Internalizing symptoms and social communication difficulties were most strongly associated with the cognitive-adaptive functioning gap, and SHAP analysis identified internalizing problems, social communication challenges, and OCD symptoms as the strongest predictors.
Abstract
Adaptive functioning typically aligns with cognitive ability in the general population, but this relationship appears more complex in neurodivergent populations. Individuals with autism, attention-deficit/hyperactivity disorder (ADHD), and obsessive-compulsive disorder (OCD) frequently show a discrepancy between cognitive ability and adaptive functioning. However, the behavioral and sociodemographic factors associated with this cognitive-adaptive functioning gap remain unclear. Data were collected from the Province of Ontario Neurodevelopmental Disorders Network (POND) and included 902 participants aged 6-21 years (autism = 409, ADHD = 210, OCD = 36, neurotypical = 214, other = 33). Cognitive functioning was assessed using full-scale IQ from the Wechsler tests, and adaptive functioning using the Adaptive Behavior Assessment System-II (General Adaptive Composite). The cognitive-adaptive functioning gap was calculated as the difference between FSIQ and ABAS-II GAC scores. This gap was modeled transdiagnostically with phenotypic (social communication, ADHD and OCD traits, internalizing and externalizing symptoms) and sociodemographic (age, sex, race, household income, caregiver education) features. Three classifiers (i.e. logistic regression, CatBoost, and Explainable Boosting Machine) were trained to distinguish children with above- versus below-median cognitive-adaptive functioning gap scores. Feature importance was assessed for the selected model using SHAP values. Sensitivity analyses repeated the performance analysis and feature-importance assessment using a 15-point FSIQ-ABAS GAC gap threshold and a continuous-outcome model of the numerical FSIQ-ABAS GAC gap. Logistic regression, CatBoost, and Explainable Boosting Machine models showed comparable performance (ROC-AUC = 0.698-0.700). CatBoost was selected for SHAP-based interpretation because it achieved competitive performance and allowed efficient tree-based SHAP estimation. SHAP analysis identified internalizing problems, social communication challenges, and OCD symptoms as the strongest predictors. Behavioral factors contributed more to the gap than sociodemographic variables. Sensitivity analyses using a 15-point gap threshold and a continuous gap outcome retained the same core behavioral contributors: internalizing problems, social communication challenges, and OCD symptoms. Internalizing symptoms and social communication difficulties were most strongly associated with the cognitive-adaptive functioning gap.
Highlights What are the main findings? Children with ADHD showed the highest overall emotional–behavioral burden, whereas ASD and SLD were characterized by greater internalizing difficulties and DMD by a distinct emotional–behavioral profile. Using the same standardized CBCL/6–18 assessment enabled direct comparison of emotional and behavioral functioning across neurodevelopmental and neuromuscular conditions. What is the implication of the main finding? A transdiagnostic assessment framework may facilitate the identification of both shared and disorder-specific emotional–behavioral patterns across heterogeneous pediatric populations. Integrating standardized behavioral screening with individualized clinical assessment may support more targeted psychosocial care and multidisciplinary decision-making. Abstract Background: Neurodevelopmental disorders, including Autism Spectrum Disorder (ASD), Attention-Deficit/Hyperactivity Disorder (ADHD), and Specific Learning Disorder (SLD), as well as neuromuscular conditions such as Duchenne Muscular Dystrophy (DMD), are frequently associated with emotional and behavioral difficulties that may affect children’s functioning and family well-being. However, direct comparisons across these heterogeneous clinical populations remain limited. This study aimed to compare emotional and behavioral profiles across children and adolescents with ASD, ADHD, SLD, and DMD using the Child Behavior Checklist (CBCL/6–18). Methods: This cross-sectional comparative study included 197 children and adolescents (ASD: 47; SLD: 50; ADHD: 50; DMD: 50) assessed at the Clinical Psychology Unit of the Fondazione Policlinico Universitario Agostino Gemelli IRCCS (Rome, Italy) between 2017 and 2024. Emotional and behavioral functioning was evaluated using the parent-report CBCL/6–18. Group differences were examined using one-way ANOVA or Welch’s ANOVA, as appropriate, followed by Tukey’s HSD or Games–Howell post hoc comparisons. Results: Significant group differences emerged for Internalizing Problems, Externalizing Problems, and Total Problems (all p < 0.001). ADHD showed the highest overall emotional and behavioral burden, with 76% of participants scoring in the clinical range for both Internalizing and Total Problems and 60% for Externalizing Problems. Elevated internalizing difficulties characterized ASD and SLD, whereas children with DMD showed generally lower CBCL scores, although 26% fell within the clinical range for Internalizing Problems. Effect sizes were moderate to large (η2 = 0.168–0.273), supporting the presence of both shared and disorder-specific emotional and behavioral patterns across heterogeneous developmental conditions. Conclusions: The findings highlight the heterogeneity of emotional–behavioral profiles across neurodevelopmental and neuromuscular conditions. The use of a common standardized assessment framework enabled the identification of both shared and disorder-specific patterns, supporting the potential value of a transdiagnostic approach to individualized assessment. Future longitudinal and multi-informant studies are warranted to clarify developmental trajectories and improve the identification of clinically meaningful emotional and behavioral needs across heterogeneous pediatric populations.
