Impact Of Emotional Disorders In The Functionality Of Children And Adolescents … · 2020. 7....

2016Vol. 2 No. 1:4

iMedPub Journalshttp://www.imedpub.com

Review Article

DOI: 10.4172/2472-1786.100012

Journal of Childhood & Developmental DisordersISSN 2472-1786

1© Under License of Creative Commons Attribution 3.0 License | This article is available in: http://childhood-developmental-disorders.imedpub.com/archive.php

Marina R Gonzalez1 and Isabel P Valdivieso López2

1 King'sCollegeLondon,London,England2 UniversidadTécnicadeManabí,

Portoviejo,Ecuador

Corresponding author: MarinaRomeroGonzalez

[email protected]

FellowAliciaKoplowitz,Child&AdolescentPsychiatry,InstituteofPsychiatry,Psychology&Neuroscience,King'sCollegeLondon,DeCrespignyPark,LondonSE58AF,UnitedKingdom.

Tel:+44(0)2078365454

Citation: Gonzalez MR, López PIV. Impact OfEmotional Disorders In The Functionality OfChildrenAndAdolescentsWithAutismSpectrumDisordersReview.JChildDevDisord.2016,2:1.

AbstractThemainobjectofthisreviewistounderstandhowemotionaldisordersdevelopandhowtheymayinteractwiththescoreoffunctioningorwiththeseverityofsymptomsinautismspectrumdisorder.Wehypothesizethatemotionaldisordersmayinfluencenegativelyinthefunctionalityofthesepatients.

ThisreviewwasbasedonasystematicresearchofpublishedarticlesavailableuptoJuly2014.Theinitialliteraturesearchresultedin149citations.Ofthose,21mettheinclusioncriteria.Manyoftheunselectedstudiesfromtheinitialpoolinvolvedsamples outside the targeted age range (e.g., adults or pre-school children) orwith non-ASD developmental disabilities. This review concluded that comorbidwithemotionaldisordersamongpatientswithASDmaybemorecommonthanpreviously thought. It may have consequent impairment in their psychologicalprofile,socialadjustment,adaptivefunctionality,cognitiveandglobalfunctioningandshouldalertclinicianstheimportanceofassessingmooddisordersinordertochoosetheappropriatetreatment.

Keywords: Autismspectrumdisorder;Emotionaldisorder;Adolscents

Impact Of Emotional Disorders In The Functionality Of Children And Adolescents

With Autism Spectrum DisordersReview

Received: October10,2015; Accepted: December07,2015; Published: December28,2015

IntroductionAutism SpectrumDisorder (ASD) is characterized by deficits insocialinteractionandcommunication,aswellasthepresenceofstereotypedbehaviourand restrictive interests [1]. In thepast,allpsychiatric issues inchildrenandadultswithautismusedtobeattributedtoautismitself.However,anincreasingnumberofstudies are arguing about accepting behaviours and symptomsthat had been considered additional or associated features ofASD as potential indicators of the presence of comorbiditieswarrantingadditionaldiagnosis.

Aninstinctivereactionisthatcomorbiditywillgenerally leadtomore severe impairments as a result of the cumulative effectsofhavingmorethanonedisorder[2].Otherwise,thepathogeniccourses that result in comorbidity may be overlapping, butnevertheless,unique.IntheexampleofASD,researchhasbeendelayed to some extent by nosological preconceptions aboutco-occurring symptomatology, many of which remain largelyuncertain[3,4].

Autismisgenerallyalifelongconditionbeginninginchildhoodandwith pathological outcomes in adulthood. Outcomes are oftendescribed as difficulties or issues in finance, employment andsocialization[5-7].FindingsfromthesestudiesindicatesubstantialprogressinthecareandtreatmentofpersonswithASD,allowingindividualstogetmoreinvolvedincommunitylifewithreducedburden on their families. Despite these advances, living withautism can be difficult [8], particularly during developmentaltransitions and critical periods of childhood.While all childrenwithASDexhibitoneormoreofthecoredomains(impairmentsinsocialinteraction,communicationandbehaviouralfunctioning),some children may have associated problems with mood andaffect.Therefore,parenting forsomechildrenwithASDcanbechallengingandcanseverelyimpactfamilyfunctioningaswellasthehealthandwellbeingofcaregiversandotherfamilymembers[9, 10]. Clearly, successful interventions for children with ASDhavethepotentialtogreatlyaffecthealthoutcomesforthechildandcanhaveextensiveeconomicbenefitsbycontributingtothechild’sindependencewhenreachingadulthood.

http://dx.doi.org/10.4172/2472-1786.100012

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2 This article is available in: http://childhood-developmental-disorders.imedpub.com/archive.php

There is no doubt that comorbid condition can complicatethe patient’s management. Reliable diagnosis of comorbidpsychiatricdisordersinchildrenwithASDisofmajorimportance.Emotional disorders are one of the main comorbid disordersoftenfind in this population [11]. In this order, anxiety-relatedconcernsareamongthemostcommonpresentingproblemsforchildrenandadolescentwithASD[12].Whenotherproblematicsymptoms are recognized as manifestation of a comorbidpsychiatric disorders rather than just isolated symptoms,morespecifictreatmentispossible.Forthisreason,oneofthegoalsofthenewDSM-5classificationmustbetoidentifysubgroupsofASD,includingcomorbiddisordersandadaptivefunctioning,whichmaybeimportanttounderstandthebiologicalmechanisms,theclinicalresultsandthereactionsoftheindividualswithASD[13](Figure 1).

InthefieldofclinicalresearchonASD,wehavewell-establishedvalidtoolsforthediagnosisofthespectrumdisorderwithAutismDiagnosticInterview-Revised[ADI-R;[14]]andAutismDiagnostic

Observation Schedule [ADOS; [15]], but a limited repertoireof evidence-based tools for assessing change in day-to-dayfunctioning.

Inthispaper,wefocusedonemotionaldisorderswhichinclude:anxietydisorders[includingobsessivecompulsivedisorder(OCD)andpost-traumatic stressdisorder (PTSD)]andmooddisorders(bipolar affectivedisorder,depressionandmania).We stronglybelievethat thesepathologiescan influencesignificantly in theprognosis across the social, familiar, adaptive, cognitive andglobalfunctioningofpatientswithASD.

Themainobjectofthisreviewistounderstandhowemotionaldisorders develop and how they may interact with the scoreof functioning or with the severity of symptoms in ASD. Wehypothesizethatemotionaldisordersmayinfluencenegativelyinthefunctionalityofthesepatients.Forallthereasonspreviouslyexposed, thespecificaimsof this revieware: (1) tosummarizetheempiricalresearchontheprevalenceofemotionaldisordersinchildrenandadolescentwithASD,(2)toprovidewhichistheimpactonthefunctionalityorseverityforthispatientsand(3)toofferfutureresearchthatcouldprovidebetterunderstandinginrelationwiththeimpactofemotionaldisordersinthispopulation.

MethodsThis review was based on a systematic research of publishedarticles available up to July 2014. The Psych-Info andMedlineonlinedatabasesweresearchedusingthefollowingkeywords:(“autism” or “autistic disorder” or “asperger(s)”, or “pervasivedevelopmental disorder”) AND (anxiety or anxious or mooddisorders or bipolar affective disorder or depression or maniaorobsessivecompulsivedisorder(OCD)orpost-traumaticstressdisorder(PTSD)orcomorbidityANDfunctioningorfunctionality).Abstracts of identified articles were then screened for thefollowinginclusioncriteria(Table 1).

Figure 1 Diagnosticandstatisticalproposalfromthementaldiseasesmanual. 5Th edition (dsm-5). Associated criteria andcharacteristicstobeconsideredforthecharacterizationofasd[13].

InclusionCriteria(a)Thetargetpopulationincludedchildrenoradolescents(between6and18years)diagnosedwithanASDincludingautism,Asperger'sDisorderorPDD-NOS.(b)Prevalenceofanyemotionaldisorder(anxietyoranxious,mooddisorders,bipolaraffectivedisorder,depression,mania,OCDorPTSD)inthispopulation.(c)Emotionaldisordersassessmentwithdirectobservationorreport(fromparent,teacher,orchild)evaluations.(d)TheassociationwithscoreoffunctioningoranypredictorofseverityfortheASD.Therewerenorestrictionsonminimumsamplesize.Allmeasuresoffunctionalityorautismseveritysymptomswereincluded.ExclusionCriteria*Unpublisheddissertationsorstudiespublishedmorethan20yearsago.Secondaryreviewswereexcluded,aswellasstudiesnotpublishedinEnglish.

