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Mental Health Comorbidities in Adolescents with ASD: Indirect Effects of Family Functioning through Youth Social Competence

Marie Johnson, Depts. of Psychology and Product Innovation, and Jessica Greenlee and Cathryn Richmond, Dept. of Psychology Graduate Students, with Dr. Marcia Winter, Dept. of Psychology

Recent research has established the high comorbidities of mental health problems in adolescents with Autism Spectrum Disorder (ASD; see Strang, et al., 2012), prompting researchers to examine factors that may contribute to elevated anxiety and depression. Given the centrality during adolescence of both the family and peer contexts (Greenlee, Winter, & Diehl, 2018) as well as the stage salience of peer relationships (Masten et al., 1995), this study focused on family functioning, social competence, and mental health in verbally-fluent adolescents with ASD. Some have suggested that adolescents with ASD who have no cognitive impairment are more interested in social interaction but also more aware of their social differences (Mazurek & Kanne, 2010). Combined with the social demands of adolescence, increased social awareness may put youth at risk for disengaging from peers; poor peer relationships, feelings of isolation, and loneliness have been associated with internalizing problems in youth with ASD (Bauminger & Kasari, 2000; Vickerstaff et al., 2007; Whitehouse et al., 2009). We reasoned that adolescents learn social skills in part from family experiences, even in the context of ASD, and that the family environment plays a role in adolescent’s social competence. Thus, while social-communication deficits are an inherent part of an ASD diagnosis, families still play a role in adolescents’ social competencies and influence their social development. Therefore, we tested part of the larger theoretical model by examining the indirect relationship between family functioning and adolescent anxiety and depression symptomatology via adolescent social competence for adolescents with ASD.

This study uses data from the Teens and Parents (TAP) Study (see Greenlee, 2019). Participants were adolescents aged 13-17 (N = 178; Mage= 14.92, SD = 1.31; 73% male) diagnosed with ASD, and their primary caregivers (PCs) who all identified as biological or adoptive mothers. PCs reported demographics and completed (1) the Self-Report of Family Inventory (SFI; Beavers & Hampston, 2000) to assess global family functioning via the Health and Competence subscale, and (2) the Social Responsiveness Scale (SRS; Constantino & Gruber, 2012) to assess deficits in adolescent social competencies. Adolescents reported their own depression and anxiety symptoms via the Revised Children’s Anxiety and Depression Scale-Short Version (RCADS; Ebesutani et al., 2012).

As shown in Figures 1 and 2, the indirect pathway from family functioning to social competence deficits and in turn to internalizing symptoms was statistically significant for adolescent anxiety (B= -1.015, SE = 0.394, 95% CI = [-1.893, -0.353]) and depression symptoms (B= -0.513, SE = 0.192, 95% CI = [-0.938, -0.189]) over and above the effects of family SES and adolescent age, sex, and restrictive and repetitive behavior. It was proposed that family functioning would play a role in adolescent mental health symptomatology via the mediating effect of social competence. Results support this hypothesis, indicating the importance of family functioning in youth social competence, and the subsequent effects on adolescent mental health. These results contribute to the understanding of mental health comorbidities in adolescents with ASD and could be used to inform future interventions.

Publication Date


Current Academic Year


Faculty Advisor/Mentor

Marcia Winter, Ph.D.


Virginia Commonwealth University. Undergraduate Research Opportunities Program

Is Part Of

VCU Undergraduate Research Posters


© The Author(s)

Mental Health Comorbidities in Adolescents with ASD: Indirect Effects of Family Functioning through Youth Social Competence