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Determinants of an autism spectrum disorder diagnosis in childhood and adolescence: Evidence from the UK Millennium Cohort Study / Mariko HOSOZAWA in Autism, 24-6 (August 2020)
[article]
Titre : Determinants of an autism spectrum disorder diagnosis in childhood and adolescence: Evidence from the UK Millennium Cohort Study Type de document : Texte imprimé et/ou numérique Auteurs : Mariko HOSOZAWA, Auteur ; Amanda SACKER, Auteur ; William MANDY, Auteur ; Emily MIDOUHAS, Auteur ; Eirini FLOURI, Auteur ; Noriko CABLE, Auteur Article en page(s) : p.1557-1565 Langues : Anglais (eng) Mots-clés : Millennium Cohort Study adolescents autism spectrum disorder diagnosis Index. décimale : PER Périodiques Résumé : This study aimed to identify determinants of a late autism spectrum disorder diagnosis, including diagnoses made 'very late' (i.e., in adolescence), using the Millennium Cohort Study, a nationally representative population-based cohort in the United Kingdom. Children diagnosed with autism spectrum disorder by age 14 (N?=?581) were included and grouped by the parent-reported timing of diagnosis: before school (up to age 5), during primary school (age 5-11) and during secondary school (age 11-14). Predictors of diagnostic timing, at the child, family and school levels, were investigated using multinomial logistic regression. Most (79%) children with autism spectrum disorder were diagnosed after school entry, and 28% were not diagnosed until secondary school. Among those not diagnosed until secondary school, 75% had been identified at age 5?years by a parent and/or teacher as having socio-behavioural difficulties. Being diagnosed after starting school was predicted by living in poverty (adjusted relative risk ratio: primary?=?1.90, 95% confidence interval: 1.03-3.53; secondary?=?2.15, 1.05-4.42) and/or having no initial parental concerns (primary?=?0.32, 0.15-0.70; secondary?=?0.19, 0.09-0.43). Having typical-range intelligence also predicted diagnosis during secondary school. The result indicates that those without cognitive delays and poorer children were at risk of 'very late' (i.e. adolescent) diagnosis. Strategies to promote earlier identification, targeting age at primary school entry, could help those more likely to be diagnosed late.Lay abstractDespite policy emphasis on early identification, many children with autism spectrum disorder are diagnosed late, with some being diagnosed as late as in adolescence. However, evidence on what determines the timing of autism spectrum disorder diagnosis including children diagnosed in adolescence is lacking. Understanding these determinants, particularly in those diagnosed later than is ideal, can inform the development of effective strategies to improve earlier identification of autism spectrum disorder. This study used a nationally representative population-based cohort in the United Kingdom to explore child, family and school level predictors of timing of autism spectrum disorder diagnosis. In the United Kingdom, 79% of the children with autism spectrum disorder were diagnosed after entering primary school and 28% during secondary school. Among those not diagnosed until secondary school, 75% had shown social difficulties noticed by parents and/or teachers at age 5?years. The results suggest that healthcare providers should be aware that, even for universal systems of care, those living in poverty and having higher intelligence are most likely to miss out on a timely diagnosis. Strategies to promote earlier identification among school-aged children, including targeting primary school entry age (i.e. around age 5) and that encouraging referrals for a formal assessment at the first report of concerns over the child's social development may benefit those children who would otherwise be diagnosed later. En ligne : http://dx.doi.org/10.1177/1362361320913671 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=428
in Autism > 24-6 (August 2020) . - p.1557-1565[article] Determinants of an autism spectrum disorder diagnosis in childhood and adolescence: Evidence from the UK Millennium Cohort Study [Texte imprimé et/ou numérique] / Mariko HOSOZAWA, Auteur ; Amanda SACKER, Auteur ; William MANDY, Auteur ; Emily MIDOUHAS, Auteur ; Eirini FLOURI, Auteur ; Noriko CABLE, Auteur . - p.1557-1565.
