An Exploratory Study of Resilience to Stressful Life Events in Autistic Children.

Background: Autistic children experience more stressful life events (SLEs) than their neurotypical peers, which are related to poor mental health outcomes in both neurotypical and autistic individuals. However, there is a lack of longitudinal research assessing the perceived impact of stressful life events on autistic children's mental health. Method: Utilizing a novel statistical technique (Ratcliff et al., 2019), called 'area of resilience to stress events' or ARSE in R, we aimed to quantify aspects of resilience, growth, and non-resilience for 67 autistic children (6-13 years old) enrolled in a larger longitudinal study who experienced a SLE. Parents reported demographic information (e.g., child age, biological sex, household income) as well as the child's internalizing and externalizing symptoms and autism characteristics across multiple time points spaced one year apart (baseline, T2, T3, T4). Results: There was substantial variability in the resilience process within the sample. Older children exhibited a less adaptive resilience process (i.e., higher total scaled scores or arsets). Perceived stress of the disruptive event was not correlated with resilience; however, there was a significant child age x stress severity interaction, suggesting that younger children in households that perceived the disruptive event as highly stressful exhibited more efficient resilience, or lower arsets scores, compared to other children. Conclusions: This study introduces an innovative methodological approach to understanding the effects of stressful life events on the mental health of autistic children. Results have implications for family-based policy and practice and highlight for whom services may be most beneficial.

Comparative analysis of electrodermal activity metrics and their association with child behavior in autism spectrum disorder.

Researchers are increasingly utilizing physiological data like electrodermal activity (EDA) to understand how stress "gets under the skin." Results of EDA studies in autistic children are mixed, with some suggesting autistic hyperarousal, others finding hypoarousal, and yet others detecting no difference compared to non-autistics. Some of this variability likely stems from the different techniques used to assess EDA. Therefore, the purpose of this study is to investigate and compare commonly used metrics of EDA (frequency of peaks, average amplitude of peaks, and standard deviation of skin conductance level) using two data processing programs (NeuroKit2 and Ledalab) and their link to observed child behavior. EDA data were collected using Empatica E4 wristbands from 60 autistic children and adolescents (5-18 years old) during a 7-min play interaction with their primary caregiver. The play interaction was coded for a range of child behaviors including mood, social responsiveness, dysregulation, and cooperation. Results indicate a strong correlation between NeuroKit2 and Ledalab and a weak correlation between metrics within each program. Furthermore, the frequency of peaks was associated with more positive child social behaviors, and the magnitude of peaks was associated with less adaptive child behaviors. Recommendations for replication and the need for generalizability of this research are given.

Using the Three-Minute Speech Sample to Examine the Parent-Adolescent Relationship in Autistic Youth: A Qualitative Analysis.

PURPOSE: This qualitative study examines autistic adolescents' perception of the quality of their relationship with their parent using the Three Minute Speech Sample. METHODS: Twenty autistic youth (13-17 years; 83% male) spoke, uninterrupted, for three minutes about their thoughts and feelings regarding their mothers. Audio-recorded speech samples were transcribed and coded for emergent themes. RESULTS: Adolescents highlighted emotional support and acceptance in the context of their relationship, support mothers provide for mental health, love and caring, efforts to build the relationship through shared activities, and areas of adolescent-parent conflict. CONCLUSION: The TMSS is a low cost, low burden method by which autistic adolescents can comfortably and effectively self-report the quality of their relationship with their parent/caregiver.

Profiles of the parenting experience in families of autistic children.

LAY ABSTRACT: Research shows that parents of autistic children, on average, are stressed; however, there is likely an array of factors that characterize the parenting experience in the context of autism other than stress. Understanding the diversity in the parenting experiences of both mothers and fathers of autistic children is important in the development of family-based intervention. A total of 188 co-habiting couples with an autistic child described their parenting experiences using a series of questionnaires examining their feelings of stress, parenting competence, and parenting attitudes and behaviors. We then sorted responses into profiles-three for mothers and four for fathers. We found that children of parents who reported the least amount of stress, highest feeling of competence, and use of responsive and directive parenting strategies (the Adaptive profile) had children with the least severe behavioral problems and autism symptoms. It was not necessary for both parents to be in the Adaptive category for child emotional and behavioral problems to less severe. We found that children did just as well when one parent was Adaptive compared with when both parents fell into this category.

