552199 research-article2014
AUT0010.1177/1362361314552199AutismKuo et al.
Original Article
Parental mediation of television viewing and videogaming of adolescents with autism spectrum disorder and their siblings
Autism 1–12 © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/1362361314552199 aut.sagepub.com
Melissa H Kuo, Joyce Magill-Evans and Lonnie Zwaigenbaum
Abstract Adolescents with autism spectrum disorder spend considerable time in media activities. Parents play an important role in shaping adolescents’ responses to media. This study explored the mediation strategies that parents of adolescents with autism spectrum disorder used to manage television and video game use, factors associated with their use of different strategies, and whether mediation strategies changed over time. A secondary purpose was to examine whether parents applied different mediation strategies to adolescents with autism spectrum disorder versus siblings, and the factors that created stress related to managing media use. Parents of 29 adolescents with autism spectrum disorder and 16 siblings completed questionnaires at two time points. Parents most frequently supervised their television viewing by watching it with the adolescents, and used restrictive strategies to regulate their videogaming. Parents used similar strategies for siblings, but more frequently applied restrictive and instructive strategies for videogaming with adolescents with autism spectrum disorder than their siblings. Restrictive mediation of television viewing for the adolescents decreased significantly over the year. Adolescents’ time spent in media activities, age, and behavior problems, and parents’ concerns about media use were significant factors associated with the strategies that parents employed. Parents’ stress related to the adolescents’ behavioral and emotional responses to parental restrictions. Keywords adolescents, autism spectrum disorders, parental mediation, television, videogaming
Introduction Adolescents with autism spectrum disorder (ASD) spend approximately 2 h watching television and 2.4 h videogaming per day (Kuo et al., 2013), which is more than the time spent doing other leisure activities (Mazurek and Wenstrup, 2013; Orsmond and Kuo, 2011). Parents and siblings are the adolescents’ most frequent companion for watching television (Kuo et al., 2013), and parents moderate the association between videogaming and problematic behaviors by setting rules (Engelhardt and Mazurek, 2013). Research on children and adolescents without ASD has documented that parental monitoring and controlling media use not only shape their response to media content, but also moderate negative effects (e.g. Gentile et al., 2004; Mendoza, 2009; Shin and Huh, 2011; Vandewater et al., 2005). Previous research on media use among adolescents with ASD primarily focuses on patterns of use (e.g. Kuo et al., 2013; Mazurek and Wenstrup, 2013) and the concurrent
associations between media use and these adolescents’ characteristics, such as demographics, behavior problems, and personal relationships (e.g. Engelhardt and Mazurek, 2013; Kuo et al., 2013). We know little about the role that parents of adolescents with ASD play in the adolescents’ media use. This study addressed this knowledge gap by focusing on parental mediating strategies. Parental mediation refers to strategies that parents use to control, supervise, or interpret the media content to which children are exposed (Warren, 2001). Parents apply
University of Alberta, Canada Corresponding author: Melissa H Kuo, Department of Occupational Therapy, University of Alberta, 2-64 Corbett Hall, Edmonton, AB, Canada T6G 2G4. Email: [email protected]
Downloaded from aut.sagepub.com at Bobst Library, New York University on May 14, 2015
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Autism
three types of mediation strategies (restrictive, social, active) to both television viewing and videogaming (Nikken and Jansz, 2006; Valkenburg et al., 1999). In restrictive mediation, parents set rules for the amount of time and content (e.g. prohibit playing of certain games). Social mediation involves coviewing or coplaying for entertainment purposes (e.g. like the same game/program), without discussing the content. Active mediation is evaluative or instructive. Parents help children understand the content and educate them about the good and bad things happening, either during or after they use the media (e.g. pointing out that what happened was pretend). Parental mediation has an association with effects of videogaming and television viewing on typically developing children and adolescents. The associations differ by strategy type. For example, active and restrictive mediation are associated with less aggression after viewing violent television programs because both mediation strategies pass on parents’ negative values of violent content (An and Lee, 2010; Nathanson, 1999). Adolescents whose parents used restrictive mediation showed more negative gaming behaviors and played video games more frequently than those whose parents did not use restrictive mediation (Shin and Huh, 2011). Few studies have directly examined types of parental mediation and media use for adolescents with ASD. Engelhardt and Mazurek (2013) found