Associations between domains of health-related quality of life and comorbid emotional and behavioral problems in youth with autism spectrum disorder.
Irritability, social withdrawal, and hyperactivity each break a different part of quality of life for kids with autism.
01Research in Context
What this study did
Menezes et al. (2021) asked parents of 470 kids with autism to fill out two forms. One form listed child mood and behavior problems. The other rated the child’s health-related quality of life in four areas: body, feelings, friends, and school.
The team used stats to see which problems matched which life-area drops.
What they found
Irritable, angry moods hurt emotional and physical quality of life the most. Kids who pulled away from others had the lowest social quality-of-life scores. High hyperactivity and non-compliance predicted poor school quality of life.
How this fits with other research
Adams et al. (2019) saw the same pattern with anxiety: child self-reports also linked worry to lower scores in all four life areas. The two studies use different reporters, yet the harm to quality of life looks the same.
Melegari et al. (2025) flipped the lens and asked about caregiver quality of life. They found the very same child problems—sleep issues in young kids and conduct or social problems in older ones—also drag parents down. Together the papers show one set of symptoms hurts both the child and the family.
Yorke et al. (2018) pooled many studies and confirmed that extra child problems raise parent stress. Michelle’s work extends this by naming which child problems hit which child life domain first, giving you clearer treatment targets.
Why it matters
You now know irritability, withdrawal, and hyperactivity each punch a different hole in quality of life. When you see one of these problems, treat it early and track the matching life area. Reducing irritability may lift both mood and physical comfort. Boosting social engagement may help friendships. Calming hyperactivity may keep the child in class and learning. Aim your intervention at the specific life area you want to improve.
Want CEUs on This Topic?
The ABA Clubhouse has 60+ free CEUs — live every Wednesday. Ethics, supervision & clinical topics.
Join Free →Pick the child’s top problem spot—irritability, withdrawal, or hyperactivity—and add one goal that tracks the matching HRQoL domain.
02At a glance
03Original abstract
BACKGROUND: Health-related quality of life (HRQoL) can be used as a measure of the impact of a particular disorder on one's daily functioning. Previous studies have found that comorbid psychiatric disorders in children and adolescents with autism spectrum disorder (ASD) are associated with poorer HRQoL than ASD alone. Less is known about potential associations between specific symptoms of comorbid psychopathology (i.e., emotional and behavioral problems) and domains of functioning or HRQoL in youth with ASD. METHOD: Participants were 470 children with ASD 2-14 years old recruited from one of three sites. Hierarchical multiple regressions were conducted with Pediatric Quality of Life Inventory 4.0 (PedsQL; Varni et al., 2001) HRQoL domains of physical functioning, emotional functioning, school functioning, and social functioning as the dependent variables. Covariates were entered at step 1, followed by the independent variables of interest at step 2: irritability, social withdrawal, stereotypic behavior, hyperactivity/noncompliance, and inappropriate speech. RESULTS: The study found that increased irritability was associated with poorer emotional and physical functioning and that greater social withdrawal was associated with worse social functioning. Furthermore, findings showed that more hyperactivity/noncompliance was associated with worse school functioning. CONCLUSIONS: Results demonstrated that certain emotional and behavioral symptoms are differentially associated with domains of HRQoL. This indicates that comorbid emotional and behavioral problems should be considered when measuring HRQoL in children with ASD. It also suggests that treating comorbid emotional/behavioral problems could improve HRQoL and functioning in certain domains for this population.
Research in autism spectrum disorders, 2021 · doi:10.1016/j.rasd.2021.101740