Langues : Anglais (eng)
in Autism > 24-6 (August 2020) . - p.1557-1565
Mots-clés : Millennium Cohort Study adolescents autism spectrum disorder diagnosis Index. décimale : PER Périodiques Résumé : This study aimed to identify determinants of a late autism spectrum disorder diagnosis, including diagnoses made 'very late' (i.e., in adolescence), using the Millennium Cohort Study, a nationally representative population-based cohort in the United Kingdom. Children diagnosed with autism spectrum disorder by age 14 (N?=?581) were included and grouped by the parent-reported timing of diagnosis: before school (up to age 5), during primary school (age 5-11) and during secondary school (age 11-14). Predictors of diagnostic timing, at the child, family and school levels, were investigated using multinomial logistic regression. Most (79%) children with autism spectrum disorder were diagnosed after school entry, and 28% were not diagnosed until secondary school. Among those not diagnosed until secondary school, 75% had been identified at age 5?years by a parent and/or teacher as having socio-behavioural difficulties. Being diagnosed after starting school was predicted by living in poverty (adjusted relative risk ratio: primary?=?1.90, 95% confidence interval: 1.03-3.53; secondary?=?2.15, 1.05-4.42) and/or having no initial parental concerns (primary?=?0.32, 0.15-0.70; secondary?=?0.19, 0.09-0.43). Having typical-range intelligence also predicted diagnosis during secondary school. The result indicates that those without cognitive delays and poorer children were at risk of 'very late' (i.e. adolescent) diagnosis. Strategies to promote earlier identification, targeting age at primary school entry, could help those more likely to be diagnosed late.Lay abstractDespite policy emphasis on early identification, many children with autism spectrum disorder are diagnosed late, with some being diagnosed as late as in adolescence. However, evidence on what determines the timing of autism spectrum disorder diagnosis including children diagnosed in adolescence is lacking. Understanding these determinants, particularly in those diagnosed later than is ideal, can inform the development of effective strategies to improve earlier identification of autism spectrum disorder. This study used a nationally representative population-based cohort in the United Kingdom to explore child, family and school level predictors of timing of autism spectrum disorder diagnosis. In the United Kingdom, 79% of the children with autism spectrum disorder were diagnosed after entering primary school and 28% during secondary school. Among those not diagnosed until secondary school, 75% had shown social difficulties noticed by parents and/or teachers at age 5?years. The results suggest that healthcare providers should be aware that, even for universal systems of care, those living in poverty and having higher intelligence are most likely to miss out on a timely diagnosis. Strategies to promote earlier identification among school-aged children, including targeting primary school entry age (i.e. around age 5) and that encouraging referrals for a formal assessment at the first report of concerns over the child's social development may benefit those children who would otherwise be diagnosed later. En ligne : http://dx.doi.org/10.1177/1362361320913671 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=428 Cross-cohort change in adolescent outcomes for children with mental health problems / R. SELLERS in Journal of Child Psychology and Psychiatry, 60-7 (July 2019)
[article]
Titre : Cross-cohort change in adolescent outcomes for children with mental health problems Type de document : Texte imprimé et/ou numérique Auteurs : R. SELLERS, Auteur ; N. WARNE, Auteur ; A. PICKLES, Auteur ; B. MAUGHAN, Auteur ; A. THAPAR, Auteur ; S. COLLISHAW, Auteur Article en page(s) : p.813-821 Langues : Anglais (eng) Mots-clés : Avon Longitudinal Study of Parents and Children Child mental health Millennium Cohort Study National Child Development Study secular change Index. décimale : PER Périodiques Résumé : BACKGROUND: Child mental health problems are common. Previous studies have examined secular changes in their prevalence but have not assessed whether later outcomes have changed. We therefore aimed to test whether outcomes of child mental health problems have changed over