Co-occurring Psychopathology in Children With and Without Autism Spectrum Disorder (ASD): Differences by Sex in the ECHO Cohorts

Heather E Volk¹, Diogo Fortes², Rashelle Musci², Amanda Kim², Theresa M Bastain³, Carlos A Camargo Jr⁴, Lisa A Croen⁵, Dana Dabelea⁶, Cristiane S Duarte⁷, Anne L Dunlop⁸, Kennedy Gachigi², Akhgar Ghassabian⁹, Irva Hertz-Picciotto¹⁰, Kathi C Huddleston¹¹, Robert M Joseph¹², Daniel Keating¹³, Rachel S Kelly¹⁴, Young Shin Kim¹⁵, Rebecca J Landa¹⁶, Leslie D Leve¹⁷, Kristen Lyall¹⁸, Jessie B Northrup¹⁹, Thomas O'Connor²⁰, Sally Ozonoff²¹, Anna Ross², Rebecca J Schmidt¹⁰, Julie B Schweitzer²¹, Lauren C Shuffrey²², Coral Shuster²³, Emily Vance², Scott T Weiss²⁴, Greta Wilkening²⁵, Robert O Wright²⁵

Affiliations

¹ Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, HH811, Baltimore, MD, 20215, USA. Hvolk1@jhu.edu.
² Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, HH811, Baltimore, MD, 20215, USA.
³ Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA.
⁴ Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
⁵ Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA.
⁶ Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
⁷ Division of Child and Adolescent Psychiatry, Columbia University, New York, NY, USA.
⁸ Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA, USA.
⁹ Departments of Pediatrics and Population Health, NYU Grossman School of Medicine, New York, NY, USA.
¹⁰ Department of Public Health Sciences and the MIND Institute, University of California Davis, Davis, CA, USA.
¹¹ George Mason University, Fairfax, VA, USA.
¹² Department of Anatomy and Neurobiology, Chobanian & Avedisian School of Medicine, Boston University, Boston, MA, USA.
¹³ Department of Psychology and Institute for Social Research, University of Michigan, Ann Arbor, MI, USA.
¹⁴ Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
¹⁵ Dept. of Psychiatry and Behavioral Sciences, UCSF, San Francisco, CA, USA.
¹⁶ Kennedy Krieger Institute, Baltimore, MD, USA.
¹⁷ Prevention Science Institute, University of Oregon, Eugene, OR, USA.
¹⁸ AJ Drexel Autism Institute, Drexel University, Philadelphia, PA, USA.
¹⁹ University of Pittsburgh, Pittsburg, PA, USA.
²⁰ Departments of Psychiatry, Neuroscience, Obstetrics and Gynecology, University of Rochester, , Rochester, NY, USA.
²¹ Department of Psychiatry and Behavioral Sciences and the MIND Institute, University of California, Davis, Sacramento, CA, USA.
²² Department of Child and Adolescent Psychiatry, Child Study Center, Hassenfeld Children's Hospital at NYU Langone, New York, NY, USA.
²³ Women and Infants Hospital of Rhode Island, Providence, RI, USA.
²⁴ Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
²⁵ Ichan School of Medicine at Mount Sinai, New York, NY, USA.

PMID: 39762643
PMCID: PMC12409737
DOI: 10.1007/s10803-024-06670-2

Co-occurring Psychopathology in Children With and Without Autism Spectrum Disorder (ASD): Differences by Sex in the ECHO Cohorts

Heather E Volk et al. J Autism Dev Disord. 2025.

. 2025 Jan 6:10.1007/s10803-024-06670-2.

doi: 10.1007/s10803-024-06670-2. Online ahead of print.