Parental Depression Symptoms and Internalizing Mental Health Problems in Autistic Children.

Autistic youth are at risk for internalizing mental health problems such as depression and anxiety. Similarly, parents of autistic youth report higher levels of depression than parents of typically developing children. The goal of this study was to examine bidirectional associations between parent depression symptoms and the internalizing problems of autistic youth in 188 families across four time points (T1-T4; spaced 12 months apart). A cross-lagged panel model revealed that mother (T1 and T2) and father (T1) depression symptoms positively predicted the youth's internalizing problems 12 months later. The youth's internalizing problems at T3 positively predicted maternal depression symptoms at T4. Future research should explore genetic and environmental pathways that link parent depression and internalizing problems in autistic youth.

Parent couple conflict and emotional and behavioral problems in youth with autism: Longitudinal investigation of bidirectional effects.

Families of youth with autism spectrum disorder (ASD) are vulnerable to maladaptive psychosocial experiences, including elevated youth emotional and behavioral problems (EBPs) and poor parent couple relationship outcomes. Yet, the extent to which these family psychosocial experiences are intertwined has been given little research attention. The present study longitudinally investigated the bidirectional associations between parent couple conflict (PCC) and youth EBPs in 188 families of children and adolescents with ASD (initially aged 5 to 12 years) across four time points (T1, T2, T3, T4), each spaced 12 months apart. Mother- and father-report of youth EBPs and PCC were entered into a cross-lagged panel model. After adjusting for youth age and intellectual disability status and parent education and couple relationship length, the results indicated that father-report of PCC predicted increased youth EBPs 12 months later (T1→T2 and T2→T3). In addition, father-report of youth EBPs predicted increased PCC 12 months later (T3→T4). Mother-report did not demonstrate cross-lagged effects. The findings suggest that fathers' perceptions of PCC and youth emotional and behavioral functioning are transactionally related, highlighting the need for family-wide interventions.

Caregiver Expressed Emotion and Pediatric Asthma: A Call for Culturally Specific Adaptations.

Background: Expressed emotion is the affective attitudes and behaviors of an individual toward another. In this preliminary study, we described expressed emotion among caregivers of children with asthma living in low-income urban area and evaluated its association with child asthma control. Methods: Forty-one children (90.2% African American/Black) and their caregivers participated. Measures included the Childhood Asthma Control Test and the Five-Minute Speech Sample coded for overall expressed emotion, emotional over-involvement, and criticism. Results: Most caregivers were rated borderline (31.7%) or high (48.8%) for expressed emotion, borderline (31.7%) or high (39.0%) for emotional overinvolvement, and low for criticism (73.2%). The association between criticism and asthma control neared statistical significance [U(Nlow = 30, NB/high = 11) = 100, z = -1.922, P = 0.055]. Conclusion: Findings suggest an examination into expressed emotion coding procedures for caregivers in low-income urban areas, and culturally specific adaptations may be necessary. Future research should confirm findings in a larger sample and consider how parental criticism affects children's asthma management.

Parent-couple satisfaction, parent depression, and child mental health in families with autistic children.

Introduction: Within two-parent households, the parent-couple subsystem (marital or romantic partner relationship) is posited to shape the mental health of both parents and children. Autistic children and their parents have an elevated-risk for mental health problems. The present study longitudinally examined the mediating role of the quality of the parent-couple relationship in time-ordered pathways between changes in the mental health problems of autistic children and in parent depression symptoms at a within-family level. Methodology: Using four time points of data collected on 188 families of autistic children (aged 5-12 years) across 3 years, the bidirectional associations between parent-couple relationship satisfaction, parent depressive symptoms, and child internalizing and externalizing mental health problems were investigated. Two multi-group (grouped by parent gender) complete longitudinal mediation models in structural equation modeling using Mplus software were conducted. Results: Parent-couple relationship satisfaction mediated: (1) the association between higher parent depressive symptoms and higher child internalizing mental health problems 12 months later for both mothers and fathers, and (2) the association between higher child externalizing mental health problems and higher father depression symptoms 12 months later. Father depression symptoms mediated a pathway from lower parent-couple satisfaction to higher child internalizing mental health problems 12 months later, and mother depression symptoms mediated the pathway from higher child externalizing mental health problems to lower parent-couple satisfaction 12 months later. Conclusion: Findings highlight the bidirectional and complex ways that parent and child mental health and the quality of the parent-couple relationship are entwined across time in families of autistic children. Family-wide interventions that address the needs of multiple family members and family systems are best suited to improve the mental health of parents and autistic children.