a 40-year period. METHODS: Three cohorts were utilized: The National Child Development Study (NCDS: N = 14,544, aged 7 in 1965), the Avon Longitudinal Study of Parents and Children (ALSPAC: N = 8,188, aged 7 in 1998), and the Millennium Cohort Study (MCS: N = 13,192, aged 7 in 2008). Mental health problems at age 7 were identified using the parent-reported Rutter-A scale (NCDS) and Strengths and Difficulties Questionnaire (ALSPAC and MCS). Associated outcomes were compared across cohorts: age 11 social functioning, age 16 exam attainment and age 16 mental health. RESULTS: Child mental health problems were common in each cohort (boys: 7.0%-9.7%; girls: 5.4%-8.4%). Child mental health problems became more strongly associated with social functioning problems (boys: NCDS OR = 1.95 (1.50, 2.53), MCS OR = 3.77 (2.89, 4.92); interaction p < .001; girls: NCDS OR = 1.69 (1.22, 2.33), MCS OR = 3.99 (3.04, 5.25), interaction p < .001), lower academic attainment for boys (NCDS OR = 0.49 (0.31, 0.78), ALSPAC OR = 0.30 (0.22, 0.41), interaction p = .009), and age 16 mental health problems (boys: NCDS d' = 0.55 (0.38, 0.72), ALSPAC d' = 0.95 (0.73, 1.16); interaction p = .004; girls: NCDS d' = 0.50 (0.34, 0.65), ALSPAC d' = 0.99 (0.78, 1.20); interaction p < .001). CONCLUSIONS: Child mental health problems have become more strongly associated with negative social, educational and mental health outcomes in recent generations. En ligne : http://dx.doi.org/10.1111/jcpp.13029 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=401
in Journal of Child Psychology and Psychiatry > 60-7 (July 2019) . - p.813-821[article] Cross-cohort change in adolescent outcomes for children with mental health problems [Texte imprimé et/ou numérique] / R. SELLERS, Auteur ; N. WARNE, Auteur ; A. PICKLES, Auteur ; B. MAUGHAN, Auteur ; A. THAPAR, Auteur ; S. COLLISHAW, Auteur . - p.813-821.
Langues : Anglais (eng)
in Journal of Child Psychology and Psychiatry > 60-7 (July 2019) . - p.813-821
Mots-clés : Avon Longitudinal Study of Parents and Children Child mental health Millennium Cohort Study National Child Development Study secular change Index. décimale : PER Périodiques Résumé : BACKGROUND: Child mental health problems are common. Previous studies have examined secular changes in their prevalence but have not assessed whether later outcomes have changed. We therefore aimed to test whether outcomes of child mental health problems have changed over a 40-year period. METHODS: Three cohorts were utilized: The National Child Development Study (NCDS: N = 14,544, aged 7 in 1965), the Avon Longitudinal Study of Parents and Children (ALSPAC: N = 8,188, aged 7 in 1998), and the Millennium Cohort Study (MCS: N = 13,192, aged 7 in 2008). Mental health problems at age 7 were identified using the parent-reported Rutter-A scale (NCDS) and Strengths and Difficulties Questionnaire (ALSPAC and MCS). Associated outcomes were compared across cohorts: age 11 social functioning, age 16 exam attainment and age 16 mental health. RESULTS: Child mental health problems were common in each cohort (boys: 7.0%-9.7%; girls: 5.4%-8.4%). Child mental health problems became more strongly associated with social functioning problems (boys: NCDS OR = 1.95 (1.50, 2.53), MCS OR = 3.77 (2.89, 4.92); interaction p < .001; girls: NCDS OR = 1.69 (1.22, 2.33), MCS OR = 3.99 (3.04, 5.25), interaction p < .001), lower academic attainment for boys (NCDS OR = 0.49 (0.31, 0.78), ALSPAC OR = 0.30 (0.22, 0.41), interaction p = .009), and age 16 mental health problems (boys: NCDS d' = 0.55 (0.38, 0.72), ALSPAC d' = 0.95 (0.73, 1.16); interaction p = .004; girls: NCDS d' = 0.50 (0.34, 0.65), ALSPAC d' = 0.99 (0.78, 1.20); interaction p < .001). CONCLUSIONS: Child mental health problems have become more strongly associated with negative social, educational and mental health outcomes in recent generations. En ligne : http://dx.doi.org/10.1111/jcpp.13029 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=401 Mental health and social difficulties of late-diagnosed autistic children, across childhood and adolescence / Will MANDY in Journal of Child Psychology and Psychiatry, 63-11 (November 2022)
[article]
