Wiener-Blotner, Aaron; (2022) Biopsychosocial risk factors for the development of conduct problems in children with autism spectrum disorder. Doctoral thesis (D.Clin.Psy), UCL (University College London).

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Abstract

BACKGROUND: The aim of this systemic review and meta-analysis was to estimate the rates at which oppositional defiant disorder (ODD) and conduct disorder (CD) occur in children and adolescents with a diagnosis of autism spectrum disorder (ASD). Furthermore, the study aimed to explore moderating factors which might influence prevalence rates of these co-occurring conditions between studies. METHODS: A systematic search was conducted on August 10, 2020 using the PsycInfo and Medline databases to identify relevant literature using key words and MeSH terms. Only studies of children and adolescents aged between 3-25 were included in the meta-analysis. A modified Hoy’s risk of bias tool was used to assess the bias of the included studies. Following the identification and selection of relevant articles, a meta-analysis was conducted using R-studio software. Moderator analysis was performed to explore whether participant characteristics and methodological design of studies were associated with differences in reported ODD and CD prevalence rates. Potential moderators included age, gender, intellectual ability, ethnicity, nationality, sample type, detection bias, and sampling bias. RESULTS: Nineteen eligible studies were identified including a total sample of 6,085 individuals with a diagnosis of ASD. The diagnostic rates of comorbid ODD and CD within the pooled sample were 14.03% [95% CI 9.0-21.22] and 3.13% [95% CI 1.4-5.4] respectively. There was significant heterogeneity in the rates of diagnosis between studies. Greater study bias was associated with increased rates of co-occurring diagnoses. Recruitment bias moderated the prevalence of CD but not ODD diagnoses. Detection bias moderated the number of ODD but not CD diagnoses. Study demographics, sample type, and intelligence were not associated with the prevalence rate of comorbidity found in the pooled sample. DISCUSSION: Study bias played a significant role over the rates of co-occurring CD and ODD reported in the ASD population, yet the findings should be interpreted with some caution. The meta-analysis was based on a predominantly Caucasian male sample and studies which used DSM-IV criteria to assign diagnoses. This lack of participant heterogeneity limits the generalizability of the study and underscores the importance of studying both population characteristic and methodology in meta-analyses. Future research should explore the impact that the updated DSM-5 have over co-occurring ODD and CD and focus on including more minoritized populations.

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