Marital satisfaction, parenting styles, and child outcomes in families of autistic children.

Theory and research on the general population suggest that parents' marital relationship quality is associated with children's emotional and behavioral functioning directly, as well as indirectly, by affecting parenting attitudes and behaviors. However, little has been done to investigate the potential connection among parent marital satisfaction, parenting styles, and outcomes for autistic children. Using longitudinal data collected from 188 couples parenting an autistic child, this study tested the time-ordered indirect effect of parent marital satisfaction (assessed at Time 1) on the internalizing and externalizing symptoms (assessed at Time 3) of autistic children (originally aged 5-12 years) via parenting styles (assessed at Time 2) using actor-partner interdependence modeling extended to mediation. Results indicated that a lower level of marital satisfaction at Time 1 predicted impaired child outcomes at Time 3 via its impact on parenting style at Time 2. For both parents, lower marital satisfaction predicted more child externalizing symptoms via reports of more authoritarian parenting style. Lower marital satisfaction in mothers at Time 1 was also associated with higher levels of child internalizing symptoms at Time 3 via increased authoritarian parenting in mothers. No partner effects were found. A family-wide approach that includes support for the parent marital relationship, which may have downstream effects on parenting, is important for promoting optimal emotional and behavioral health in autistic children.

La teoría y las investigaciones sobre la población en general indican que la calidad de la relación conyugal de los padres está asociada con el funcionamiento conductual y emocional de los niños tanto directamente como indirectamente, ya que afecta las actitudes y las conductas de crianza. Sin embargo, se ha hecho poco para investigar la posible conexión entre la satisfacción conyugal de los padres, los estilos de crianza y las consecuencias en los niños autistas. Utilizando datos longitudinales recogidos de 188 parejas que criaban a un niño autista, este estudio evaluó el efecto indirecto según el orden del tiempo de la satisfacción conyugal de los padres (evaluada en el primer intervalo) en las síntomas de exteriorización y de interiorización (evaluados en el tercer intervalo) de los niños autistas (inicialmente de entre 5 y 12 años) mediante los estilos de crianza (evaluados en el segundo intervalo) utilizando un modelo de interdependencia actor-pareja extendido a la mediación. Los resultados indicaron que un nivel más bajo de satisfacción conyugal en el primer intervalo predijo consecuencias disfuncionales en los niños en el tercer intervalo mediante su efecto en el estilo de crianza en el segundo intervalo. Para ambos padres, una menor satisfacción conyugal predijo más síntomas de exteriorización de los niños mediante informes de un estilo de crianza más autoritario. Una menor satisfacción conyugal en las madres en el primer intervalo también estuvo asociada con niveles más altos de síntomas de interiorización en los niños en el tercer intervalo mediante una mayor crianza autoritaria en las madres. No se encontraron efectos de la pareja. Con el fin de promover una salud conductual y emocional óptima en los niños autistas, es importante implementar un método para toda la familia que incluya apoyo para la relación conyugal de los padres, la cual puede tener efectos posteriores en la crianza.

Trajectories of Dysregulation in Children with Autism Spectrum Disorder.

Objective: This study determined whether child and family environment factors are associated with differences in developmental trajectories of emotional and behavioral dysregulation in children with autism spectrum disorder (ASD).Method: Participants included 186 families of a child with ASD (5-12 years old at baseline; 86% male; 83% non-Hispanic Caucasian; 35% comorbid intellectual disability). At each of the four time points (each spaced 12 months apart), mothers and fathers within each family completed well-validated measures on their own mental health, their child's dysregulation, their parent-child relationship, and their parent couple relationship. Longitudinal multi-level modeling was used to describe trajectories of dysregulation across 3 years and test whether parent depression, closeness in the parent-child relationship, and positive parent dyadic coping were associated with differences in child trajectories.Results: On average, child dysregulation decreased across time. Closer mother-child and father-child relationship quality was associated with lower baseline dysregulation. More severe child restricted and repetitive behaviors, fewer maternal depression symptoms, and more positive parent dyadic coping were associated with declines in child dysregulation over time.Conclusions: On average, children with ASD become less dysregulated across time. However, there is important variability in dysregulation trajectories of children with ASD. Children with ASD who have a high (versus low) severity of restricted and repetitive behaviors appear to be at risk for greater dysregulation. The family environment, and specifically a closer parent-child relationship, better maternal mental health, and more positive couple coping, may contribute to a pattern of improved child regulation across time in ASD.