Titre : Mental health and social difficulties of late-diagnosed autistic children, across childhood and adolescence Type de document : Texte imprimé et/ou numérique Auteurs : Will MANDY, Auteur ; Emily MIDOUHAS, Auteur ; Mariko HOSOZAWA, Auteur ; Noriko CABLE, Auteur ; Amanda SACKER, Auteur ; Eirini FLOURI, Auteur Article en page(s) : p.1405-1414 Langues : Anglais (eng) Mots-clés : Female Child Adolescent Humans Autistic Disorder/diagnosis/psychology Cohort Studies Mental Health Attention Deficit Disorder with Hyperactivity Educational Status Autism Spectrum Disorder Millennium Cohort Study co-occurring mental health conditions diagnosis trajectories Index. décimale : PER Périodiques Résumé : BACKGROUND: Autism can be diagnosed from 2 years of age, although most autistic people receive their diagnosis later than this after they have started education. Research is required to understand why some autistic children are diagnosed late, and the level and nature of unmet need prior to diagnosis for late-diagnosed children. METHODS: We examined trajectories of emotional, behavioural and social difficulties (EBSDs) across childhood and adolescence, comparing 'earlier-diagnosed' (diagnosed 7 years or younger) with 'late-diagnosed' (diagnosed between 8 and 14 years) autistic children. Data were from the Millennium Cohort Study, a population-based UK birth cohort. EBSDs were measured using the parent-report Strengths and Difficulties Questionnaire, at 3, 5, 7, 11 and 14 years. We used Growth Curve Modelling to investigate levels and rates of change in these difficulties, and to compare earlier- (n=146) and late-diagnosed (n=284) autistic children. RESULTS: Aged 5, earlier-diagnosed autistic children had more emotional (i.e., internalising), conduct, hyperactivity and social difficulties; although clinical difficulties in these areas were nevertheless common in late-diagnosed children. There was a faster annual increase in scores for all domains for late-diagnosed children, and by age 14 years, they had higher levels of EBSDs. These results persisted when we ran adjusted models, to account for the late-diagnosed group having higher rates of late-diagnosed attention deficit/hyperactivity disorder, higher IQ, a higher proportion of females and older and more educated mothers. CONCLUSIONS: Emotional, behavioural and social difficulties are associated with, and may influence, the timing of autism diagnosis. Late-diagnosed autistic children often have high levels of mental health and social difficulties prior to their autism diagnosis, and tend to develop even more severe problems as they enter adolescence. En ligne : http://dx.doi.org/10.1111/jcpp.13587 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=490
in Journal of Child Psychology and Psychiatry > 63-11 (November 2022) . - p.1405-1414[article] Mental health and social difficulties of late-diagnosed autistic children, across childhood and adolescence [Texte imprimé et/ou numérique] / Will MANDY, Auteur ; Emily MIDOUHAS, Auteur ; Mariko HOSOZAWA, Auteur ; Noriko CABLE, Auteur ; Amanda SACKER, Auteur ; Eirini FLOURI, Auteur . - p.1405-1414.
Langues : Anglais (eng)
in Journal of Child Psychology and Psychiatry > 63-11 (November 2022) . - p.1405-1414
Mots-clés : Female Child Adolescent Humans Autistic Disorder/diagnosis/psychology Cohort Studies Mental Health Attention Deficit Disorder with Hyperactivity Educational Status Autism Spectrum Disorder Millennium Cohort Study co-occurring mental health conditions diagnosis trajectories Index. décimale : PER Périodiques Résumé : BACKGROUND: Autism can be diagnosed from 2 years of age, although most autistic people receive their diagnosis later than this after they have started education. Research is required to understand why some autistic children are diagnosed late, and the level and nature of unmet need prior to diagnosis for late-diagnosed children. METHODS: We examined trajectories of emotional, behavioural and social difficulties (EBSDs) across childhood and adolescence, comparing 'earlier-diagnosed' (diagnosed 7 years or younger) with 'late-diagnosed' (diagnosed between 8 and 14 years) autistic children. Data were from the Millennium Cohort Study, a population-based UK birth cohort. EBSDs were measured using the parent-report Strengths and Difficulties Questionnaire, at 3, 5, 7, 11 and 14 years. We used Growth Curve Modelling to investigate levels and rates of change in these difficulties, and to compare earlier- (n=146) and late-diagnosed (n=284) autistic children. RESULTS: Aged 