Table 1Inclusionandexclusioncriteria.

Forbrevity,thefollowingabbreviationsareusedthroughoutthisreview: Autistic Disorder (AD), Asperger's Disorder/Syndrome(AS),PervasiveDevelopmentalDisorder-NotOtherwiseSpecified(PDD-NOS),High-FunctioningAutism(HFA),andAutismSpectrumDisorder(ASD).

Theinitialliteraturesearchresultedin149citations.Ofthose,21mettheinclusioncriteria.Manyoftheunselectedstudiesfromtheinitialpoolinvolvedsamplesoutsidethetargetedagerange(e.g.,adults or pre-school children) or with non-ASD developmental

disabilities.Thesecondphase,whichsystematicallyexaminedthethreemajor autism journals, identified four additional articles.Becausethepurposeofthestudiesvaried,theywereclassifiedinto four broad categories according to their primary questionin relation with the functionality: cognitive and executivefunctioning, social and family functioning assessment, globalassessmentof functioningorqualityof lifeandothermeasureof autism severity symptoms. It should benoted that someofthestudiesaddressedmorethanonedomain. In thiscase, the

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studiesweregroupedand reviewedaccording to theirprimaryresearchquestion.

ResultsCognitive and executive functioningInthisreview,theauthorsfocusonmeasuresusedinASDclinicalstudiesinordertoevaluatethefunctionality(Table 2,2b).Outofthe25studies,6ofthemfocusedtheirprimaryresearchquestionaccordingwiththecognitiveand2,withtheexecutivefunctioningscores. Six studies reported information about the prevalenceand the impact in the functioning being themain comorbiditytheanxietydisorder[11,16-18].Therangeofanxietydisorderswasbetween39,2to42,7%[11,16].Allof thesestudiesuseddifferent measures in order to assess the anxiety comorbidityandtheASDdiagnosis.Weisbrotetal.[19]andThede&Coolidge[20]usedclinicalevaluationswhichincludedinterviewsbychildpsychiatrists according to DSM-IV criteria. The rest of them[11, 16-18] confirmed the diagnosis with at least one of theassessmentcriteriadescribedontheTable 2,2b.Simonoffetal.[11]andHollocksetal.[17]usedthesamesampleofpatients.AswecanseeontheTable 2andaccordingwiththemainresults,Sukhodolskyetal.[16]andWeisbrotetal.[19]foundapositivecorrelation; children with higher IQ were found to experiencethemostsevereanxiety.Ontheotherhand,Simonoffetal.[11]found that ASDdiagnosis, IQ, and adaptive behaviorwere notassociated with the presence of an anxiety disorder. Similarly,Pearson et al. [18] concluded that verbal IQwas not found tohave any correlation with anxiety disorders according to theparentreportsofthepopulationinthesample.

Regardingexecutivefunctioning,Hollocksetal.[17]indicatedasignificantassociationbetweenpoorerexecutivefunctioningandhigher levels of anxiety, but is not associatedwith depression.However,Thede&Coolidge[20]foundnosignificantdifferencesinexecutivefunctioningbetweentheASandHFA.

Mukaddesetal.[21]andSimonoffetal.[22]reportedinformationabout comorbidity with depressive disorder and severe mooddysregulationandproblems(SMP).Theyusedthesamesamplesotheresultsshouldnotbeinterpretedindependently(Table 2).Simonoffetal.[22]istheoneandonlystudythatevaluatedtheSMPinpatientswithASD.Theyfoundthatintellectualabilityandadaptive functioning did not predicted SMP and relationshipsbetweenSMPandtestsofexecutivefunctionwerenotsignificantaftercontrollingforIQ.

Global functioning and quality of lifeOutof the25 studies, 5of themaredescribed in this section.Mattila et al. [23], Mazzone et al. [24] and White et al. [25]focused their primary research question in accordance to theChildren’sGlobalAssessmentScale(CGAS),Farrugia[26]usedthelifeinterferencemeasure(LIM)andVanSteenseletal.[27]usedtheEuroQol-5D.

Four studies reported information about co-morbidity withanxiety disorder [23, 25-27]. As it is shown in the table 3, allof these studies used different measures to assess the ASDdiagnosisandanxietycomorbidity.InthestudyofFarrugia[26],

the diagnoses from the community were accepted and werenot confirmed as part of the study. However, the rest of thestudies confirmed the diagnosis with at least one assessment.All the studieswith theexceptionofMattilaet al. [23], all theother studies used different control samples (Table 3). Whiteetal.[25]usedASDwithanxietycomorbiditywithoutcognitivebehaviouraltherapy(CBT)interventiontocomparewithasimilarsampleofpatientswhowerereceivingCBT.Regardingthemainresults,Farrugia[26]foundthatthecorrelationsamonganxietysymptoms, negative automatic thoughts, behavioral problemsandoverallimpairmentweresignificantlyhigherintheASgroupthan in either comparison group. In the same way,Mattila etal. [23] found that oppositional defiant disorder (ODD), majordepressivedisorderandanxietydisordersascomorbidconditionsindicatedsignificantlylowerlevelsoffunctioning.Similarly,inthestudyofVanSteenseletal.[27]theresultsshowedthathigheranxietyseverityscoresontheADOS,wereassociatedwithalowerqualityof life, irrespectiveofthesamplegroup.Althoughallofthem showed similar results, they used different functionalityscales(Table 6).Ontheotherhand,Whiteetal.[25]foundthatthere was no relationship between Developmental Disability(DD)-CGASscoresandparent-reportedanxiety scores,adaptivebehaviourscores,oreducationalplacement.Mazzoneetal.[24]was the only study that considered the association betweenfunctioninganddepressivesymptoms.Theresultsshowedthathigherlevelsofdepressivesymptomsincreasetheriskofpoorerglobalfunctioning.TherewasnosignificantassociationbetweenIQ and mood symptoms, behavioural problems or globalfunctioning.

Psychosocial and/or family functioningOutofthe25studies,5ofthem[28-32],focusedtheirprimaryresearch question accordingly with the psychosocial or familyfunctioning. The measures used for assessing this sort offunctioning were very heterogeneous between the differentstudies(Table 6).OnlyBaumingeretal.[32]focusedtheirmainfunctioningassessmentonfamilyevaluation.

Joshietal.[28]andWozniak&Biederman[31]focusedonmooddisorderinpatientswithASDandtheimpactonthefunctionality.Thediagnosticmeasuresweresimilaronbothstudies.However,asitisshowsinthetable 4,thesamplescharacteristicsandthecontrol groupwere very different. Regarding themain results,Joshi et al. [28] examined not only the social functioning, butalsotheclinicalandfamiliarcorrelatesofbipolardisorderwhenitoccurswithandwithoutASDcomorbidityinawell-characterized,research-referred population of youth with bipolar disorder.Wozniak&Biederman[31]systematicallyinvestigatedtheoverlapbetween mania and PDD in a consecutive sample of referredyouths,examiningitsprevalenceandcorrelates.Accordingwiththepurposeofthisreview,theresultsfoundbyJoshietal.[28]were inconsistent. Wozniak & Biederman [31] found that thefunctioningofchildrenwithPDD+maniawaspoorer thanPDDgroup, as evidenced by their scores on the social adjustmentinventory for children and adolescents (SAICA) and the globalassessmentoffunctioning(GAF)(Table 6).

The rest of the studies described in this section assessed the

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associationbetween the social functioning and its comorbiditywith anxiety [29, 30, 32]. They used different ASD diagnosticagreements(Table 4).Accordingwiththemainresults,Meyeretal. [29] concluded that anxietywas related to deficits in socialawarenessandexperience.Intheoppositeeffectdirection,Bellini[30] found that physiological arousal and social skills deficitscombined contributed to a significant variance in symptomsof social anxiety. Finally, Bauminger et al. [32] investigatedthe relationship between internalizing and externalizing (I-E)behaviors and family variables, including both parenting stressandqualityofattachmentrelations.Theresultswereinconsistentaccordingwiththepurposeofthisreview(Table 4).