Authors

Affiliations

¹ Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, HH811, Baltimore, MD, 20215, USA. Hvolk1@jhu.edu.
² Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, HH811, Baltimore, MD, 20215, USA.
³ Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA.
⁴ Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
⁵ Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA.
⁶ Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
⁷ Division of Child and Adolescent Psychiatry, Columbia University, New York, NY, USA.
⁸ Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA, USA.
⁹ Departments of Pediatrics and Population Health, NYU Grossman School of Medicine, New York, NY, USA.
¹⁰ Department of Public Health Sciences and the MIND Institute, University of California Davis, Davis, CA, USA.
¹¹ George Mason University, Fairfax, VA, USA.
¹² Department of Anatomy and Neurobiology, Chobanian & Avedisian School of Medicine, Boston University, Boston, MA, USA.
¹³ Department of Psychology and Institute for Social Research, University of Michigan, Ann Arbor, MI, USA.
¹⁴ Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
¹⁵ Dept. of Psychiatry and Behavioral Sciences, UCSF, San Francisco, CA, USA.
¹⁶ Kennedy Krieger Institute, Baltimore, MD, USA.
¹⁷ Prevention Science Institute, University of Oregon, Eugene, OR, USA.
¹⁸ AJ Drexel Autism Institute, Drexel University, Philadelphia, PA, USA.
¹⁹ University of Pittsburgh, Pittsburg, PA, USA.
²⁰ Departments of Psychiatry, Neuroscience, Obstetrics and Gynecology, University of Rochester, , Rochester, NY, USA.
²¹ Department of Psychiatry and Behavioral Sciences and the MIND Institute, University of California, Davis, Sacramento, CA, USA.
²² Department of Child and Adolescent Psychiatry, Child Study Center, Hassenfeld Children's Hospital at NYU Langone, New York, NY, USA.
²³ Women and Infants Hospital of Rhode Island, Providence, RI, USA.
²⁴ Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
²⁵ Ichan School of Medicine at Mount Sinai, New York, NY, USA.

PMID: 39762643
PMCID: PMC12409737
DOI: 10.1007/s10803-024-06670-2

Abstract

Purpose: Our goals were to: 1) examine the occurrence of behavioral and emotional symptoms in children on the autism spectrum in a large national sample, stratifying by sex, and 2) evaluate whether children with increased autism-related social communication deficits also experience more behavioral and emotional problems.

Methods: Participants (n = 7,998) were from 37 cohorts from the Environmental influences on Child Health Outcomes (ECHO) Program. Cross-sectional information on demographic factors, parent-report of an ASD diagnosis by clinician, Social Responsiveness Scale (SRS) scores, and Child Behavior Checklist (CBCL) scores were obtained for children aged 2.5-18 years by surveys. We examined mean differences in CBCL Total Problems and DSM-oriented subscale scores by autism diagnosis and by child sex. Analyses using logistic regression were conducted to examine whether autism was associated with higher CBCL scores. We further examined if these relationships differed by child age category (< 6 years, 6-11 years, 12 + years). The relationships between SRS score and CBCL total and subscale scores were examined using quantile regression models, with analyses adjusted for child sex and age.

Results: In ECHO, 553 youth were reported by a parent to have a clinician diagnosis of autism spectrum disorder (ASD) (432 [78%] boys and 121 [22%] girls). Youth on the spectrum had higher mean CBCL raw scores on Total Problems and all DSM-oriented subscales compared to those not on the spectrum (all p < 0.0001). Analyses adjusted for sex and stratified by age group indicated that higher odds of autism diagnosis were associated with total, depression, anxiety, and attention-deficit/hyperactivity disorder (ADHD) scales in the top 30% of the CBCL score distribution. Autistic girls were more likely to have parent-reported depression and anxiety compared to autistic boys. In quantile regression analyses, we observed evidence of stronger associations between SRS and CBCL for those in higher quantiles of CBCL total problems scale score (beta representing 1-unit change in SRS associated with 1-unit increase in CBCL total problems scale score), among children in the 70-90th percentile (β = 1.60, p < 0.01), or top 10th percentile (β = 2.43, p < 0.01) of the CBCL total problems scale score distribution. Similar findings were seen for the DSM-oriented depression, anxiety, and ADHD subscales.

Conclusion: Results from this large national sample suggest increased behavioral and emotional problems among autistic children compared to non-autistic children throughout early life. Among children on the spectrum this may warrant increased monitoring for co-occurring behavioral and emotional problems.

Keywords: Anxiety; Autism spectrum disorder; Depression; Psychopathology.

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Conflict of interest statement

Declarations. Conflict of interests: The following authors have nothing to declare (HEV, CAC, JBS, RMJ, DPK, TMB, YSK, LDL, ALD).

Figures

**Figure 1.**
Distribution of Selected CBCL Raw Scores Among ASD and non-ASD Youth

**Figure 2.**
Associations Between SRS Score and CBCL Raw Score According to Quantile Regression

See this image and copyright information in PMC

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Co-occurring Psychopathology in Children With and Without Autism Spectrum Disorder (ASD): Differences by Sex in the ECHO Cohorts

Affiliations

Co-occurring Psychopathology in Children With and Without Autism Spectrum Disorder (ASD): Differences by Sex in the ECHO Cohorts

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Grants and funding

LinkOut - more resources

Full Text Sources