5, earlier-diagnosed autistic children had more emotional (i.e., internalising), conduct, hyperactivity and social difficulties; although clinical difficulties in these areas were nevertheless common in late-diagnosed children. There was a faster annual increase in scores for all domains for late-diagnosed children, and by age 14 years, they had higher levels of EBSDs. These results persisted when we ran adjusted models, to account for the late-diagnosed group having higher rates of late-diagnosed attention deficit/hyperactivity disorder, higher IQ, a higher proportion of females and older and more educated mothers. CONCLUSIONS: Emotional, behavioural and social difficulties are associated with, and may influence, the timing of autism diagnosis. Late-diagnosed autistic children often have high levels of mental health and social difficulties prior to their autism diagnosis, and tend to develop even more severe problems as they enter adolescence. En ligne : http://dx.doi.org/10.1111/jcpp.13587 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=490 Within-family relations of mental health problems across childhood and adolescence / Lydia Gabriela SPEYER in Journal of Child Psychology and Psychiatry, 63-11 (November 2022)
[article]
Titre : Within-family relations of mental health problems across childhood and adolescence Type de document : Texte imprimé et/ou numérique Auteurs : Lydia Gabriela SPEYER, Auteur ; Hildigunnur Anna HALL, Auteur ; Yuzhan HANG, Auteur ; Claire HUGHES, Auteur ; Aja Louise MURRAY, Auteur Article en page(s) : p.1288-1296 Langues : Anglais (eng) Mots-clés : Child Male Child, Preschool Adolescent Humans Female Child Behavior Disorders/psychology Family Relations Child Behavior/psychology Cohort Studies Mental Health Longitudinal Studies Millennium Cohort Study Parental mental health externalising internalising within-family Index. décimale : PER Périodiques Résumé : BACKGROUND: While transactional models suggest that parent and child mental health reciprocally influence one another over development, research has largely focused on parent-to-child effects. Additionally, it is not known whether observed associations hold when appropriate statistical tools are used to operationalise within-family dynamics. METHODS: We investigated within-family mental health dynamics using autoregressive latent trajectory models with structured residuals, stratified by child gender. Parental psychological distress was assessed using the Kessler (K6) scale, and children's internalising and externalising problems were assessed using the Strengths and Difficulties Questionnaire. Both measures were administered at the age 3, 5, 7, 11, 14 and 17 waves of the Millennium Cohort Study (N=10,746, ~50% female). RESULTS: Maternal psychological distress was positively associated with subsequent internalising and externalising problems for girls but only with internalising problems for boys. Paternal psychological distress was associated with boys' later internalising and externalising problems during early adolescence. Among boys, internalising problems were associated with later maternal psychological distress, while externalising problems were associated with later paternal psychological distress. Among girls, internalising problems were associated with subsequent paternal psychological distress, while externalising problems were associated with later maternal psychological distress. Finally, maternal and paternal psychological distress showed negative bidirectional associations in early childhood but positive associations in middle childhood and early adolescence. CONCLUSIONS: Findings support a transactional model of family mental health, with both child-to-parent and parent-to-child effects playing a role in the development of mental health difficulties. Mental health intervention efforts should, therefore, target the whole family system. En ligne : http://dx.doi.org/10.1111/jcpp.13572 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=490
in Journal of Child Psychology and Psychiatry > 63-11 (November 2022) . - p.1288-1296[article] Within-family relations of mental health problems across childhood and adolescence [Texte imprimé et/ou numérique] / Lydia Gabriela SPEYER, Auteur ; Hildigunnur Anna HALL, Auteur ; Yuzhan HANG, Auteur ; Claire HUGHES, Auteur ; Aja Louise MURRAY, Auteur . - p.1288-1296.