Children's appraisals of threat in pediatric cancer☆.

PURPOSE: Although many children with cancer cope well with challenges, some experience distress that results in poor adjustment. Children's perceptions of threat may be one explanation for heterogeneity in outcomes, but relatively little is known about what children find threatening. This study aimed to describe the threats that children report. METHOD: Youth (4-18 years old) newly diagnosed with cancer and their primary/parent caregivers (PC) participated in a multi-method study. Appraisals of threat were assessed via self-report and a narrative technique at two weeks post-diagnosis. PCs reported children's anxiety and depressive symptoms three months post-diagnosis and children reported their quality of life (QOL) six months post-diagnosis. RESULTS: Youth reported various types of threatening events (e.g., receiving the cancer diagnosis, fear or pain of procedures) across multiple domains (e.g., threat to self, physical threat, threat of loss). Adolescents tended to report threat to life (e.g., the seriousness of the diagnosis itself) whereas younger children reported other threats (e.g., procedural pain). Children with high perceived threat to self had higher subsequent anxiety symptoms and lower QOL compared to those with low appraisals of threat to self. There was also a significant mean difference between high and low appraisals of threat of loss in child reported QOL. CONCLUSIONS: Youths' reported threats, as well as how threat appraisals related to adjustment outcomes in distinct ways, underscores the developmental nature of how youth interpret medically stressful events and the utility of developmentally sensitive assessment. Understanding perceived threat could ultimately inform efforts to foster positive long-term adaptation for youth with cancer.

Use and Benefit of Dyadic Coping for Couple Relationship Satisfaction in Parents of Children with Autism.

Parents of children with autism spectrum disorder (ASD) are at increased risk for unsatisfying and conflict-ridden couple relationships (i.e., marital or romantic partner relationships). There is a critical need to identify the couple-level processes that contribute to this risk. The current study examined the use of dyadic coping, defined as the appraisals and behaviors that partners in relationships use and receive to manage stressors, and to examine whether dyadic coping mediated the association between parenting stress and couple relationship satisfaction in parents who have a child with ASD and in parents who do not have a child with ASD. In total, 184 couples that had a child with ASD (aged 5-12 years) and comparison group of 183 couples who have a child without a neurodevelopmental condition participated in the study. A multivariate analysis of covariance indicated that parents of children with ASD reported less positive and more negative dyadic coping than did parents in the comparison group. Hierarchical linear modeling indicated that dyadic coping mediated the association between parenting stress and couple relationship satisfaction. Findings have important implications for programs aimed at enhancing parent couple relationship in families of children with ASD.

Los padres de niños con trastorno del espectro autista (TEA) corren mayor riesgo de tener relaciones de pareja insatisfactorias y conflictivas (p. ej.: relaciones de pareja o conyugales). Existe una necesidad imperiosa de reconocer los procesos a nivel de la pareja que contribuyen a este riesgo. El presente estudio analizó el uso del afrontamiento diádico, definido como las evaluaciones y las conductas que los integrantes de la pareja usan y reciben para manejar los factores desencadenantes de estrés, y si este afrontamiento sirvió como mediador de la asociación entre el estrés por la crianza y la satisfacción con la relación de pareja en los padres que tienen un niño con TEA y en los padres que no tienen un niño con TEA. Participaron en el estudio un total de 184 parejas que tenían un hijo con TEA (de entre 5 y 12 años) y un grupo comparativo de 183 parejas que tenían un hijo sin un trastorno del desarrollo neurológico. Un análisis multifactorial de la covarianza indicó que los padres de los niños con TEA informaron un afrontamiento diádico menos positivo y más negativo que los padres en el grupo de comparación. Los modelos lineales jerárquicos indicaron que el afrontamiento diádico sirvió como mediador de la asociación entre el estrés por la crianza y la satisfacción con la relación de pareja. Los resultados tienen consecuencias importantes para los programas orientados a mejorar la relación de los padres como pareja en las familias de niños con TEA.

Depression symptoms in adolescents with autism spectrum disorder: A contextual approach to mental health comorbidities.