Measures of symptoms severity or adaptive functioningInthelastsection,wefound7studiesthatdescribetheimpactonthefunctionalitythroughtheseverityofsymptoms,usingarangevariabilityofmeasures(Table 5).

Bradleyetal,[33],VanSteenseletal.[34]andGadowetal.[35]evaluated the comorbidity with anxiety disorders. The sampleofpatientsandthediagnosismeasureswerealsoverydifferent(Table 5).Accordingtothemainresultsfoundontheirstudies,Gadowetal.[35]reportedthattheseverityofASDappearedtobenegativelyassociatedwithpsychiatric symptoms.The followingstudieswere inconsistent relating to this review;Bradley et al.[33]concludedthatthechildrenwithADhadanaverageof5.25clinically significant disorders based on cut-off scores on thediagnostic assessment of the severely handicapped-II (DASH-II)(Table 6)comparedtoanaverageof1.25forthenon-ADgroup.ThegoaloftheVanSteenseletal.[34]studywastoestimatethesocietalcostsofchildrenwithhigh-functioningASDandcomorbidanxietydisorderandtoexplorewhethercostsareassociatedwiththe type/severity of ASD or anxiety disorder. They found thatthemeanofseverityscoreofananxietydisorderdidnotdifferbetweentheASD+anxietydisorderandanxietydisordergroup.

Regardingcomorbiditywithmooddisorders,wefound3studies[2, 36, 37]. Aswe can see in table 5, they used very differentsamples, diagnosis and control groups. Relating to the mainresults,Simonoffetal.[36]andMunesueetal.[37]foundmoreconsistentresultsthanGadowetal.[2](Table 5).Simonoffetal.[36]concludedthatlowerIQandadaptivefunctioningpredictedhigherhyperactivityandtotaldifficultiesscores.Inthesameway,Munesueetal.[37]establishedthatpatientswithmooddisordershowedsignificantlylowerscoresontheTokyoautisticbehaviourscale(TABS)(table 6)thanthosewithoutmooddisorder.

Finally, Pfeiffer et al. [38] was the only study that evaluatedboth, comorbidity between anxiety and depression disorder.Theyfoundthattherewerenosignificantrelationshipsbetweendepressionandoveralladaptivebehaviouroranxietyandoveralladaptivebehaviour.

DiscussionBasedonthedatapresentedinthesestudiescollectively,thereisnodoubtthatemotionalproblemsarequiteprevalentinyoung

peoplewithASD.VariablessuchasspecificASDdiagnosis, levelofcognitiveandglobal functioning,degreeofsocialandfamilyimpairment,adaptivefunctioningandseverityofsymptomslikelyhave an influence on the individual's experience of emotionalproblems.Unfortunately,thereislittleclarityonhowbesttoassessthefunctionalityinthispopulationandthedirectimpactoftheemotionaldisordersintheyouthpatientswithASDfunctioning.Thestudiessummarized in this reviewhaveaddressedabroadrangeofquestionsaboutthefunctionality impactofemotionaldisorders in youngpeoplewithASD. Themain strengthof thisreviewisthatourintentwastonotonlysummarizetheavailableempirical literature,butalsoemphasizetheneedforconsistentfutureresearch.

Methodology issuesBy addressing methodological issues that limit the findings oftheextantliterature,futurestudiescancontributenoticeablytoourbetterunderstandingof the impactof emotionaldisordersinthispopulationandanswermorepointedscientificquestions.Manyofthereviewedstudies[e.g.,[17,22,33]],reportedusing‘gold standard’ diagnostic tools for ASD [i.e., ADI-R [14] andADOS [15]]. Some studies did not employ any independentconfirmation of the diagnoses, instead they included childrenbasedsolelyonpreviousclinicaldiagnosesofASD[e.g.,[21,26,30]]. Other studies, such as Gadow et al. [35], used rigorousdiagnosticevaluationprocedures (e.g., interview,observations)and established inter-diagnostician reliability, but did not usethe ADI-R or ADOS, which were designed specifically for theassessmentofautismandotherspectrumconditions.

The studies reviewed demonstrated little consistency in termsofhowcomorbiditydisordersweremeasured.Researchontheapplicability of traditional measures of childhood emotionalsymptomsissorelyneeded.Ifvalidandreliablemeasurescannotbeidentified,newmeasureswillneedtobedevelopedinorderto accurately capture symptoms of emotional problems inpeoplewithASD.Forexample,previousreportshavesupportedthe validity of themania diagnosis in non-PDD children whenexamining clinical correlates [31] aswell as external validatorssuch as the Child Behavior Checklist (CBCL) [39], but not inPDD children. Until we have consensus on ‘best practice’measurements,ahealthyscepticismiscalled,withrespecttotheprecisionofthetoolswecurrentlyhaveformeasuringchildhoodemotionalproblemswhenevaluatingchildrenwithASD. In thesameway, the functionalitymeasures described in this reviewwereveryheterogeneousandwithawidespreadvariabilityacrossthedifferentstudies.Furtherresearchisnecessaryforassesstheimpactonfunctionality(globalscores,cognitive,social,adaptivefunctioning.etc.)inthispopulation.

A methodological concern seen in most of the studies is theinclusion ofmixed ASD samples, comprised of youthwith AD,AS,andPDD-NOS.Also,givendifferencesincognitivefunctioningusually associated with ASD subtypes, future studies shouldexaminehowdiagnosismightindependentlybeassociatedwithemotionaldisorders.

Themajorityofthestudiesreviewedusedclinic-basedsamples

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[e.g.,[30,35]]orsamplesrecruitedfromavarietyofothersources(e.g.,autismsupportgroups)[e.g.,[18,38]].Incontrast,Simonoffetal.[11]drewtheirASDsamplefromalargepopulation-derived,non-clinicalcohort.Clinicalsamplesareoftenneededtoaccrueanadequatenumberofparticipantsandforensuringstatisticalpower, but such samples can make it difficult to generalizefindings.Clinical-based samplesare likelynot representativeofallchildrenwithASDinmanyimportantaspects,suchasdegreeof parental investment, level of behavior disturbance, andprevioustreatmentexposure.Furtherstudiesusingnon-clinical,communitybasedandschoolsamplesareneededtoevaluatetheprevalenceandtheimpactofemotionaldisordersinthebroaderASDpopulation.

Other limitation of this study is related to the fact that themajority of them are cross-sectional [e.g.,[24, 29]] and tounderstandthedevelopmentalchangeandtoclarifytheclinicalphenotypicmanifestation across the lifespan and thedirectionoftheassociationbetweentheriskfactors(emotionaldisorders)andtheoutcome(functionality)[e.g.,[30,32]]longitudinalstudiesareneeded.Forexample,theresultsofthestudyofBaumingeretal.[32]wereinconsistentbecausetheyconcludedthatparentingstressemergedasthemostimportantpredictorofchildren'sI-Eproblemsbut,theinverseassociationbetweentheimpactoftheI-Eproblemsintheparentingstresswerenotanalyzed.

Main resultsThe most important clinically relevant question in this reviewis the degree to which emotional disorders in children withASD,affect the functionalityof their lives, inotherwords,howco-occurring emotional problems affect the prognosis for thefunctionality inchildrenwithASD.Foransweringthisquestion,our study found only three primary studies,White et al. [25],Wozniak & Biederman [31] andMunesue et al. [37], in whichthey compared the functionality between a group of patientswith ASD+ and emotional disorders and a group of patientswith ASD without the emotional disorders. They studied thecomorbidity with anxiety disorder, mania and mood disordersrespectively. Wozniak & Biederman [31] and Munesue et al.[37]determinedasignificantnegativeassociationbetweenASDand the comorbidity with emotional disorders. These resultswereconsistentwithourhypothesis;affectingconsiderablythefunctionalityscores.AccordingwiththestudyofWhiteetal.[25],theysupportedtheimportanceofassessingglobalfunctioninginadditiontosymptomchangeandtreatmentresponseinclinicaltrials.Inapreviousreview,Whiteetal.[40]obtainedtheanxietycomorbidityestimatedrangingfrom11%to84%.

The secondary studies provided more information about theimpairment in patientswith ASD and emotional disorders, buttheassociationwitha comparativegroupofpatientswithASDandwithouttheriskfactorsisneeded.