that parents of children and adolescents with ASD who set up rules (restrictive mediation) reported fewer oppositional behaviors than did parents who had no rules. Kuo et al. (2013) found that adolescents with ASD whose parents watched television with them reported better parent–child relationships than did those whose parents did not watch television with them. The limited evidence highlights the need to understand how parents mediate media use for adolescents with ASD and the impact on relationships and behaviors. Parents may benefit from understanding other parents’ experiences when managing television and video game use. Parental mediation for typically developing adolescents changes over time. As adolescents mature, parenting styles often shift from controlling, involved, and ensuring the adolescents’ well-being to allowing more freedom to make decisions and taking responsibility for the consequences of their choices (Steinberg and Steinberg, 1994). Parents of typically developing adolescents decrease their mediation of media use because they trust their adolescent to make choices regarding the appropriate media use (PadillaWalker and Coyne, 2011). Moreover, parents need to adapt their mediating strategies in order to keep their mediation effective (Gentile et al., 2012). In this study, we tracked how parents managed the adolescents’ media use over time by using a longitudinal design. Knowing how types of mediating strategies change over time helps parents effectively manage their developing adolescents’ media use. Factors associated with use of different mediation strategies for television viewing and videogaming have been
examined for typically developing adolescents. The factors include demographic (child and parent characteristics) and perceptual (parental concerns) factors (Shin and Huh, 2011); however, results are inconsistent across studies (e.g. Austin et al., 1999; Barkin et al., 2006; Eklund and Bergmark, 2013; Gentile et al., 2012; Nikken and Jansz, 2006; Warren, 2001), possibly due to variations in sample size, age of participants, and country of residence. The results did not provide clear direction for the current study. We focused primarily on the association of mediation strategies with severity of autism symptoms, behavior problems, child age, and parental concerns about media use. In terms of age, in some research younger children were more likely to receive both restrictive and active mediation than were older children (Barkin et al., 2006; Eklund and Bergmark, 2013; Gentile et al., 2012; Nikken and Jansz, 2006; Warren, 2001), and less likely to receive social mediation (Shin and Huh, 2011). Others reported that parents were more likely to apply social mediation to younger than to older children (Austin et al., 1999; Gentile et al., 2012). Parents’ perceptions of media are important in how they use mediating strategies. Parents who were concerned about negative effects were more likely to mediate actively or restrictively (Barkin et al., 2006; Eklund and Bergmark, 2013; Nikken and Jansz, 2006; Shin and Huh, 2011; Warren, 2003). Parents with positive perceptions were more likely to use social mediation and watch television or play games with the children (Nikken and Jansz, 2006; Shin and Huh, 2011; Warren, 2003). Management of media use, including television viewing and videogaming, is a major issue for parents of adolescent with ASD causing stress within families (Nally et al., 2000). Understanding the parents’ experiences lays a basis for supporting their management of television and video game use. Thus, the overall purpose of this study was to explore parents’ strategy use to regulate television viewing and videogaming, whether strategies changed over time or varied based on factors such as behavior problems, and whether strategies differed for adolescents with ASD and siblings without ASD to determine if unique parental mediation was needed for individuals with ASD. We collected both quantitative and qualitative information from parents. There were five research questions. 1. What mediation strategies do parents of adolescents with ASD use to supervise television viewing and videogaming? 2. Does parental mediation change over time? 3. What factors are associated with parents’ use of different types of mediation? 4. Do parents use different mediation strategies for adolescents with ASD and typically developing siblings? 5. What factors are associated with parental stress related to management of media use?
Downloaded from aut.sagepub.com at Bobst Library, New York University on May 14, 2015
3
Kuo et al. Table 1. Demographic characteristics of parents (Time 1). Variables Age (in years) Mean (SD) Relationship to adolescent (n, %) Mother Father Marital status (n, %) Married Divorced/Separated Other Ethnicity (n, %) Caucasian Other Education level (n, %) High school or less Certificate/postsecondary diploma University degree or higher Employment status (n, %) Unemployed Full-time Part-time/temporary Household income (Canadian dollars) $10,000–$49,999 $50,000–$89,999 $90,000–$159,999 $160,000 or higher Median
44.8 (5.6) 24 (83%) 5 (17%) 22 (76%) 4 (14%) 3 (10%) 25 (86%) 4 (14%) 6 (20%) 10 (35%) 13 (45%) 6 (21%) 18 (62%) 5 (17%) 9% 26% 52% 13% $110,000
SD: standard deviation.
