textcopyright} 2023 Elsevier Ltd",

year = "2023",

month = jul,

doi = "10.1016/j.jpsychires.2023.05.013",

language = "English",

volume = "163",

pages = "43--54",

journal = "Journal of Psychiatric Research",

issn = "0022-3956",

publisher = "Elsevier Ltd.",

}

TY - JOUR

T1 - Adaptive behaviors and related factors in children and adolescents with autism spectrum disorder

T2 - Report from ELENA cohort

AU - for the ELENA study group

AU - Miniarikova, Ela

AU - Audras-Torrent, Lee

AU - Berard, Mathilde

AU - Peries, Marianne

AU - Picot, Marie Christine

AU - Munir, Kerim

AU - Baghdadli, Amaria

AU - Chabaux, Catherine

AU - Chatel, Clarisse

AU - Cohen, David

AU - Damville, Emmanuel

AU - Geoffray, Marie Maude

AU - Gicquel, Ludovic

AU - Jardri, Renaud

AU - Maffre, Thierry

AU - Novo, Alexandre

AU - Odoyer, Roxane

AU - Oreve, Marie Joëlle

AU - Périsse, Didier

AU - Poinso, François

AU - Pottelette, Julien

AU - Robel, Laurence

AU - Rolland, Catherine

AU - Schoenberger, Marie

AU - Sonié, Sandrine

AU - Speranza, Mario

AU - Vespérini, Stéphanie

N1 - Funding Information: In addition, interventions or support received by children with ASD, or by their parents, appeared to be protective of the child's AB (Baghdadli et al., 2012; Bal et al., 2015; Remington et al., 2007). Also, this protective effect for AB may be related to the possibility of attending school irrespective of regular or special education settings (Rattaz et al., 2020).The second objective of our study was to identify the factors related to AB in ASD. We found a relationship with child's gender for young children, as also described by Ratto et al. (2018), with boys having higher communication and daily living skills than girls. Consistent with multiple studies (Chang et al., 2013; Chatham et al., 2018; Klin et al., 2007; Pathak et al., 2019; Perry et al., 2009; Puig et al., 2013; Ray-Subramanian et al., 2011), we also found a positive association with IQ regardless of age group affiliation. These finding need to be expanded by longitudinal studies to explore adaptive trajectories according to IQ, previous studies suggesting that children with co-occurring ASD and ID had low-growth adaptive trajectories (Baghdadli et al., 2012; 2018) and that children without ID had better adaptive trajectories (Darrou et al., 2010; Szatmari et al., 2015). Nevertheless, clinicians need to provide age-appropriate interventions for people with ASD and without ID, who also need support to adapt socially in emotional relationships or take responsibility for their own health (Cheak-Zamora et al., 2019; Rock and Becker, 2021). In contrast, we found a weak association between ASD severity and adaptive skills in both young and latency age children (Frost et al., 2017; Liss et al., 2001; Perry et al., 2009). A strong and negative association between ASD severity and AB for communication and socialization was observed only for adolescents. It can be supposed that it was the consequence of the effect of less commonly available early intensive interventions and supports for older adolescents compared to the younger children. The increase in social constraints with age, may also explain our result of an association between ASD severity and socialization skills found in adolescents. In our sample, behavioral problems occurrence was negatively associated with adaptive skills, regardless of the age group. This can be interpreted into the light of the finding of better adaptive skills in our sample for children without psychiatric comorbidities as reported by previous studies (Kraper et al., 2017; Scandurra et al., 2019). In our sample, comorbidity type and child's age influenced this association. For young children and adolescents, affective problems were comorbidities with the greatest negative impact on adaptive skills. This implies promoting interventions focusing on socio-affective dimension, such as parent-mediated social communication therapy (Aldred and Green, 2019). The association described in the literature between higher language skills during childhood and better AB was contrasted in our sample. Early language skills were positively related to all areas of AB for children but not for adolescents. Relations between language skills and AB were also found for young children, which should be interpreted with caution due to the lack of precision in language assessment at this stage. In agreement with other studies, motor skills were positively associated in our sample with daily living skills regardless of age group (Bremer and Cairney, 2018; MacDonald et al., 2013). A recent longitudinal study (Travers et al., 2017) highlighted that motor skills were associated to AB beyond adolescence, with an increasing negative impact of motor difficulties on daily skills until adulthood, which implies specific support over time.In our sample, children receiving special interventions had overall lower AB than those who did not. Longitudinal studies are needed, as some studies showed that children who received specialized interventions had positive adaptive trajectories (Baghdadli et al., 2012; Bal et al., 2015; Remington et al., 2007). Also, young children and children attending regular or special class mostly had better AB than those out of school, in agreement with Rattaz et al. study (2020), which also underlined the influence of school attendance on psychiatric disorders such as anxiety. This result implies the use of supports and interventions targeting AB from the earliest years of life in order to promote school inclusion in children with ASD.In our sample children with ASD who had higher communication and socialization skills, regardless of age group, had parents with higher educational levels, as previously described (Ibrahim, 2020). In adolescents, daily living skills were also associated with higher mothers' educational level. It can be assumed that parents with higher educational level also have better material and educational resources to support their children at home towards better adaptation outcomes. In our sample, communication skills were positively correlated with SES both in young children and latency age children. However, daily living skills and socialization were strongly and positively associated with SES only in young children, supporting previous findings that children from lower SES families were at risk for weaker AB and mostly in early age (Aishworiya et al., 2021). Consequently, there is a challenge to promote access to care and education for children from socially deprived families. In our sample, the parental age at diagnosis was not related to the children's AB, except for adolescents, where socialization skills were positively related to mothers' age. This result is in contradiction with literature where higher parental age was a risk factor for ASD incidence and severity (Idring et al., 2014; Lyall et al., 2020; Sandin et al., 2016; Wu et al., 2017). Higher AB were found in families where children were living with two parents notably for young children and latency age children, the contrary was found in adolescents. We suppose that the parental support for developing daily AB is promising notably in the early development.This work was supported by the French Health Ministry (DGOS) PHRCN 2013 [Grant number 1: 13-0232] and the Caisse Nationale de Solidarité pour l'Autonomie (CNSA) [Grant number 2: 030,319]. The CHU of Montpellier (AOI) provided additional support. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Funding Information: We warmly thank the contributing families, the ELENA staff (Cécile Rattaz, Florine Dellapiazza, Noémie Fourgassié, Laura Fragey, Marion Sevens, Julie Loubersac, Cécile Michelon, and Laëtitia Ferrando) and the ELENA study group. We also express gratitude to the Caisse Nationale de Solidarité pour l’Autonomie (CNSA) and the French Health Ministry (DGOS) for funding this research. Funding Information: This work was supported by the French Health Ministry ( DGOS ) PHRCN 2013 [Grant number 1: 13-0232 ] and the Caisse Nationale de Solidarité pour l’Autonomie (CNSA) [Grant number 2: 030,319 ]. The CHU of Montpellier (AOI) provided additional support. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Publisher Copyright: © 2023 Elsevier Ltd

