Autism Traits Without an ASD Diagnosis Negatively Affect Family Function Over Time

Poorer family functioning over time was associated in families with a child with autistic traits without a formal autism spectrum disorder diagnosis.

Autistic traits without a formal autism spectrum disorder (ASD) diagnosis associated with poorer family functioning over time. These findings were published in Autism.

Investigators from the Erasmus MC Sophia Children’s Hospital in The Netherlands sourced data for this study from the Social Spectrum Study, in which all children aged 2 to 10 years referred to 6 centers for child and adolescent mental health with autism trait levels were invited to participate in this study. Caregivers of 290 children responded to questionnaires about child and family characteristics at baseline and at 1 year. Associations between symptoms of autism and family function over time were evaluated using cross-lagged models. An intact family was defined as a living situation with either biological or adoptive parents.

In the weighted sample, the children were 67.8% boys, had a mean age of 9.07 (SD, 2.26) years, 89.1% were Dutch, they had a full-scale intellectual quotient score of 98.78 (SD, 16.78) points, 45.9% had a best-estimate clinical diagnosis of autism, and 40.6% were diagnosed with Autism Diagnostic Observation Schedule classification. The caregiver respondents were 96.9% women, had a mean age of 38.40 (SD, 5.10) years, and 95.1% were the biological parent of a child.

Overall, the children had on average 1.44 (SD, 1.20) siblings and 75.3% of families were intact.

Our results indicated an association between autism traits in children and family functioning over approximately one year.

At the first and second evaluations, the McMasters Family Assessment Device scores were 20.58 (SD, 4.78) and 19.61 (SD, 4.96) points, respectively.

Both the full (β, 0.175; P =.018) and partial (β, 0.177; P =.016) cross-lagged models of autism symptoms at baseline predicted family functioning at follow-up, indicating that fewer autism symptoms associated with fewer family functioning problems over time. Conversely, family functioning at baseline did not predict autism symptoms at follow-up (β, 0.023; P =.686).

The significant trends were not explained by co-occurring internalizing and externalizing symptoms.

Stratified by diagnosis, the significant relationship between autistic symptoms at baseline and family functioning at follow-up remained significant only among patients without a formal diagnosis of ASD (β, 0.375; P <.0001) and not for those with ASD (β, -0.067; P =.588).

The limitations of this study included the small sample size and the exploratory nature of the study.

Study authors concluded, “Our results indicated an association between autism traits in children and family functioning over approximately 1 year. […] This finding mainly concerned nonautistic children with high autism trait levels.”


ten Hoopen LW, de Nijs PFA, Slappendel G, et al. Associations between autism traits and family functioning over time in autistic and non-autistic children. Autism. 2023;13623613231151784. doi:10.1177/13623613231151784