Department of Psychology, Manchester Metropolitan University, Manchester, UK.
Centre for Addiction and Mental Health, University of Toronto, Toronto, Canada.
Psychol Med. 2023 Dec;53(16):7707-7719. doi: 10.1017/S0033291723001599. Epub 2023 Jun 29.
Mental health problems are elevated in autistic individuals but there is limited evidence on the developmental course of problems across childhood. We compare the level and growth of anxious-depressed, behavioral and attention problems in an autistic and typically developing (TD) cohort.
Latent growth curve models were applied to repeated parent-report Child Behavior Checklist data from age 2-10 years in an inception cohort of autistic children (Pathways, = 397; 84% boys) and a general population TD cohort (Wirral Child Health and Development Study; WCHADS; = 884, 49% boys). Percentile plots were generated to quantify the differences between autistic and TD children.
Autistic children showed elevated levels of mental health problems, but this was substantially reduced by accounting for IQ and sex differences between the autistic and TD samples. There was small differences in growth patterns; anxious-depressed problems were particularly elevated at preschool and attention problems at late childhood. Higher family income predicted lower base-level on all three dimensions, but steeper increase of anxious-depressed problems. Higher IQ predicted lower level of attention problems and faster decline over childhood. Female sex predicted higher level of anxious-depressed and faster decline in behavioral problems. Social-affect autism symptom severity predicted elevated level of attention problems. Autistic girls' problems were particularly elevated relative to their same-sex non-autistic peers.
Autistic children, and especially girls, show elevated mental health problems compared to TD children and there are some differences in predictors. Assessment of mental health should be integrated into clinical practice for autistic children.
自闭症个体中存在较高的心理健康问题，但关于儿童期问题发展过程的证据有限。我们比较了自闭症和典型发育（TD）队列中焦虑抑郁、行为和注意问题的水平和增长。
应用潜在增长曲线模型对自闭症儿童的起始队列（Pathways，n=397；84%为男性）和一般人群 TD 队列（Wirral 儿童健康与发展研究；WCHADS，n=884；49%为男性）的 2-10 岁时的父母报告儿童行为检查表重复数据进行分析。生成百分位图以量化自闭症儿童与 TD 儿童之间的差异。
自闭症儿童表现出较高水平的心理健康问题，但通过考虑自闭症和 TD 样本之间的智商和性别差异，这一问题大大减少。增长模式存在较小差异；焦虑抑郁问题在学龄前特别高，注意力问题在晚童年期较高。较高的家庭收入预测所有三个维度的基础水平较低，但焦虑抑郁问题的增长幅度较大。较高的智商预测注意力问题的水平较低，且随儿童期快速下降。女性性别预测焦虑抑郁问题水平较高，行为问题的下降速度较快。社交情感自闭症症状严重程度预测注意力问题水平升高。与同性非自闭症同龄人相比，自闭症女孩的问题尤其突出。
与 TD 儿童相比，自闭症儿童，尤其是女孩，表现出更高的心理健康问题，而且在预测因素方面存在一些差异。应将心理健康评估纳入自闭症儿童的临床实践中。