PY - 2023/7

Y1 - 2023/7

N2 - There are strong individual differences in adaptive behaviors (AB) in autism spectrum disorder (ASD) with conflicting results in literature about specific patterns and related factors. The present study aims to describe AB and identify related factors in terms of clinical and socio-familial characteristics in 875 children and adolescents with ASD in the multiregional ELENA cohort in France. Results showed that AB in children and adolescents with ASD were lower than in typically developing subjects, regardless of age group. AB were associated with clinical (gender, age at diagnosis, IQ, ASD severity, psychiatric comorbidities, motor and language skills, challenging behaviors), interventional (school attendance, special interventions) and familial characteristics (age, educational and socio-economic status of parents, household status, number of siblings). There is a need of interventions focusing on improvement of AB, tailored to children's characteristics.

AB - There are strong individual differences in adaptive behaviors (AB) in autism spectrum disorder (ASD) with conflicting results in literature about specific patterns and related factors. The present study aims to describe AB and identify related factors in terms of clinical and socio-familial characteristics in 875 children and adolescents with ASD in the multiregional ELENA cohort in France. Results showed that AB in children and adolescents with ASD were lower than in typically developing subjects, regardless of age group. AB were associated with clinical (gender, age at diagnosis, IQ, ASD severity, psychiatric comorbidities, motor and language skills, challenging behaviors), interventional (school attendance, special interventions) and familial characteristics (age, educational and socio-economic status of parents, household status, number of siblings). There is a need of interventions focusing on improvement of AB, tailored to children's characteristics.

KW - Adaptive behaviors

KW - Autism spectrum disorder

KW - Children

KW - VABS-II

UR - http://www.scopus.com/inward/record.url?scp=85159156553&partnerID=8YFLogxK

U2 - 10.1016/j.jpsychires.2023.05.013

DO - 10.1016/j.jpsychires.2023.05.013

M3 - Article

AN - SCOPUS:85159156553

SN - 0022-3956

VL - 163

SP - 43

EP - 54

JO - Journal of Psychiatric Research

JF - Journal of Psychiatric Research

ER -

Adaptive behaviors and related factors in children and adolescents with autism spectrum disorder: Report from ELENA cohort

Abstract

Keywords

Access to Document

Fingerprint

Cite this