Network analysis of core and associated symptoms in preschool children with autism spectrum disorder

Abstract Background: Complex relationships may exist in the symptoms of autism spectrum disorder (ASD) and may interfere with each other. Previous studies investigate the relationships between core and associated symptoms. However, there is still a lack of holistic view, especially in the relationships between core and associated symptoms.Methods: Data were collected from a sample of 474 children with ASD. The Social Responsiveness Scale (SRS) was used to evaluate the existence and severity of autistic core symptoms of social impairment, Children’s Sleep Habits Questionnaire (CSHQ) to sleep status, and Child Behavior Checklist (CBCL/1.5-5) to behavior performance of subjects. A network analysis approach was performed to assess the partial relationships of these symptoms.Results: The social communication problem was the most central symptom of ASD. There were broad relationships between the core and associated symptoms, such as the relationships between autistic core symptoms and characteristic symptoms of ADHD and within associated symptoms. All these correlations were positive, except for a negative relationship between anxious/depressed problems and social awareness. The associations between some of these symptoms were stronger than the other associations, and the relationship between emotional problems and aggressive behavior was relatively stronger than the other relationships. The strength centrality and network edges were highly stable.Limitations: Two main limitations exist in current study. First, the network analyses was conducted by using cross-sectional data, so it remains unknown that whether the network structure will change with the progress of the course of the disease or the change of the severity of symptoms. Second, some nodes may actually be measuring overlapping constructs, which could artificially inflate edge weights and centrality.Conclusions: An overall perspective of connections of symptoms of ASD using network analysis indicated that controlling these associated symptoms may improve core symptoms, such as ADHD-related symptoms. It may help identify new ways to improve symptoms in ASD.