A longitudinal comparison of emotional, behavioral and attention problems in autistic and typically developing children

N. Wright, V. Courchesne, A. Pickles, R. Bedford, E. Duku, C. M. Kerns, T. Bennett, S. Georgiades, J. Hill, A. Richard, H. Sharp, I. M. Smith, T. Vaillancourt, A. Zaidman-Zait, L. Zwaigenbaum, P. Szatmari, M. Elsabbagh

Research output: Contribution to journalArticlepeer-review

3 Citations (SciVal)


Background: Mental health problems are elevated in autistic individuals but there is limited evidence on the developmental course of problems across childhood. We compare the level and growth of anxious-depressed, behavioral and attention problems in an autistic and typically developing (TD) cohort. 

Methods: Latent growth curve models were applied to repeated parent-report Child Behavior Checklist data from age 2-10 years in an inception cohort of autistic children (Pathways, N = 397; 84% boys) and a general population TD cohort (Wirral Child Health and Development Study; WCHADS; N = 884, 49% boys). Percentile plots were generated to quantify the differences between autistic and TD children. 

Results: Autistic children showed elevated levels of mental health problems, but this was substantially reduced by accounting for IQ and sex differences between the autistic and TD samples. There was small differences in growth patterns; anxious-depressed problems were particularly elevated at preschool and attention problems at late childhood. Higher family income predicted lower base-level on all three dimensions, but steeper increase of anxious-depressed problems. Higher IQ predicted lower level of attention problems and faster decline over childhood. Female sex predicted higher level of anxious-depressed and faster decline in behavioral problems. Social-affect autism symptom severity predicted elevated level of attention problems. Autistic girls' problems were particularly elevated relative to their same-sex non-autistic peers. 

Conclusions: Autistic children, and especially girls, show elevated mental health problems compared to TD children and there are some differences in predictors. Assessment of mental health should be integrated into clinical practice for autistic children.

Original languageEnglish
Pages (from-to)7707-7719
Number of pages13
JournalPsychological Medicine
Issue number16
Early online date29 Jun 2023
Publication statusPublished - 29 Dec 2023

Bibliographical note

Funding Information:
The WCHADS was funded by the Medical Research Council (grant number: G0400577, G0900654; MR/L022257/1). The Pathways study was supported by: Canadian Institutes of Health Research, Fonds de Recherche du Québec, Kids Brain Health Network (formerly NeuroDevNet), Autism Speaks (US), Government of British Columbia, Alberta Innovates Health Solutions, and the Sinneave Family Foundation. AP and NW were partially supported by NIHR grant NF-SI-0617-10120 and NIHR Maudsley Biomedical Research Centre. VC is supported by CIHR. RB is supported by a King's Prize Fellowship (204823/Z/16/Z).


  • attention problems
  • Autism
  • behavioral problems
  • emotional problems
  • longitudinal
  • trajectories

ASJC Scopus subject areas

  • Applied Psychology
  • Psychiatry and Mental health


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