D. P. Chieffo, Federica Moriconi, Valentina Delle Donne et al.· Children· 0 citations
Objectives: Youth with Neurofibromatosis Type 1 (NF1) and children with Autism Spectrum Disorder (ASD) exhibit social impairments and challenges in executive functioning and attention. Biopsychosocial models underscore the interplay between cognitive processes and social functioning and could inform intervention development. This study evaluated whether diagnostic group moderated associations between cognitive functioning and social impairments in youth with NF1 and youth with ASD. Participants and Methods: Youth ages 8–12 (M = 10.3) with NF1 (n = 29), ASD (n = 35), and typically developing controls (TDC) (n = 26), matched on age, sex, and race, completed neuropsychological evaluations. Caregivers completed questionnaires assessing executive function and social behavior. Analyses evaluated group differences in cognitive and social functioning, and whether diagnostic group moderated the associations between cognitive processes and social impairments. Results: Significant correlations between parent-reported executive functioning and attention problems and social impairments were observed only for the NF1 and ASD groups. Moderation analysis revealed behavior regulation and attention problems were similarly related to social impairments across all three groups, while metacognition was significantly associated with social impairments only for the NF1 and ASD group. Auditory attention was not significantly associated with social impairments for any group. Conclusions: Findings highlight shared and distinct cognitive-social associations across NF1 and ASD groups. Interventions targeting executive functioning and attention may improve social functioning for children with NF1 and ASD. Future longitudinal work assessing the underlying neurocognitive mechanisms of social impairments in these populations is needed.
Manali Zope, L. Blaskey, Jeffrey I. Berman et al.· Journal of Pediatric Neurops...· 0 citations
Attention-deficit/hyperactivity disorder (ADHD) is a predominantly childhood-onset neurodevelopmental disorder. However, ADHD is not limited to childhood. The disorder has a highly heterogeneous developmental trajectory from childhood into adulthood, ranging from full remission to persistence of ADHD with adverse outcomes. The research in this thesis largely used data from the 18-year follow-up study of the IMAGE/NeuroIMAGE cohort. This follow-up successfully included 421 participants, among which adults (Mage = 28.84) with childhood ADHD (n = 154), their siblings (n = 138), and controls (n = 129). Outcomes collected at follow-up included 51 measures across 7 domains of functioning, including psychiatric status, behavioral and emotional problems, academic and professional functioning, adaptive functioning, neurocognitive functioning, physical health,
and healthcare service use.
Compared to their siblings and controls, adults with childhood ADHD showed worse long-term outcomes on more than 60% of the outcomes across the 7 domains of functioning, while their other outcomes were similar. Most group differences lay in the domains of behavioral and emotional problems, adaptive functioning, and neurocognitive functions. These negative outcomes seemed to be largely independent of a current ADHD diagnosis, as both the group with persistent ADHD and the group with remitted ADHD differed from the controls on the majority of outcomes. Siblings did not show an increased risk of negative outcomes.
Among adults with a history of childhood ADHD, only 26% used ADHD medication in adulthood. Also, they were 3 to 7 times more likely to use neurological medications (analgesics and NSAIDs). Differences in medication use largely disappeared after adjusting for a current ADHD diagnosis or depression. Overall, differences between men and women were comparable to those observed in the general population; there was no evidence of a "double burden" of sex regarding ADHD.