INTRODUCTION: Although research on mental health comorbidities in autism spectrum disorder (ASD) has increased in recent years, little has been done to evaluate potential individual × environment interactions associated with these comorbidities. The current study explored whether ASD-related characteristics (social-communication impairment) and environmental factors (peer and family contexts) had additive or interactive effects on the depression symptoms of youth with ASD. METHOD: In a cross-sectional sample of adolescents with ASD (N = 176; 13-17 years old; 72.7% male), primary caregivers and adolescents responded to a series of surveys online pertaining to adolescents' mental health (Revised Child Anxiety and Depression Scale), family functioning (Self-Report of Family Inventory), and experiences of peer victimization (Peer Experiences Questionnaire-Revised). RESULTS: There were statistically significant interactions between social-communication skills and the environment in both family (△R2 = 0.02) and peer (△R2 = 0.02) contexts. For youth with better social-communication skills, there was a positive association between peer victimization and depression symptoms and a negative association between family competence and depression symptoms. CONCLUSION: Findings support social-push interactive models in which better social-communication skills are associated with fewer depression symptoms in the context of less-stressful peer and family environments, highlight the utility of ecologically informed approaches to the mental health of youth with ASD, and suggest several areas for future study.

Brief Report: Gender Differences in Experiences of Peer Victimization Among Adolescents with Autism Spectrum Disorder.

Peer victimization (PV) is a common problem for many adolescents with autism spectrum disorder (ASD) and can negatively impact the mental health and well-being of these youth. Results of the current study of 105 adolescents with ASD (n = 50 girls, 55 boys) indicated that girls and boys experience similar types of PV at similar frequencies. However, relational victimization accounted for a significant portion of variance in anxiety symptoms, above and beyond social communication deficits and restricted and repetitive behaviors, in girls but not in boys. Findings provide preliminary evidence suggesting that the impact of PV on mental health symptoms may be different for girls and boys with ASD, highlighting the need for more research focused on understanding potentially unique social processes for adolescent girls with ASD.

The impact of cumulative stress on asthma outcomes among urban adolescents.

INTRODUCTION: Many families living in low-income, urban areas experience a number of stressors (e.g., poverty, neighborhood stress, family functioning) that place adolescents at risk for worse asthma outcomes. Adolescents may face additional challenges (e.g., peer pressure, school stress) that add to their overall stress and influence their disease care and health outcomes. The current study examined the impact of a cumulative risk model of stressors including poverty, neighborhood stress, school stress, peer pressure, and caregiver-adolescent conflict on asthma outcomes (e.g., emergency department [ED] visits, asthma control, quality of life [QOL]) among urban adolescents (13-17 years). METHODS: Data were collected from 61 urban families of adolescents with asthma (54.1% female; 93.4% African American) in the United States. Caregivers and adolescents completed questionnaires assessing stressors and asthma outcomes separately during a research session. RESULTS: Cumulative risk was significantly associated with worse adolescent QOL and asthma control, and more ED visits. The cumulative risk index was also a more robust predictor of QOL and asthma control than any one individual predictor. Poverty, neighborhood stress, and school stress emerged as individual predictors of ED visits. Further, adolescents with well-controlled asthma had significantly lower neighborhood and school-related stress scores. CONCLUSIONS: Findings suggest that beyond the risk conferred by individual risk factors, an accumulation of stress can have an especially negative impact on asthma outcomes for urban adolescents. Future intervention work aimed at improving asthma outcomes should consider incorporating strategies for minimizing overlapping sources of stress in adolescents' daily lives.

Parents' child-related schemas: Associations with children's asthma and mental health.

The parent-child relationship, a key dyad of the family, can influence disease-related and psychological processes in children with asthma. Although the critical role of parenting behaviors in asthma outcomes is well established, less is known about the attitudes and beliefs underlying parents' interactions with their children and how those attitudes may relate to asthma outcomes. Thus, this study aimed to identify profiles of parents' schemas pertaining to their children with asthma and examine whether child mental and physical health outcomes differed by profile membership. Caregivers of children (n = 177; 5-12 years old) with asthma completed the Five Minute Speech Sample (Magaña et al., 1986), which was later coded for positive and negative attitudes and attributions about their children. Using a pattern-based approach, cluster analyses revealed three profiles of schemas: high negativity-low positivity, low negativity-low positivity, and low negativity-high positivity. Profiles differed in levels of externalizing and internalizing child symptoms, and lung function. Results support the growing body of research placing emphasis on the role of parenting in pediatric asthma outcomes. Caregiver schemas may constitute a point of intervention in families of children with asthma. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Discrepancies between parent and self-reports of adolescent psychosocial symptoms: Associations with family conflict and asthma outcomes.