CognitiveabilityforchildrenwithASDcanrangefromlowtohighacrossanyrangeofseverityforthecondition[41,42].LowerIQ

mayinteractwiththeseverityofthechild’sautismtoincreasetheneedforassistancewithactivitiesofdailyliving[43].Intellectualdisability(ID)isoneofthemostcommonco-occurringdisordersinASD[44,45]andisanimportantpredictorofoutcome[5-8].SeveralresearchstudieshaveestablishedtheimpactofgeneralIQonadaptive(dailylife)functionsinASDsamples[46],butlittleis known in relationwith the impactof comorbiddisordersoncognitivefunctionsinthispopulation.Accordingwiththeresultsof this review, there is controversy in the conclusions acrossthedifferentstudies.TheresultsofsomestudiesindicatedthatchildrenwithASDmayexperienceanxietysymptomswhicharesimilar to those seen innon-ASDclinical samples,but that thepresentation of anxiety symptoms in this population may beaffectedby cognitive functioning. Thus, Sukhodolskyet al. [16]foundthatchildrenwithhigherIQandgreatersocialimpairmentexperiencethemostsevereanxiety.ThishypothesisisreinforcedbyGadowetal.[35]andWeisbrotetal.[19].Ontheotherhand,Simonoffetal.[11],Pearsonetal.[18]andSimonoffetal.[22]foundnosignificantassociation.Mazzoneetal. [24]supportedthis hypothesis; they concluded that there was no significantassociation between IQ and mood symptoms, behaviouralproblemsorglobalfunctioning.

Regardingexecutivefunctioning,Hollocksetal.[17]contrarilytoThede&Coolidge[20]suggestedthatpoorexecutivefunctioningis one factor associated with the high prevalence of anxietydisorderinchildrenandadolescentswithASD.

Assessmentofglobal functioning isan importantconsiderationintreatmentoutcomeresearch;yet,thereislittleguidanceonitsevidence-basedassessmentforchildrenwithASD[25].Outcomemeasures sensitive to change in global functioning designedfor use in the ASD population are needed [47].Wagner et al.[48] addressed this need by modifying the CGAS [49]. In thisreview,manystudiesshowedthathigheranxietyseverity,majordepression,maniaandbipolardisorderascomorbidconditionsindicatedsignificantlylowerlevelsoffunctioningorlowerqualityoflife[23,24,27,28,31].Incontrast,theonlyprimarystudyofWhite et al. [25] found no relationship betweenDD-CGAS andanxietyscores.

Concerning topsychosocial functioningandaccordingwith theprimarystudyofWozniak&Biederman[31],therewasanegativecorrelationbetweencomorbiditywithmaniaandscoresontheSAICA. Using different measures, Meyer et al. [29] and Bellini[30]supportedthisfinding,buttheystudiedanxietycomorbidity.Alternatively, Hollocks et al. [17] found that social cognitionabilitywasnotassociatedwitheitheranxietyordepression.

Relatingtosymptomsseverityandadaptivefunctioning,(Table 5) themajorityofthestudieswereinconsistentwiththeobjectiveofthisreview.OnlySimonoffetal.[36]andMunesueetal.[37]found a consistent correlation. In examining the role of riskfactors, Simonoff et al. [36] found that lower IQ and adaptivefunctioning predicted higher hyperactivity and total difficultiesscores., in addition,Munesue et al. [37] concluded thatmooddisorder showed significantly lower scores on the TABS [50],

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than those without mood disorder, although scores on high-functioningautismspectrumscreeningquestionnaire(ASSQ)[51],andautism-spectrumquotient(AQ)[52],werenotsignificant.Alimitationof these studieswas that the clinical scientistsoftenusedmeasuresthattargetedspecificproblemareas(e.g.anxiety,depression,aggressivebehaviour)ratherthanglobalfunctioning,and most often, these measures have been developed forindividuals without ASD [53, 54]. Because individuals withASD do not typically present a unified, prominent problematicsymptomorbehaviour,but ratheramyriad,anarrowfocusonimprovementinasinglesymptomdomainmayfailtocapturethefullrangeofpossiblefunctioningorchange.Althoughmeasuringchangeinthetargetedbehaviouraldomainsismethodologicallynecessary,futureresearchisneededbecausethefullrangeofa

participant’sabilitiesanddeficitsmaynotbecaptured ifglobalmeasuresarenotincluded.

ConclusionChildrenwithASDandemotionaldisordersmaysufferfromtwodisorders. Comorbid with emotional disorders among patientswith ASD may be more common than previously thought. Itmayhaveconsequentimpairmentintheirpsychologicalprofile,social adjustment, adaptive functionality, cognitive and globalfunctioning and should alert clinicians to the importance ofassessing mood disorders in order to choose the appropriatetreatment. Identification of the comorbid condition mayhave important therapeutic and scientific implication. Futureresearchesareneededtounderstandhowemotionaldisordersdevelopandhowtheymayinteractwiththescoreoffunctioninginthispopulation.

Table 2Cognitivefunctioning.

Year Author Comorbidity Measures

N Sample Caractheristics

Control Group

Main Results

2010 MukaddesNMetal.(a)(A)

(K-SADS-PL-T)(OrvaschelandPuig-Antich,1987)

60 AS(30)IQ>70 AD(30)IQ>70

(I)ASgroupdisplayedgreatercomorbiditywithdepressivedisordersandADHD-CT,theyalsohadhigherrangeofIQscore.Fromaclinicalperspective,itcouldbeconcludedthatbothdisordersinvolveahighriskfordevelopingpsychiatricdisorders,withASpatientsatgreaterriskfordepression.

2012 Simonoffetal.(b)(1)(A,B)

PONS((Santosh,2006);SDQCAPA(Angold&Costello,2000)

91 ASD16year(91),12year(79)

None (NA)PrevalenceofHigh-SMPwas26,37%(N=24).Thisstudyconcludedthatseveremoodproblemswereassociatedwithcurrentandearlieremotionalproblems.IntellectualabilityandadaptivefunctioningdidnotpredicttoSMP.RelationshipsbetweenSMPandtestsofexecutivefunctionwerenotsignificantaftercontrollingforIQ.

2006 Personetal.(a)(A,B)

PIC-R(Wirt,1984). 51 AD(26),PDD-NOS(25).Agerange:4–18(M:10)

None (NA)AftercontrollingforverbalIQ,thechildrenwithADhadsignificantlymoresocialdifficulties,atypicalbehaviours,andsocialwithdrawal(thecoresymptomsofautism),thandidthechildrenwithPDD-NOSNosignificantdifferencesfoundbetweenchildrenwithPDD-NOSandADonanxietysymptoms,althoughbothgroupsapproachedclinicalsignificance.

2008 Sukhodolskyetal.(a)(A)

(CASI)(Gadow&Sprafkin,1997a,b)

171 AD(151),AS(6),PDD-NOS(14). Agerange:5–14(M:8)[C]

None (P)73(43%)metscreeningcut-ofcriteriaforatleastoneanxietydisorder.HigherlevelsofanxietyassociatedwithhigherIQ,functionallanguageuse,andstereotypedbehaviours.

2005 Weisbrotetal.(a)(A)

(ECI-4;Gadow&Sprafkin,1997a)(CSI-4;Gadow&Sprafkin,2002).(CBCL;Achenbach1991a),

483 PDD-NOS(209), AD(170),AS(104).Agerange:3–12

Non-ASD,(326)

(P)ChildrenwithASearnedhigherratingsonseveralanxietyitemsthanchildrendiagnosedwithAD.ChildrenwiththehighestlevelsofanxietyhadhighermeanIQscoresthandidthelowanxiousASDgroup.

2008 Simonoffetal.(c)(A,C)

(CAPA) 112 AD(62),PDD-NOS(50). Agerange:10–14(M:11)[R]

None (NA)41.9%metcriteriaforatleastoneanxietydisorder.ASDdiagnosis(ADorPDD-NOS),IQ,andadaptivebehaviourwerenotassociatedwiththepresenceofananxietydisorder.TheseresultsindicatethatanxietydisordersarecommoninthebroaderASDpopulation,notjustclinicalcases.

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Table 2bExecutivefunctioning.

2014HollocksMJetal.(1)(a)(A,B,C)

SDQ,PONS 90ASD(90)Rangeofage:14-16

None

(N)Resultsindicatedasignificantassociationbetweenpoorerexecutivefunctioningandhigher levelsofanxiety,butnotdepression. (NA)In contrast, social cognitionabilitywasnotassociatedwitheitheranxietyordepression.Thismaysuggestthatpoor executive functioning is one factor associated with the high prevalence ofanxietydisorderinchildrenandadolescentswithASD.

