Determinants of the evolutions of behaviours, school adjustment and quality of life in autistic children in an adapted school setting: an exploratory study with the International Classification of Functioning, disability and health (ICF)

Abstract

Background Previous studies about Quality of Life (QoL) in autistic children (ASD) have put forward the negative impact of factors such as Autism Spectrum Disorder (ASD) severity, psychiatric comorbidities and adaptive behaviour impairment. However, little is known about the relation of these factors to school adjustment, measured with the International Classification of Functions disability and health (ICF) framework (World Health Organization, 2001), and QoL evolutions. Thus, this study aimed at investigating the determinants of behaviours, school adjustment and QoL changes in 32 children in an ASD inclusion program over one academic year. Methods Using Bayesian methods, we studied the impact of ASD severity, psychiatric comorbidities, adaptive behaviour level and a diagnosis of Pathological Demand Avoidance (PDA) on evolutions of behaviour, school adjustment (measured with the ICF) and QoL. Results As predicted, adequate adaptive behaviour levels were associated with better progress of behaviours and school adjustment whereas psychiatric comorbidities were related to worse outcome of school adjustment. Contrary to our hypotheses, severe ASD was associated to better evolution of adjustment at school. PDA was not discriminant. We did not find any association between the studied factors and the evolution of QoL over the academic year. Conclusion Our results show that the assessment of adaptive behaviour levels, psychiatric comorbidities and ASD severity level may be useful predictors to discriminate of school adjustment evolution (assessed by teachers within the ICF model) over a one-year period in autistic children. The assessment of this time course of school adjustment was sensitive to change and adapted to differentiate evolutions in an inclusive education framework. The investigation of quality of school life of autistic children as well as its determinants may therefore be relevant to improving academic adaptation. However, further research in larger groups, over longer periods and in different personalized school settings for autistic children is needed.

Parent's Stress and Quality of Life for Children Diagnosed with Autism

“…The main risk factors for QoL impairment in autistic children are autism severity, behavior problems, low adaptive behavior level, and psychiatric comorbidities as anxiety disorder. Qol impairment in ASD also involves parental well-being, which may be related to the child's behavior disturbances (Schneider et al, 2022).…”

Facilitating Inclusive School Adjustment for Students with Autism: Challenges and Intervention Strategies

“…However, in the process of receiving integrated education, students with autism may exhibit behaviors and thought patterns that differ from those of neurotypical students. Moreover, schools and parents may overlook social factors, leaving students with autism at high risk of social isolation and rejection by classmates or friends, which can affect their academic performance [2]. Research indicates that children with autism may struggle with school adjustment and social learning difficulties due to their behavioral traits [3].…”