Discrepancies often exist between self-reported and parent-reported symptoms when assessing youth psychosocial functioning. Parent-child discrepancies in ratings may be important for understanding psychopathology and patterns of family functioning, particularly during adolescence and for youth with chronic illness. This study examined patterns of multirater reporting discrepancies in a pediatric asthma population. Adolescents (n = 707; 11-17 years old) and their primary caregivers completed ratings of adolescents' psychological symptoms. Latent profile analysis identified five profiles of parent-adolescent discrepancies, including one group with highly discordant ratings, two groups in agreement, and two groups with slightly discordant ratings. Adolescents who agreed with their parents on the presence of elevated symptoms and those who had significant discrepancies in ratings, such that parents reported elevated symptoms compared to youth self-report, had poor pulmonary functioning and elevated reports of parent-rated family conflict. Results suggest the need to assess internalizing and externalizing symptoms in adolescents with asthma using a multirater approach while also highlighting the complexity in interpreting patterns of discrepancies. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Primary and Secondary Caregiver Reports of Quality of Life in Pediatric Asthma: Are They Comparable?

PURPOSE: This study aimed to compare primary and secondary caregiver QOL within families of children with asthma and determine the potential importance of including secondary caregiver QOL in clinical and research settings. METHODS: Participants included 118 families of children with asthma that had primary and secondary caregivers. Families completed measures in a single research session. Caregivers reported on QOL, psychological functioning, and family burden; children completed a measure of QOL. Child lung function was determined from objective spirometry. Adherence to prescribed controller medication was measured for 6 weeks following the research visit. RESULTS: Primary caregiver QOL was significantly lower than secondary caregiver QOL (Mean overall QOL of 5.85 versus 6.17, p < .05). Better medication adherence was associated with higher primary caregiver QOL (ρ = .22, p = .02); secondary caregiver QOL, not primary caregiver QOL, was positively associated with child QOL (ρ = .20, p = .03). Families with discrepant QOL scores between caregivers (difference in scores of at least .50) were characterized by more family burden and primary caregiver psychological symptoms. CONCLUSIONS: Differences in QOL scores between caregivers may be a reflection of primary caregivers' greater investment in daily asthma management. In families reporting low burden and few psychological difficulties in the primary caregiver, QOL assessments from either caregiver may may be informative and representative of how parents are adapting to child asthma. In families experiencing high levels of burden or more primary caregiver psychological difficulties, QOL reports from secondary caregivers may not be as clinically meaningful.

Medical and Behavioral Correlates of Depression History in Children and Adolescents With Autism Spectrum Disorder.

BACKGROUND AND OBJECTIVES: Depression is commonly associated with autism spectrum disorder (ASD) across the life span. We sought to identify medical and behavioral problems associated with a history of a parent-reported diagnosis of depression in a large sample of school-aged children and adolescents with ASD. METHODS: A sample of 1272 participants (aged 6-17 years; mean [SD]: 9.56 [2.79] years) from the Autism Speaks Autism Treatment Network consortium were divided into "ever-depressed" (n = 89) and "nondepressed" (n = 1183) groups on the basis of caregiver endorsement of children's current or previous diagnoses of depression. RESULTS: In total, 7.0% of children with ASD (4.8% of those aged 6-12 years and 20.2% of those aged 13-17 years) were reported to have a history of a depression diagnosis. Positive depression history was associated with greater chronological age, higher IQ, and Asperger disorder diagnosis. After controlling for age, IQ, and within-spectrum categorical diagnosis, the ever-depressed group exhibited significantly greater rates of seizure disorders (odds ratio = 2.64) and gastrointestinal problems (odds ratio = 2.59) and trend-level differences in aggression, somatic complaints, and social impairments. The groups did not differ in autism severity, repetitive behaviors, sleep problems, eating problems, self-injurious behavior, or current intervention use. CONCLUSIONS: Co-occurring depression is a particularly common problem in higher-functioning older children within the Autism Treatment Network. Our findings indicate that children with ASD and a history of a depression diagnosis are more likely to also have co-occurring medical problems, although the presence and direction of causality is unclear.