Differences in profiles of emotional behavioral problems across instruments in verbal versus minimally verbal children with autism spectrum disorder

Abstract

There has been increasing attention to the assessment of minimally verbal (MV) children with autism spectrum disorder (ASD). Previous research has begun to examine the relationship between verbal abilities and emotional and behavioral problems (EBP). The current study compared parent-reported EBP in children of differing language levels on two instruments commonly used in ASD research and clinical practice, the Child Behavior Checklist (CBCL) and Aberrant Behavior Checklist (ABC). The study consisted of 1,937 6-18 years old children with ASD from the Simons Simplex Collection. Children were divided into three language groups, by ADOS module (Module 1 = MV, 2 = phrase speech (PS), and 3 = verbally fluent (VF)) and then compared on CBCL and ABC subscales. The ABC and CBCL showed different patterns of elevations across the language groups. MV children were reported to have more impairment than VF children on the ABC irritability, lethargy, and hyperactivity scales. Children with less language (MV and PS) exhibited less impairment on the CBCL internalizing domain than VF children, but did not differ on the externalizing domain. Post hoc comparisons showed that internalizing differences were driven by fewer children with less language exhibiting clinically elevated anxious/depressed scores compared to VF children. The present study underscores the significance of considering language when assessing EBP. Results have implications for the psychiatric screening of children with ASD, particularly those with language impairments. Researchers should exercise caution when applying EBP instruments designed for use with different populations and purposes to broad samples of children. Autism Res 2019, 12: 1367-1375. © 2019 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: Some emotional and behavioral problem (EBP) scales include items that may be inappropriate for children with ASD and limited language. The present study found that there was a tendency for children with language impairment to have lower internalizing scores on the Child Behavior Checklist, but higher scores lethargy and irritability scores on the Aberrant Behavior Checklist, relative to verbally fluent children. This suggests that each of these instruments may underestimate EBPs in certain subsets of children.

Keywords: affect/emotion; children; language.

Figure 1.

Language group differences of mean ABC subscale scores. Note: *p < .001; Bars represent +/− 1 SE; ¹group differences were no longer significant when controlling for NVIQ; MV=Minimally Verbal; PS=Phrased Speech; VF=Verbally Fluent.

Figure 2.

(A-B) Language group differences of mean CBCL domain scores; (C-D) Language group differences of distribution of mean CBCL domain score distributions in the clinical, borderline, and not clinical range. Note: *p < .001; Bars represent +/− 1 SE; MV=Minimally Verbal; PS=Phrase Speech; VF=Verbally Fluent. Clinical Borderline Not Clinical

Figure 3.

(A-C) Language group differences of mean CBCL syndrome scale scores; (D-F) Language group differences of distribution of mean CBCL syndrome scale score distributions in the clinical, borderline, and not clinical range. Note: *p<.001; Bars represent +/− 1 SE; MV=Minimally Verbal; PS=Phrased Speech; VF=Verbally Fluent. Clinical Borderline Not Clinical