Methods Participants Participants were recruited through services organizations in Alberta, Canada. Parents indicated their interest via telephone, email, or the project website. A short phone interview with parents determined whether the adolescent met the inclusion criteria: (1) aged 12–19 years, (2) resided with his or her parent(s), (3) diagnosed with an ASD by a licensed professional according to criteria specified in Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; DSM-IV-TR; American Psychiatric Association, 2000), and (4) had a score of 15 points or higher on the Lifetime form of the Social Communication Questionnaire (SCQ; Rutter et al., 2003). Siblings were in the same age range without a diagnosed disability. Parents of 33 adolescents with ASD completed questionnaires at the first time point. For 15 families, there was no sibling or the sibling was not aged 12–19 years. In all, 18 siblings without ASD participated. About 1 year later, four parents withdrew due to family issues or being too busy. At the second time point, parents of 29 adolescents with ASD and 16 siblings participated. There were no significant differences in the reported
characteristics between families who withdrew and those who participated at both time points. We used only data from the parents who participated at both time points. Tables 1 and 2 summarize demographic characteristics at entry to the study.
Procedures Data were collected at two time points, approximately 1 year apart. At the first time point, parents completed mailed paper-and-pencil questionnaires about adolescent/ family characteristics and the strategies they used to mediate the adolescents’ television and video game use. Parents were also asked questions about the adolescents’ siblings, if available, to help address whether there were differences in parental mediation within the same home environment. At the second time point, parents completed similar questions on parental mediation on adolescents with ASD and siblings. Parents received gift cards in appreciation of their participation after the return of questionnaires.
Measures Background information. Parents completed a questionnaire addressing adolescent (age, gender, type of education, comorbidity), sibling (age, gender), and family characteristics (parental education level, employment status, household income). Parental mediation. The television mediation measure (15 items; Valkenburg et al., 1999) and video game mediation measure (14 items; Nikken and Jansz, 2006) were used to evaluate parents monitoring of television viewing and videogaming. Both measures ask about the frequency (0 = never/rarely, 1 = sometimes, 2 = often, or 3 = always) of restrictive (e.g. “How often do you forbid the teen to play certain games?”), active (e.g. “How often do you explain what something on TV really means?”), and social mediation (e.g. “How often do you watch TV together just for fun?”). Average scores for each type of mediation were calculated, with higher scores indicating more frequent usage. Alpha reliabilities at the first time point were 0.89 (television) and 0.86 (video game) for adolescents with ASD and 0.89 for both measures for siblings. At the second time point, reliabilities were 0.87 (television) and 0.90 (video game) for the adolescents, and 0.84 and 0.91 for siblings. Parents also answered an open-ended question about the effective strategies that they had used to regulate television and video game use at the second time point. They also rated how concerned they were about the time spent and content of media use by the adolescent and sibling on a 3-point scale (1 = not concerned to 3 = very concerned). Parental stresses. At both time points, parents were asked: “Do you feel stressed when managing the teen’s media
Downloaded from aut.sagepub.com at Bobst Library, New York University on May 14, 2015
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Autism
Table 2. Demographic characteristics of adolescents with ASD and siblings (Time 1). Characteristics Age (in years) Mean (SD) Gender (n, %) Male Female Education level (n, %) Grades 6–8 Grades 9–12 Higher than Grade 12 Ungraded special education Education type (n, %) Regular mainstream school Supported within a regular class Special class SCQ autism symptoms (Mean, SD) Time 1 Time 2 CBCL behavior problems T-score (Mean, SD) Time 1 Internalizing problems Externalizing problems Time 2 Internalizing problems Externalizing problems Comorbidityb (n, %) ADHD Anxiety Obsessive-compulsive disorder Depression Other Timeb (h/day) Television Videogaming
Adolescents with ASD
Siblings
Statistica
15.1 (2.3)
14.4 (2.2)
t(43) = 1.09, n.s.
26 (90) 3 (10)
8 (50) 8 (50)
10 (34) 15 (52) 2 (7) 2 (7)
6 (38) 10 (62) 0 0
χ2(3) = 2.45, n.s.
10 (35) 9 (30) 10 (35)
16 (100)
N/A
15.3 (5.8) 12.8 (5.5)
4.8 (4.3) 4.0 (3.6)
t(15) = 7.49, p
AUT0010.1177/1362361314552199AutismKuo et al.
