A comparison of severity and inter-relationships of autism symptoms between children and adolescents: A network analysis approach

Background: Autism spectrum disorder (ASD) is a neurodevelopmental condition that affects social interactions, communication and behavior. The severity of ASD symptoms changes from childhood to adolescence. This study compared the severity and symptom network of ASD between children and adolescents. Methods: Six domains of ASD were measured: poor social adaptation, empathy deficits, restricted and repetitive behaviors and interests, age-appropriate social integration, unique cognitive functions, and communication barriers. Univariate analyses were used to compare symptom severity between children and adolescents. Two methods were applied in the network analyses: Expected Influence (EI), which showed how central a symptom is to the overall ASD profile, and the Network Comparison Test (NCT), which examined how the connections between symptoms differ between children and adolescents. The predicted symptom networks were constructed based on partial correlations among symptoms, thus representing the unique association between each pair while controlling for others. Results: Among 1148 participants (678 children, 470 adolescents) diagnosed with ASD, the total autism severity scores measured by the Asperger Syndrome Screening Scale (ASSS) were significantly higher in children than in adolescents (P = 0.01), with children scoring approximately 2 units higher on average. For children, “Communication Barriers” was the most central symptom, exhibiting the strongest connections to other symptoms in the model, followed by “Empathy Deficits” and "Restricted and Repetitive Behaviors and Interests". For adolescents, “Communication Barriers” was also the most central symptom, followed by “Restricted and Repetitive Behaviors and Interests ” and "Empathy Deficits". The overall structure of the symptom networks, including the inter-connections between symptoms, was similar between children and adolescents. Conclusion: The similarity in autism symptom network structures between children and adolescents highlights the universal clinical characteristics of ASD, implicating the need for effective interventions across both age groups targeting communication barriers, empathy deficits, and poor social adaptation.