2006

ThedeandCoolidge(2)

(A)

CPNI;(Coolidge,2002)

31

AS(16),HFA(15).Agerange:5–17 (M:10)

Age,gendermatchedTD*(31)

(I) Childrenwith AS hadmore symptoms of anxiety than did childrenwith HFA;10of16childrenwithAShadelevatedGADscale scores. ASDchildren (ASandHFAcombined)showedgreaterdeficitsthanthecontrolchildrenontheExecutiveFunction scale of the CPNI. However, there were no significant differences inexecutivefunctioningbetweentheASandHFAchildren

CognitiveFunctioning:(a)TheWechslerAbbreviatedScaleofIntelligence(Wechsler,1999)(b)Adaptivefunctioning(VinelandAdaptiveBehaviourScalescompositescore)(c)WISC-IIIUKversion,30Raven_sStandardmatrix(SPM)orColouredProgressivematrices(CPM).Executivefunctioningmeasures:(1)Oppositeworlds,Trailmaking[Reitan,1958],Numbersbackwards,Cardsortingtask.(2)CoolidgePersonalityandNeuropsychologicalInventory.Correlation: (P)Positive (comorbidity is associatedwithhigh functionality) (I) Inconsistent (with thegoalof this review) (N)Negative(comorbidityisassociatedwithpoorfunctionality)(NA)Noassociation.ASDDiagnosis:(A)ClinicalDiagnosed(DSM-IV).(B)ADI-R(LeCouteuretal.,1989)and/orADOS-G(Lordetal.,2000)(C)SCQ(Goodman,2003)*TP(TypicalDevelopment)

Year Author ComorbidityMeasures N Sample

CharacteristicsControlGroup MainResults

2012 VanSteenselFJetal.(c)(B)

(ADIS-C=P)(SilvermanandAlbano,1996);CSBQ(ASD-likesymptoms)

115ASD(115)AgeM:11.37years

AnxietyD(122)M-Age:12,79.

(N)HigheranxietyseverityscoresontheADIS,aswellashigherscoresontheCSBQ(ASD-likebehaviours),wereassociatedwithalowerqualityoflife,irrespectiveofgroup.However,whetheranxietyincreasesASD(symptoms),ASD(symptoms)causeanxiety,orboth(symptomsexacerbatingoneanother),isunclear.TheresultsofthisstudysupportahighlysimilarphenotypeofanxietydisordersinchildrenwithASD.Nogroupdifferencesinqualityoflifewerefoundaccordingtoparentalorchildreport.

2006 Farrugiaetal.(a)(A)

SpenceChildren'sAnxietyScale(SCAS;Spence,1998)

29 AS.Agerange:12–16(M:13)

Anxietydisordered(34);TD(30)

(N)Self-reportedsymptomsofanxietywereequivalenttothoseofteenswithanxietydisorders;anxietysymptoms,neg.automaticthoughtsweresignificantlyhigherthanincontrolgroup.Thecorrelationsamonganxietysymptoms,negativeautomaticthoughts,behaviouralproblemsandoverallimpairmentweresignificantlyhigherintheASgroupthanineithercomparisongroup.

2013 Whiteetal.(d)(B)

CATS;Schniering&Rapee,2002) 30

ASD+AnxietyDisorder.(15)CBT14weekstreatment

ASD+AnxietyDisorder(15)

(NA)DD-CGASscoreswerestronglycorrelatedwithparent-reporteddegreeofASD-relatedimpairmentandpragmaticcommunication.Contrarytowhatwehypothesized,therewasnorelationshipbetweenDD-CGASscoresandparent-reportedanxietyscores,adaptivebehaviourscores,oreducationalplacement.DD-CGASscoreswerealsonegativelycorrelatedwithverbalIQ,asexpected.

2010 MattilaMLetal.(b)(B)

AnxietyDisordersInterviewSchedule–Child/ParentVersion(ADIS-/P)

50ASD/AS(50)Rangeofage(9-16)

None

(N)Theresultssupportcommon(prevalence74%)andoftenmultiplecomorbidpsychiatricdisordersinAS/HFA;behavioraldisorderswereshownin44%,anxietydisordersin42%andticdisordersin26%.Oppositionaldefiantdisorder,majordepressivedisorderandanxietydisordersascomorbidconditionsindicatedsignificantlylowerlevelsoffunctioning

2013 Mazzoneetal.(b)(A,B) (K-SADS-E) 30 AS/HFA(30)

MajorDepression(30)TD(35)

(N)Thepresenceofinternalizingsymptomswasreportedin18,9%oftheAS/HFAgroup,in18,9%oftheMDgroupandin3,9%oftheTDgroup.AS/HFAgroupreportedhigherdepressionsymptomscomparedtotheTDgroup.Higherlevelofdepressionsymptomsincreasetheriskofpoorerglobalfunctioning.TherewasnosignificantassociationbetweenIQandmoodsymptoms,behaviouralproblemsorglobalfunctioning.

Table 3Globalfunctioningandqualityoflife.

FunctioningMeasures:(a)TheLifeInterferenceMeasure(LIM;Lynehametal.2003);(b)ChildrenGlobalassessmentScale(CGAS)(Shafferetal.,1983);(c)The EuroQol-5D(EuroQolgroup,1990);(d)DD-CGAS(Wagneretal,2007).ASDDiagnosis:(A)ClinicalDiagnosed(DSM-IV).(B)ADI-R(LeCouteuretal.,1989)and/orADOS-G(Lordetal.,2000).Correlation:(P)Positive(comorbidityisassociatedwithhighfunctionality)(I)Inconsistent(withthegoalofthisreview)(N)Negative(comorbidityisassociatedwithpoorfunctionality)(NA)Noassociation.

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Table 4Psychosocialandfamilyfunctioning.

Year Author ComorbidityMeasures

N SampleCharacteristics ControlGroup

MainResults

2006 Meyeretal.(D)(a)

BASC(Reynolds&Kamphaus,1998)

31 AS.Agerange:7–13(M:10)

TD(33) (N)Thisstudyexaminedtheassociationsbetweeninformationprocessing,socialfunctioningandpsychologicalfunctioning,includingco-occurringpsychiatricdisorders.TeenswithASandtheirparentsreportedhigherlevelsofanxietythandidthecontrolgroup.Anxietywasrelatedtodeficitsinsocialawarenessandexperience.Cognitiveandsocial-cognitiveabilitieswereassociatedwithaspectsofsocialinformationprocessingtendencies,butnotwithemotionalandbehaviouraldifficulties

2006 Bellinietal.(A)*(b)

(SAS-A;LaGreca,1999);(MASC;March,1999)

41 AD(19),AS(16),PDD-NOS(6). Agerange:12–18(M:14);NoMR

None (N)Socialskilldeficitsandphysiologicalhyperarousalcombined,contributedtovarianceinsymptomsofsocialanxietyinteenswithASD.

2013 JoshiGetal.(C)(c,d)

(CBCL)(Achenbach,1991)(K-SADS-E))

155 BD+ASD(47) BD(155) (I)Thirtypercent(47/155)ofthebipolarIprobandsmetcriteriaforASD.TheageatonsetofbipolarIdisorderwassignificantlyearlierinthepresenceofASDcomorbidityandsignificantlypoorerGAFscoresthanBPD-Iprobands.BPD-I+ASDprobandshadsignificantlymoreimpairedscoresonallCBCLsubscalescomparedtoBPD-Iprobandsexceptforthesomaticcomplaintsscale.HoweverBipolarIprobandshassignificantlypoorerSAICAscoresindependentofcomorbidwithASD.BipolarIdisordercomorbiditywithASDrepresentsaveryseverepsychopathologicstateinyouth.

1997 WozniakJ.etal.(C)(c)

(K-SADS-E);(CBC[Achenbach,1991]

190 PDD+mania(14),maniawithoutPDD(114)

PDDwithoutmania(52)

(N)The14childrenwithbothPDD+maniarepresented21%ofthePDDsubjectsand11%ofallmanicsubjects.FunctioningofchildrenwithPDD+maniawasverypoorasevidencedbytheirscoresontheSAICA,GAFandCBCLclinicalsubscales.Thesescores,plusthehighrateofhospitalizationassociated,suggestthatPDD+maniaisahighlydisablingcondition,warrantingfurtherstudyandattention.