Our meta-analyses showed that a history of stimulant use was associated with an increased risk of ADHD persistence. Additionally, ADHD persistence was associated with an increased risk of depression and addiction. Our own machine-learning-based prediction models did not predict long-term ADHD outcomes any better than conventional logistic regression. Despite suboptimal performance, several potentially relevant predictors were identified: anxiety symptoms, autistic traits, and childhood motor coordination problems.
The key takeaway is that the developmental trajectory into adulthood is heterogeneous and difficult to predict. While one group will achieve average adult functioning, adults with a childhood ADHD diagnosis have an elevated risk of difficulties, particularly psychiatric disorders and behavioral or emotional problems. In our sample, childhood stimulant use was not associated with long-term functional outcomes (assessed more than 10 years later).
Children with autism spectrum disorder (ASD) frequently experience elevated emotional and behavioral difficulties, yet factors associated with variability remain incompletely understood. Adaptive functioning and sensory processing differences have been linked to behavioral problems, but little is known about whether associations differ between boys and girls. This study examined relationships between adaptive functioning, sensory processing, and behavioral problems in children with ASD, focusing on gender as a moderator. The purposive sampling included 110 autistic children (Mage = 85.61 months, SD = 31.51; 50 boys and 60 girls) and their primary caregivers. Adaptive functioning was assessed using the Vineland Adaptive Behavior Scales-Third Edition, sensory processing using the Short Sensory Profile, and behavioral problems using the Child Behavior Checklist. Gender differences were examined with Mann-Whitney tests, associations with Spearman's correlations, and moderation analyses using PROCESS with bootstrap resampling. Girls demonstrated higher internalizing and externalizing behavioral problems than boys, whereas boys showed greater sensory processing differences. Correlational analyses revealed distinct patterns: adaptive functioning showed stronger associations with behavioral difficulties among girls, whereas sensory processing differences were associated with behavioral problems among boys. Moderation analyses indicated that gender moderated the relationship between adaptive functioning and behavioral problems, such that higher adaptive functioning was associated with fewer behavioral difficulties among girls but not boys. These findings highlight gender-specific patterns in associations between functional abilities and behavior profiles in autism, underscoring the importance of considering gender in developmental pathways and intervention approaches.
C. Shulman, Daniel S. Bitton, Zili Nir· Autism Research· 0 citations
A high frequency of positive screening results for symptoms suggestive of ADHD and ASD, significant overlap between these conditions, and a low proportion of self-reported formal diagnoses are revealed.
Fernanda Santos Marcuz Cavalaro, Josieli de França Oliveira Lima, Gabriela Costa Alves· Revista de Estudos Interdisc...· 0 citations
Objective Studies have revealed the prognostic significance of intelligence in children with autism spectrum disorder (ASD), but the correlations of non-social cognitive functions and clinical characteristics of high-functioning children and adolescents with ASD remain unclear. To identify individual needs, this study aimed to investigate their correlations in high-functioning children and adolescents with ASD and conduct an exploratory comparison between subgroups. Methods We recruited children and adolescents who met the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria for ASD, excluding those with intellectual disability. The Wechsler Intelligence Scale for Children, Fourth Edition and Conners’ Continuous Performance Test, Second-Edition were administered to assess intelligence and attention. Their parents completed questionnaires, including the Child Behaviour Checklist, the Social Responsiveness Scale, and the Aberrant Behaviour Checklist, to report their clinical characteristics. Group differences were analyzed using t-tests and chi-square tests. Partial correlation was used to measure correlations between variables of cognitive tests and questionnaires, while adjusting for age, sex, and, where appropriate, the presence of attention-deficit/hyperactivity disorder. Results A total of 98 high-functioning participants with ASD were recruited (mean age, 11.44±3.13 years; 75.5% male). Significant correlations were found between their non-social cognitive functions and clinical characteristics. Specifically, Full Scale Intelligence Quotient (FSIQ), working memory, processing speed, attention, and impulse control were negatively associated with the severity of autistic, emotional, and behavioral symptoms. In addition, the Asperger’s disorder group demonstrated significantly better FSIQ, perceptual reasoning, working memory, processing speed, attention, and impulse control than the high-functioning autism group. Conclusion Significant correlations between non-social cognitive functions and autistic, emotional, and behavioral symptoms underscore the increased needs of high-functioning individuals with relatively poorer non-social cognitive abilities. Individualized support and management strategies can be developed and provided accordingly.
W. Chin, Yi Fang, Chen Lin et al.· Psychiatry Investigation· 0 citations
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