Langues : Anglais (eng)
in Journal of Child Psychology and Psychiatry > 63-11 (November 2022) . - p.1288-1296
Mots-clés : Child Male Child, Preschool Adolescent Humans Female Child Behavior Disorders/psychology Family Relations Child Behavior/psychology Cohort Studies Mental Health Longitudinal Studies Millennium Cohort Study Parental mental health externalising internalising within-family Index. décimale : PER Périodiques Résumé : BACKGROUND: While transactional models suggest that parent and child mental health reciprocally influence one another over development, research has largely focused on parent-to-child effects. Additionally, it is not known whether observed associations hold when appropriate statistical tools are used to operationalise within-family dynamics. METHODS: We investigated within-family mental health dynamics using autoregressive latent trajectory models with structured residuals, stratified by child gender. Parental psychological distress was assessed using the Kessler (K6) scale, and children's internalising and externalising problems were assessed using the Strengths and Difficulties Questionnaire. Both measures were administered at the age 3, 5, 7, 11, 14 and 17 waves of the Millennium Cohort Study (N=10,746, ~50% female). RESULTS: Maternal psychological distress was positively associated with subsequent internalising and externalising problems for girls but only with internalising problems for boys. Paternal psychological distress was associated with boys' later internalising and externalising problems during early adolescence. Among boys, internalising problems were associated with later maternal psychological distress, while externalising problems were associated with later paternal psychological distress. Among girls, internalising problems were associated with subsequent paternal psychological distress, while externalising problems were associated with later maternal psychological distress. Finally, maternal and paternal psychological distress showed negative bidirectional associations in early childhood but positive associations in middle childhood and early adolescence. CONCLUSIONS: Findings support a transactional model of family mental health, with both child-to-parent and parent-to-child effects playing a role in the development of mental health difficulties. Mental health intervention efforts should, therefore, target the whole family system. En ligne : http://dx.doi.org/10.1111/jcpp.13572 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=490 The Prevalence and Psychopathological Correlates of Sibling Bullying in Children with and without Autism Spectrum Disorder / U. TOSEEB in Journal of Autism and Developmental Disorders, 48-7 (July 2018)
[article]
Titre : The Prevalence and Psychopathological Correlates of Sibling Bullying in Children with and without Autism Spectrum Disorder Type de document : Texte imprimé et/ou numérique Auteurs : U. TOSEEB, Auteur ; G. MCCHESNEY, Auteur ; D. WOLKE, Auteur Article en page(s) : p.2308-2318 Langues : Anglais (eng) Mots-clés : Autism spectrum disorder Childhood Millennium Cohort Study Prosocial Psychopathology Sibling bullying Index. décimale : PER Périodiques Résumé : Using data from a prospective population based study, the prevalence and psychopathological correlates of sibling bullying in children with and without autism spectrum disorder (ASD) were estimated. There were 475 children with ASD and 13,702 children without ASD aged 11 years. Children with ASD were more likely to be bullied by their siblings compared to those without ASD. They were also more likely than those without ASD to both bully and be bullied by their siblings, which was associated with lower prosocial skills as well as more internalizing and externalizing problems compared to those not involved in any sibling bullying. Interventions to improve social and emotional outcomes in children with ASD should focus on both the affected and the unaffected sibling. En ligne : http://dx.doi.org/10.1007/s10803-018-3484-2 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=367
in Journal of Autism and Developmental Disorders > 48-7 (July 2018) . - p.2308-2318[article] The Prevalence and Psychopathological Correlates of Sibling Bullying in Children with and without Autism Spectrum Disorder [Texte imprimé et/ou numérique] / U. TOSEEB, Auteur ; G. MCCHESNEY, Auteur ; D. WOLKE, Auteur . - p.2308-2318.
Langues : Anglais (eng)
in Journal of Autism and Developmental Disorders > 48-7 (July 2018) . - p.2308-2318
Mots-clés : Autism spectrum disorder Childhood Millennium Cohort Study Prosocial Psychopathology Sibling bullying Index. décimale : PER Périodiques Résumé : Using data from a prospective population based study, the prevalence and psychopathological correlates of sibling bullying in children with and without autism spectrum disorder (ASD) were estimated. There were 475 children with ASD and 13,702 children without ASD aged 11 years. Children with ASD were more likely to be bullied by their siblings compared to those without ASD. They were also more likely than those without ASD to both bully and be bullied by their siblings, which was associated with lower prosocial skills as well as more internalizing and externalizing problems compared to those not involved in any sibling bullying. Interventions to improve social and emotional outcomes in children with ASD should focus on both the affected and the unaffected sibling. En ligne : http://dx.doi.org/10.1007/s10803-018-3484-2 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=367