2010 BaumingerNetal.(A,B)(e)

(CBC) 77 HFA(23)IsraelHFA(20)USARateofage(8-12)

TD(22)Israel,TD(20)USA

(I)ChildrenwithASDexhibitedsignificantlygreaterlevelsofpsychopathologyasassessedbytheCBCandparentsofchildrenwithASDexhibitedhigherparentingstressasassessedbytheParentingStressIndex[Abidin,1995].Parentingstressemergedasthemostimportantpredictorofchildren'sI-Eproblems.

FunctioningMeasures:(a)SocialencodingerrorsonthevideoandWhyKidsDoThings(WKDT:CrickandDodge,1996)(b)PhysicalSymptomssubscaleofMASCandTheSocialSkillsRatingSystem(SSRS;Gresham&Elliot,1990)(c)[SocialAdjustmentInventoryforChildrenandAdolescents(SAICA)(OrvaschelandWalsh,1984),GlobalFunctioning(GAF)(d)MoosfamilyenvironmentScale(FES).(MoosRHetal.1974);(e)Mother–childrelationshipqualities.[InventoryofParentandPeerAttachment[IPPA;Armsden&Greenberg,1987].ASDDiagnosis:(A)ClinicalDiagnosed(DSM-IV).(B)ADI-R(LeCouteuretal.,1989)and/orADOS-G(Lordetal.,2000)(C)DiagnosisbasedonDSM-III-Rcriteria.(D)AutismSpectrumScreebibgQuestionare(ASSQ:Enlersetal.,1999)andAustralianScaleforAsperger´sSyndrome(ASAS:Attwood,1998)*Previousdiagnosis.Correlation:(P)Positive(comorbidityisassociatedwithhighfunctionality)(I)Inconsistent(withthegoalofthisreview)(N)Negative(comorbidityisassociatedwithpoorfunctionality)(NA)Noassociation.

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Year Author ComorbidityMeasures N Sample

Characteristics ControlGroup MainResults

2005 Gadowetal.(A)(a)

(CSI-4;Gadow&Sprafkin,2002)

301

AD.(103),AS(80),PDD-NOS(118). Agerange:6–12(M:8);Clinicreferrals

Non-ASDreferrals(181); regulared(404);specialed(60)

(NA)25.2%and19.5%ofmalesandfemales,respectively,withASDscreenedpositiveforgeneralizedanxietydisorder.TheauthorsreportedthatseverityofASDappearedtobenegativelyassociatedwithpsychiatricsymptomssuchthatchildrenwithADweregenerallyratedashavingfewerandlessseverepsychiatricsymptoms.

2004 Bradleyetal.(B)(b)

(DASH-II;Matson,1995)

12

AD.Agerange:12–20 (M:16);FSIQb75[M]

Learningdisabled (17)TD(16)

(I)42%(n=5)ofsamplereachedclinicalsignificanceforanxietyproblems,comparedto0%ofmentallyretardedsamplewithoutautism.ThechildrenwithADhadanaverageof5.25clinicallysignificantdisorders(excludingAD)basedoncut-offscoresontheDASH-II,comparedtoanaverageof1.25forthenon-ADgroup.

2013

VanSteenselFJetal.(A,B)(c)

(ADIS-C=P) 73 ASD+AnxietyD-group(73)

Anxiety-Group(34)

(I)ThemeanofseverityscoreofananxietydisorderdidnotdifferbetweentheASD+AD-andAD-group.FortheASD-subtypes(autisticdisorder,Asperger’sdisorderorPDD-NOS),nodifferenceswerefoundwithrespecttothenumberofanxietydisorders,anxietyseverityscores,orthepresentationofanxietydisorders.

2013 Simonoffetal(A,B)(d)

(SDQ).(CAPA) 81 ASD(81)12-16-

year None

(N)Prevalenceforemotionalproblemwas34,5%at12yearsand30,7%at16years.LowerIQandadaptivefunctioningpredictedhigherhyperactivityandtotaldifficultiesscores.Greateremotionalproblemsat16werepredictedbypoorermaternalmentalhealth,family-baseddeprivationandlowersocialclass.

2005 Pfeifferetal.(A)(e)

(RCMAS;Reynolds&Richmond,1978)and(CDI;Kovacs,1978)-ParentVersion

50 AS.Agerange:6–17(M:9) None

(NA)Therewerenosignificantrelationshipsbetweendepressionandoveralladaptivebehaviouroranxietyandoveralladaptivebehaviour.However,thedatasupportspositiverelationshipsbetweenanxietyandsensorydefensivenessinallagerangesandarelationshipbetweendepressionandhyposensitivityinolderchildren.Strongerinverserelationshipswereapparentbetweenspecificadaptivebehavioursincluding:(a)symptomsofdepressionandfunctionalacademics,leisure,socialskills;(b)anxietyandfunctionalacademics;and(c)bothsensoryhyper-andhyposensitivityandcommunityuseandsocialskills).

2012 Gadowetal.(A,B)(a)

(CSI-4),(DICA-P;Reich2000)

287

ASD+ADHD(74),ASD/-ADHD(107),CMTD+ADHD(47),ADHDOnly(59)

TD (Mother)(169) (Tearcher)(173)

(I)TheASDgroupobtainedmoresevereratingsforalldepressionsymptomsfromboth,motherandteacherthancontrols.TheyalsofoundlittlerelationbetweenIQorverbalabilityandglobaldepressionscoresinchildrenwithASD.SeverityofdepressionsymptomswasforthemostpartcomparableforboyswithASDwithandwithoutADHD,whichraisesanumberofinterestingquestionsaboutpathogenicprocessesthatresultinASDandtheirroleinmooddysregulationaswellascriteriafordepressioninASD.

2007 MunesueTetal.(C)(d)

HospitalaccordingtoDSM-IV

44HFA+MD(16)RangeofAge(12-29)

HFA(28)Rangeofage(8-38)

(N)Sixteenpatients(36.4%)werediagnosedwithmooddisorder(MD).Themajorcomorbidmooddisorderinpatientswithhigh-functioningASDisbipolardisorderandnotmajordepressivedisorder.Rateofmooddisorderinfirst-andsecond-degreerelatives,andIQswerenotsignificantlydifferentbetweenthetwogroups.PatientswithmooddisordershowedsignificantlylowerscoresonTABSthanthosewithoutmooddisorder,althoughscoresonASSQandAQwerenotsignificantlydifferentbetweenthetwogroups.

Table 5Symptomsseverityandadaptivefunctioning.

Symptomsseverity:(a)CSI-4;Gadow&Sprafkin,2002)(b)DASH-II;Matson,1995(c)AnxietySeverityscore(ADIS-C=P)(d)AdaptativeFunctioning.(VinelandAdaptiveBehaviourScalescompositescore)(e)SensoryProfileforchildren(Dunn,1999).TheAdolescent/AdultSensoryProfile(Brown&Dunn,2002),AdaptiveBehaviorAssessmentSystem:ParentVersion.(ABAS)and(SFA)(Dunn,1999)(d)SeverityofAutism[ScoreofTABS,ASSQandAQ).ASDDiagnosis: (A)ClinicalDiagnosed(DSM-IV). (B)ADI-R(LeCouteuretal.,1989)and/orADOS-G(Lordetal.,2000) (C) (TABS;KuritaandMiyake,1990), (ASSQ;Ehlersetal.,1999),and(AQ;Baron-Cohenetal.,2001).Correlation:(P)Positive(comorbidity isassociatedwithhighfunctionality)(I)Inconsistent(withthegoalofthisreview)(N)Negative(comorbidityisassociatedwithpoorfunctionality)(NA)Noassociation.

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Year Author Functionality Functionality Measures

2010 MukaddesNMetal. Cognitive RateofCognitiveFunctioning(IQ,VerbalIQ,PerformanceIQ)(WISC-R)

2012 Simonoffetal.Cognitive&Executive

Rateofcognitivefunction(IQ).VinelandAdaptiveBehaviourScalescompositescore&cardsortandtrailmaking

2005 Weisbrotetal. Cognitive&Severity RangeofCognitivefunctioning(IQ)&EarlyChildhoodInventory-4andScoringformatsforDSM-IVcriteria.