Original Article
Parental mediation of television viewing and videogaming of adolescents with autism spectrum disorder and their siblings
Autism 1–12 © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/1362361314552199 aut.sagepub.com
Melissa H Kuo, Joyce Magill-Evans and Lonnie Zwaigenbaum
Abstract Adolescents with autism spectrum disorder spend considerable time in media activities. Parents play an important role in shaping adolescents’ responses to media. This study explored the mediation strategies that parents of adolescents with autism spectrum disorder used to manage television and video game use, factors associated with their use of different strategies, and whether mediation strategies changed over time. A secondary purpose was to examine whether parents applied different mediation strategies to adolescents with autism spectrum disorder versus siblings, and the factors that created stress related to managing media use. Parents of 29 adolescents with autism spectrum disorder and 16 siblings completed questionnaires at two time points. Parents most frequently supervised their television viewing by watching it with the adolescents, and used restrictive strategies to regulate their videogaming. Parents used similar strategies for siblings, but more frequently applied restrictive and instructive strategies for videogaming with adolescents with autism spectrum disorder than their siblings. Restrictive mediation of television viewing for the adolescents decreased significantly over the year. Adolescents’ time spent in media activities, age, and behavior problems, and parents’ concerns about media use were significant factors associated with the strategies that parents employed. Parents’ stress related to the adolescents’ behavioral and emotional responses to parental restrictions. Keywords adolescents, autism spectrum disorders, parental mediation, television, videogaming
Introduction Adolescents with autism spectrum disorder (ASD) spend approximately 2 h watching television and 2.4 h videogaming per day (Kuo et al., 2013), which is more than the time spent doing other leisure activities (Mazurek and Wenstrup, 2013; Orsmond and Kuo, 2011). Parents and siblings are the adolescents’ most frequent companion for watching television (Kuo et al., 2013), and parents moderate the association between videogaming and problematic behaviors by setting rules (Engelhardt and Mazurek, 2013). Research on children and adolescents without ASD has documented that parental monitoring and controlling media use not only shape their response to media content, but also moderate negative effects (e.g. Gentile et al., 2004; Mendoza, 2009; Shin and Huh, 2011; Vandewater et al., 2005). Previous research on media use among adolescents with ASD primarily focuses on patterns of use (e.g. Kuo et al., 2013; Mazurek and Wenstrup, 2013) and the concurrent
associations between media use and these adolescents’ characteristics, such as demographics, behavior problems, and personal relationships (e.g. Engelhardt and Mazurek, 2013; Kuo et al., 2013). We know little about the role that parents of adolescents with ASD play in the adolescents’ media use. This study addressed this knowledge gap by focusing on parental mediating strategies. Parental mediation refers to strategies that parents use to control, supervise, or interpret the media content to which children are exposed (Warren, 2001). Parents apply
University of Alberta, Canada Corresponding author: Melissa H Kuo, Department of Occupational Therapy, University of Alberta, 2-64 Corbett Hall, Edmonton, AB, Canada T6G 2G4. Email: [email protected]
Downloaded from aut.sagepub.com at Bobst Library, New York University on May 14, 2015
2
Autism
three types of mediation strategies (restrictive, social, active) to both television viewing and videogaming (Nikken and Jansz, 2006; Valkenburg et al., 1999). In restrictive mediation, parents set rules for the amount of time and content (e.g. prohibit playing of certain games). Social mediation involves coviewing or coplaying for entertainment purposes (e.g. like the same game/program), without discussing the content. Active mediation is evaluative or instructive. Parents help children understand the content and educate them about the good and bad things happening, either during or after they use the media (e.g. pointing out that what happened was pretend). Parental mediation has an association with effects of videogaming and television viewing on typically developing children and adolescents. The associations differ by strategy type. For example, active and restrictive mediation are associated with less aggression after viewing violent television programs because both mediation strategies pass on parents’ negative values of violent content (An and Lee, 2010; Nathanson, 1999). Adolescents whose parents used restrictive mediation showed more negative gaming behaviors and played video games more frequently than those whose parents did not use restrictive mediation (Shin and Huh, 2011). Few studies have directly examined types of parental mediation and media use for adolescents with ASD. Engelhardt and Mazurek (2013) found that parents of children and adolescents with ASD who set up rules (restrictive mediation) reported fewer oppositional behaviors than did parents who had no rules. Kuo et al. (2013) found that adolescents with ASD whose parents watched television with them reported better parent–child relationships than did those whose parents did not watch television with them. The limited evidence highlights the need to understand how parents mediate media use for adolescents with ASD and the impact on relationships and behaviors. Parents may benefit from understanding other parents’ experiences when managing television and video game use. Parental mediation for typically developing adolescents changes over time. As adolescents mature, parenting styles often shift from controlling, involved, and ensuring the adolescents’ well-being to allowing more freedom to make decisions and taking responsibility for the consequences of their choices (Steinberg and Steinberg, 1994). Parents of typically developing adolescents decrease their mediation of media use because they trust their adolescent to make choices regarding the appropriate media use (PadillaWalker and Coyne, 2011). Moreover, parents need to adapt their mediating strategies in order to keep their mediation effective (Gentile et al., 2012). In this study, we tracked how parents managed the adolescents’ media use over time by using a longitudinal design. Knowing how types of mediating strategies change over time helps parents effectively manage their developing adolescents’ media use. Factors associated with use of different mediation strategies for television viewing and videogaming have been
