Verbal Ability and Psychiatric Symptoms in Clinically Referred Inpatient and Outpatient Youth with ASD
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Youth with autism spectrum disorder (ASD) experience high rates of psychiatric symptoms, but the relation between verbal ability and psychiatric symptoms is unknown. This study utilized a large sample of clinically referred inpatient and outpatient youth with ASD to compare psychiatric comorbidity between verbal and minimally-verbal youth, adjusting for nonverbal IQ, age, and ASD symptom severity. Results indicated that verbal youth were more likely to present with and meet clinical cutoffs for depression and oppositional defiant disorder symptoms, with greater impairment associated with depression. Youth in inpatient settings had greater symptom severity and impairment across almost all psychiatric comorbidities. These results present the most direct estimate to date of the association between verbal ability and psychiatric comorbidity in ASD.
KeywordsAutism spectrum disorder (ASD) Psychiatric comorbidity Verbal ability Autism inpatient collection Minimally verbal Child and Adolescent Symptom Inventory
We gratefully acknowledge the contributions of the coordinating site advisory group: Donald L. St. Germain, MD and Girard Robinson, MD, and our scientific advisory group: Connie Kasari, PhD., Bryan King, MD, James McCracken, MD, Christopher McDougle, MD, Lawrence Scahill, MSN, PhD, Robert Schultz, PhD and Helen Tager-Flusberg, PhD, the input of the funding organizations and the families and children who participated. The Autism Inpatient Collection (AIC) phenotypic database and biorepository is supported by a grant from the Simons Foundation Autism Research Initiative and the Nancy Lurie Marks Family Foundation (SFARI #296318 to M.S.). Dr. Mazefsky also received support from NICHD grant K23HD060601 during the course of this project and is currently supported by NICHD; R01HD079512. The DDCLI data were supported by the Matt and Debra Cody Center for Autism and Developmental Disabilities. Dr. Lerner received support from NIMH grant R01MH110585 and the Simons Foundation Autism Research Initiative (SFARI# 381283), during the course of this project. The ADDIRC is made up of the co-investigators: Matthew Siegel, MD (PI) (Maine Medical Center Research Institute; Tufts University), Craig Erickson, M.D. (Cincinnati Children’s Hospital; University of Cincinnati), Robin L. Gabriels, PsyD (Children’s Hospital Colorado; University of Colorado), Desmond Kaplan, MD (Sheppard Pratt Health System), Carla Mazefsky, PhD (Western Psychiatric Institute and Clinics; University of Pittsburgh), Eric M. Morrow, MD, PhD (Bradley Hospital; Brown University), Giulia Righi, PhD (Bradley Hospital; Brown University), Susan L Santangelo, ScD (Maine Medical Center Research Institute; Tufts University), and Logan Wink, MD (Cincinnati Children’s Hospital; University of Cincinnati). Collaborating investigators and staff: Jill Benevides, BS, Carol Beresford, MD, Carrie Best, MPH, Katie Bowen, LCSW, Briar Dechant, BS, Tom Flis, BCBA, LCPC, Holly Gastgeb, PhD, Angela Geer, BS, Louis Hagopian, PhD, Benjamin Handen, PhD, BCBA-D, Adam Klever, BS, Martin Lubetsky, MD, Kristen MacKenzie, BS, Zenoa Meservy, MD, John McGonigle, PhD, Kelly McGuire, MD, Faith McNeill, BS, Tamara Palka, MD, Ernest Pedapati, MD, Christine Peura, BA, Joseph Pierri, MD, Christie Rogers, MS, CCC-SLP, Brad Rossman, MA, Jennifer Ruberg, LISW, Elise Sannar, MD, Cathleen Small, PhD, Kahsi A. Smith, PhD, Nicole Stuckey, MSN, RN, Brittany Troen, MA, R-DMT, Barbara Tylenda, PhD, Mary Verdi, MA, Jessica Vezzoli, BS, Deanna Williams, BA, and Diane Williams, PhD, CCC-SLP.
All authors contributed to the study concept and design. KDG, CAM, MS, and the ADDIRC contributed to the acquisition of data. MDL, CAM, and RJW contributed to the analysis of data. MDL, CAM, ET, and RJW contributed to the interpretation of data. MDL, CAM, RJW, and ET contributed to drafting of the manuscript. KDG and MS contributed to critical revisions to the manuscript for important intellectual content. KDG, CAM, MS, and the ADDIRC acquired funding for the project. MDL, KDG, CAM, and MS contributed administrative, technical, or material support.
Compliance with Ethical Standards
Conflict of interest
K.D.G. declares Shareholder, Checkmate Plus, publisher of the Child and Adolescent Symptom Inventory. All other authors declare they have no conflicts of interest.
Research Involving Human Participants
All procedures performed involving human participants were in accordance with the ethical standards of the institutional research committees where the data was collected and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in this study.
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