2006 Personetal. Social&Cognitive EmotionalfunctioningandSocialSkills:PersonalityInventoryforChildren-Revised(SubscaleScores)&Rateofcognitivefunctioning:VerbalIQ

2008 Sukhodolskyetal. Cognitive Rangeofcognitivefunctioning(IQ,functionallanguageuse,andstereotypedbehaviors.)

2008 Simonoffetal. Cognitive WISC-IIIUKversion,30Raven_sStandardmatrix(SPM)orColouredProgressivematrices(CPM)

2006 ThedeandCoolidge Executive Parent-report measures of psychological and executive functioning: Coolidge Personality and

NeuropsychologicalInventory.

2014 HollocksMJetal.

Cognitive&Executive

(Wechsler,1999)]SocialcognitiveMeasure[Frith-Happéanimations(Abell,Happe,&Frith,2000;Castelli,Frith,Happe,&Frith, 2002, Strange stories (Happé,1994), &Oppositeworlds, Trailmaking [Reitan,1958],Numbersbackwards,Cardsortingtask.

2012 VanSteenseletal.

QualityofLife(QoL) EuroQol-5D

2006 Farrugiaetal Severity&QoL Strengths and Difficulties Questionnaire (SDQ; Goodman,1997) & Life Interference Measure (LIM;Lyneham,Abbott,&Rapee,2003)

2013 Whiteetal. Global&SeverityDD-CGAS(Wagneretal,2007),ClinicalGlobalImpresions-Improvement(CGI-I),&ChildrenComunicationChecklist-2(CCC-2)ChildandAdolescentSymptomInventoryASDAnxietyScale,SocialResponsivenessSacle,VinelandAdaptativeBehaviourScale.Schollplacement.

2010 MattilaMLetal. Global [Children'sGlobalAssessmentScale(GAF)]

2013 Mazzoneetal Global&Cognitive ChildrenGlobalassessmentScale(CGAS)(Shafferetal.,1983)&Rateofcognitivefunctioning(IQ)

2006 Meyeretal. Social Rangeof cognitiveandSocial cognitiveability: Socialencodingerrorson thevideoandWhyKidsDoThings(WKDT:CrickandDodge,1996)

2006 Bellini Social Physiologicalarousal(PhysicalSymptomssubscaleofMASC)andTheSocialSkillsRatingSystem(SSRS;Gresham&Elliot,1990)

2013 JoshiGetal. Social&Global&Family

Psychosocialfunctioning[SocialAdjustmentInventoryforChildrenandAdolescents(SAICA)(OrvaschelandWalsh,1984)&(GAF)&(FES).(MoosRHetal.1974)]

1997 WozniakJ.etal. Social&global Psychosocialfunctioning[SocialAdjustmentInventoryforChildrenandAdolescents(SAICA)(Orvaschel

andWalsh,1984)&GAF

2010 BaumingerNetal. Cognitive&Family (VIQ of 80 or Peabody Picture and Vocabulary Test [PPVT;Dunn & Dunn, 1997] & Mother–child

relationshipqualities.[IPPA;Armsden&Greenberg,1987].

2005 Gadowetal. Severity ChildSymptomInventory-4(CSI-4;Gadow&Sprafkin,2002)

2004 Bradleyetal. Severity DiagnosticAssessmentfortheSeverelyHandicapped(DASH-II;Matson,1995)

2013 VanSteenseletal. Severity AnxietySeverityscore(ADIS-C=P):rangingfrom0to8,andsummingtheratingsofallanxietydisorders.

2013 Simonoffetal Cognitive&Adaptive

Rate of cognitive function (IQ) and Adaptative Functioning. (Vineland Adaptive Behaviour Scalescompositescore

2005 Pfeifferetal. AdaptiveSensoryProfileforchildren(Dunn,1999).TheAdolescent/AdultSensoryProfile(Brown&Dunn,2002)AdaptiveBehaviorAssessmentSystem:ParentVersion.(ABAS)SchoolFunctionAssessment(SFA)(Dunn,1999)

2012 Gadowetal. Severity&Cognitive

SeverityofSymtoms[ChildSymptomInventory-4(CSI-4)]NeuropsychologicalMeasures[TheWechslerAbbreviatedScaleofIntelligence(Wechsler,1999)]

2007 MunesueTetal.

Severity&cognitive

RateofCognitiveFunctioning[WechslerIntelligenceScale(FIQ,VIQ,PIQ)]SeverityofAutism[ScoreofTABS,ASSQandAQ)

Table 6Functionalitymeasures.

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18 PearsonDA,LovelandKA,LacharD,LaneDM,ReddochSL,MansourR,ClevelandLA (2006)A comparisonofbehavioral andemotionalfunctioning in childrenandadolescentswithAutisticDisorderandPDD-NOS.ChildNeuropsychol12:321-333.

19 Weisbrot DM, Gadow KD, DeVincent CJ, Pomeroy J (2005) Thepresentation of anxiety in children with pervasive developmentaldisorders.JChildAdolescPsychopharmacol15:477-496.

20 Thede L, Coolidge F (2007) Psychological and NeurobehavioralComparisons of Children with Asperger’s Disorder Versus High-FunctioningAutism.JAutismDevDisord37:847-854.

21 MukaddesNM,HergunerS, TanidirC (2010)Psychiatricdisordersinindividualswithhigh-functioningautismandAsperger'sdisorder:similaritiesanddifferences.WorldJBiolPsychiatry11:964-971.

22 Simonoff E, Jones CR, Pickles A, Happe F, Baird G, Charman, T(2012)Severemoodproblemsinadolescentswithautismspectrumdisorder.JChildPsycholPsychiatry53:1157-1166.

23 MattilaML,HurtigT,HaapsamoH,JussilaK,Kuusikko-GauffinS,KielinenM,Moilanen I (2010)ComorbidpsychiatricdisordersassociatedwithAspergersyndrome/high-functioningautism:acommunity-andclinic-basedstudy.JAutismDevDisord40:1080-1093.

24 Mazzone L, Postorino V, De Peppo L, Fatta L, Lucarelli V, Reale L,Vicari S (2013)Mood symptoms in children and adolescentswithautismspectrumdisorders.ResDevDisabil34:3699-3708.

25 White SW, Smith LA, Schry AR (2014) Assessment of globalfunctioninginadolescentswithautismspectrumdisorders:utilityoftheDevelopmentalDisability-ChildGlobalAssessmentScale.Autism18:362-369.

26 Farrugia S, Hudson J (2006) Anxiety in adolescents with Aspergersyndrome: Negative thoughts, behavioral problems, and lifeinterference.FocusonAutismandOtherDevelopmentalDisabilities21:25-25.

27 VanSteenselFJ,BogelsSM,DirksenCD(2012)Anxietyandqualityoflife:clinicallyanxiouschildrenwithandwithoutautismspectrumdisorderscompared.JClinChildAdolescPsychol41:731-738.

28 JoshiG,BiedermanJ,PettyC,GoldinRL,FurtakSL,WozniakJ(2013)Examiningthecomorbidityofbipolardisorderandautismspectrumdisorders: a large controlled analysis of phenotypic and familialcorrelatesinareferredpopulationofyouthwithbipolar Idisorderwith andwithout autism spectrumdisorders. J Clin Psychiatry 74:578-586.

29 Meyer JA, Mundy PC, Van Hecke AV, Durocher, JS (2006) SocialattributionprocessesandcomorbidpsychiatricsymptomsinchildrenwithAspergersyndrome.Autism10:383-402.

30 Bellini (2006) The development of social anxiety in adolescentswith autism spectrum disorders. Focus on Autism and OtherDevelopmentalDisabilities21:138.

31 Wozniak J, Biederman J (1997)Mania in childrenwith PDD. J AmAcadChildAdolescPsychiatry36:1646-1647.

32 Bauminger N, Solomon M, Rogers SJ (2010) Externalizing andinternalizingbehaviorsinASD.AutismRes3:101-112.

33 Bradley EA, Summers JA, Wood HL, Bryson SE (2004) Comparingratesofpsychiatricandbehaviordisordersinadolescentsandyoungadultswithsevereintellectualdisabilitywithandwithoutautism.JAutismDevDisord34:151-161.

34 VanSteenselFJ,DirksenCD,BogelsSM(2013)Acostofillnessstudyof children with high-functioning autism spectrum disorders and

References1 AmericanPsychiatricAssociation,A(2000)DiagnosticandStatistical

ManualofMentalDisorders(IV-Red.).

2 Gadow KD, Guttmann-Steinmetz S, Rieffe C, Devincent C J (2012)Depression symptoms in boyswith autism spectrumdisorder andcomparisonsamples.JAutismDevDisord42:1353-1363.

3 Gadow KD, DeVincent CJ, Pomeroy J, Azizian A (2004) PsychiatricsymptomsinpreschoolchildrenwithPDDandclinicandcomparisonsamples.JAutismDevDisord34:379-393.

4 Sverd J, Dubey DR, Schweitzer R, Ninan R (2003) Pervasivedevelopmentaldisordersamongchildrenandadolescentsattendingpsychiatricdaytreatment.PsychiatrServ54:1519-1525.

5 WallaceKS,RogersSJ(2010)Interveningininfancy:implicationsforautismspectrumdisorders.JChildPsycholPsychiatry51:1300-1320.

6 Howlin P, Goode S, Hutton J, RutterM (2004) Adult outcome forchildrenwithautism.JChildPsycholPsychiatry45:212-229.

7 FountainC,WinterAS,BearmanPS(2012)Sixdevelopmentaltrajectoriescharacterizechildrenwithautism.Pediatrics129:e1112-1120.

8 Billstedt E,GillbergC,GillbergC (2005)AutismafterAdolescence:Population-based13-to22-yearFollow-upStudyof120Individualswith Autism Diagnosed in Childhood. Journal of Autism andDevelopmentalDisorders,35:351-360.

9 Allik H, Larsson JO, Smedje H (2008) Sleep patterns in school-agechildren with Asperger syndrome or high-functioning autism: afollow-upstudy.JAutismDevDisord38:1625-1633.

10 Mugno D, Ruta L, D'Arrigo VG,Mazzone, L (2007) Impairment ofqualityoflifeinparentsofchildrenandadolescentswithpervasivedevelopmentaldisorder.HealthQualLifeOutcomes5:22.

11 SimonoffE,PicklesA,CharmanT,ChandlerS,LoucasT,BairdG(2008)Psychiatric disorders in children with autism spectrum disorders:prevalence, comorbidity, and associated factors in a population-derivedsample.JAmAcadChildAdolescPsychiatry47:921-929.

12 GhaziuddinM,GhaziuddinN,GredenJ(2002)Depressioninpersonswithautism:implicationsforresearchandclinicalcare.JAutismDevDisord32:299-306.

13 GrzadzinskiR,HuertaM,LordC(2013)DSM-5andautismspectrumdisorders(ASDs):anopportunityforidentifyingASDsubtypes.MolAutism4:12.

14 LordC,RutterM,LeCouteurA(1994)AutismDiagnosticInterview-Revised: a revised version of a diagnostic interview for caregiversof individuals with possible pervasive developmental disorders. JAutismDevDisord24:659-685.

15 LordC,RisiS,LambrechtL,CookEHJr,LeventhalBL,DiLavorePC,RutterM(2000)Theautismdiagnosticobservationschedule-generic:astandardmeasureofsocialandcommunicationdeficitsassociatedwiththespectrumofautism.JAutismDevDisord30:205-223.

16 SukhodolskyD,Scahill L,GadowK,ArnoldLE,AmanM,McDougleC,VitielloB(2008)Parent-RatedAnxietySymptomsinChildrenwithPervasive Developmental Disorders: Frequency and AssociationwithCoreAutismSymptomsandCognitiveFunctioning. JournalofAbnormalChildPsychology36:117-128.

17 Hollocks MJ, Jones CR, Pickles A, Baird G, Happe F, Charman T,Simonoff E (2014) The association between social cognition andexecutive functioning and symptoms of anxiety and depression inadolescentswithautismspectrumdisorders.AutismRes7:216-228.

2016Vol. 2 No. 1:4



comorbid anxiety disorders as compared to clinically anxious andtypicallydevelopingchildren.JAutismDevDisord43:2878-2890.

35 GadowKD,DevincentCJ,Pomeroy J,AzizianA (2005)ComparisonofDSM-IV symptoms in elementary school-age childrenwith PDDversusclinicandcommunitysamples.Autism9:392-415.

36 SimonoffE,JonesCR,BairdG,PicklesA,HappeF,CharmanT(2013)Thepersistence and stability of psychiatric problems in adolescents withautismspectrumdisorders.JChildPsycholPsychiatry,54:186-194.

37 MunesueT,OnoY,MutohK,ShimodaK,NakataniH,KikuchiM(2008)Highprevalenceofbipolardisordercomorbidityinadolescentsandyoung adults with high-functioning autism spectrum disorder: apreliminarystudyof44outpatients.JAffectDisord111:170-175.

38 Pfeiffer B, Kinnealey M, Reed C, Herzberg G (2005) SensorymodulationandaffectivedisordersinchildrenandadolescentswithAsperger'sdisorder.AmJOccupTher59:335-345.

39 AchenbachTM(1991)Integrativeguideforthe1991CBCL/4-18,YSRandTRFprofiles.UniversityofVermont.

40 WhiteSW,OswaldD,OllendickT,ScahillL(2009)Anxietyinchildrenandadolescentswith autism spectrumdisorders. Clin PsycholRev29:216-229.

41 Coplan J, Jawad, AF (2005)Modeling clinical outcome of childrenwithautisticspectrumdisorders.Pediatrics116:117-122.

42 Coplan J, Souders MC, Mulberg AE, Belchic JK, WrayJ, Jawad AF,LevySE(2003)Childrenwithautisticspectrumdisorders.II:parentsareunabletodistinguishsecretinfromplacebounderdouble-blindconditions.ArchDisChild88:737-739.

43 Payakachat N, Tilford JM, Kovacs E, Kuhlthau K (2012) Autismspectrumdisorders:areviewofmeasuresforclinical,healthservicesand cost-effectiveness applications. Expert Rev PharmacoeconOutcomesRes12:485-503.

44 Matson JL, Shoemaker M (2009) Intellectual disability and its

relationshiptoautismspectrumdisorders.ResDevDisabil30:1107-1114.

45 Fernell E,Hedvall A,Norrelgen F, ErikssonM,Hoglund-Carlsson L,Barnevik-OlssonM,GillbergCetal. (2010)Developmentalprofilesin preschool childrenwith autism spectrumdisorders referred forintervention.ResDevDisabil31.

46 SchatzJ,Hamdan-AllenG(1995)EffectsofageandIQonadaptivebehaviordomainsforchildrenwithautism.JAutismDevDisord25:51-60.

47 VolkmarF,RBaDP(2011)Evidence-BasedPracticesandTreatmentsforChildrenwithAutism.NewYork.365-391.

48 WagnerA, Lecavalier L,ArnoldLE,AmanMG,Scahill L, StiglerKA,Vitiello B (2007) Developmental disabilities modification of theChildren'sGlobalAssessmentScale.BiolPsychiatry,61:504-511.

49 ShafferD,GouldMS,BrasicJ,AmbrosiniP,FisherP,BirdH,AluwahliaS (1983) A children's global assessment scale (CGAS). Arch GenPsychiatry40:1228-1231.

50 Kurita H, Hiyake Y (1990) The reliability and validity of the TokyoAutisticBehaviourScale.JpnJPsychiatryNeurol44:25-32.

51 Ehlers S, Gillberg C, Wing L (1999) A screening questionnaire forAsperger syndrome and other high-functioning autism spectrumdisordersinschoolagechildren.JAutismDevDisord29:129-141.

52 Baron-Cohen S, Wheelwright S, Skinner R, Martin J, Clubley E(2001)Theautism-spectrumquotient(AQ):evidencefromAspergersyndrome/high-functioning autism, males and females, scientistsandmathematicians.JAutismDevDisord31:5-17.

53 LecavalierL,WoodJJ,HalladayAK, JonesNE,AmanMG,CookEH,Scahill,L(2014)Measuringanxietyasatreatmentendpointinyouthwithautismspectrumdisorder.JAutismDevDisord,44:1128-1143.

54 WoleryM,GarfinkleAN(2002)Measuresininterventionresearchwithyoungchildrenwhohaveautism.JAutismDevDisord32:463-478.

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