examined for typically developing adolescents. The factors include demographic (child and parent characteristics) and perceptual (parental concerns) factors (Shin and Huh, 2011); however, results are inconsistent across studies (e.g. Austin et al., 1999; Barkin et al., 2006; Eklund and Bergmark, 2013; Gentile et al., 2012; Nikken and Jansz, 2006; Warren, 2001), possibly due to variations in sample size, age of participants, and country of residence. The results did not provide clear direction for the current study. We focused primarily on the association of mediation strategies with severity of autism symptoms, behavior problems, child age, and parental concerns about media use. In terms of age, in some research younger children were more likely to receive both restrictive and active mediation than were older children (Barkin et al., 2006; Eklund and Bergmark, 2013; Gentile et al., 2012; Nikken and Jansz, 2006; Warren, 2001), and less likely to receive social mediation (Shin and Huh, 2011). Others reported that parents were more likely to apply social mediation to younger than to older children (Austin et al., 1999; Gentile et al., 2012). Parents’ perceptions of media are important in how they use mediating strategies. Parents who were concerned about negative effects were more likely to mediate actively or restrictively (Barkin et al., 2006; Eklund and Bergmark, 2013; Nikken and Jansz, 2006; Shin and Huh, 2011; Warren, 2003). Parents with positive perceptions were more likely to use social mediation and watch television or play games with the children (Nikken and Jansz, 2006; Shin and Huh, 2011; Warren, 2003). Management of media use, including television viewing and videogaming, is a major issue for parents of adolescent with ASD causing stress within families (Nally et al., 2000). Understanding the parents’ experiences lays a basis for supporting their management of television and video game use. Thus, the overall purpose of this study was to explore parents’ strategy use to regulate television viewing and videogaming, whether strategies changed over time or varied based on factors such as behavior problems, and whether strategies differed for adolescents with ASD and siblings without ASD to determine if unique parental mediation was needed for individuals with ASD. We collected both quantitative and qualitative information from parents. There were five research questions. 1. What mediation strategies do parents of adolescents with ASD use to supervise television viewing and videogaming? 2. Does parental mediation change over time? 3. What factors are associated with parents’ use of different types of mediation? 4. Do parents use different mediation strategies for adolescents with ASD and typically developing siblings? 5. What factors are associated with parental stress related to management of media use?
Downloaded from aut.sagepub.com at Bobst Library, New York University on May 14, 2015
3
Kuo et al. Table 1. Demographic characteristics of parents (Time 1). Variables Age (in years) Mean (SD) Relationship to adolescent (n, %) Mother Father Marital status (n, %) Married Divorced/Separated Other Ethnicity (n, %) Caucasian Other Education level (n, %) High school or less Certificate/postsecondary diploma University degree or higher Employment status (n, %) Unemployed Full-time Part-time/temporary Household income (Canadian dollars) $10,000–$49,999 $50,000–$89,999 $90,000–$159,999 $160,000 or higher Median
44.8 (5.6) 24 (83%) 5 (17%) 22 (76%) 4 (14%) 3 (10%) 25 (86%) 4 (14%) 6 (20%) 10 (35%) 13 (45%) 6 (21%) 18 (62%) 5 (17%) 9% 26% 52% 13% $110,000
SD: standard deviation.
Methods Participants Participants were recruited through services organizations in Alberta, Canada. Parents indicated their interest via telephone, email, or the project website. A short phone interview with parents determined whether the adolescent met the inclusion criteria: (1) aged 12–19 years, (2) resided with his or her parent(s), (3) diagnosed with an ASD by a licensed professional according to criteria specified in Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; DSM-IV-TR; American Psychiatric Association, 2000), and (4) had a score of 15 points or higher on the Lifetime form of the Social Communication Questionnaire (SCQ; Rutter et al., 2003). Siblings were in the same age range without a diagnosed disability. Parents of 33 adolescents with ASD completed questionnaires at the first time point. For 15 families, there was no sibling or the sibling was not aged 12–19 years. In all, 18 siblings without ASD participated. About 1 year later, four parents withdrew due to family issues or being too busy. At the second time point, parents of 29 adolescents with ASD and 16 siblings participated. There were no significant differences in the reported
characteristics between families who withdrew and those who participated at both time points. We used only data from the parents who participated at both time points. Tables 1 and 2 summarize demographic characteristics at entry to the study.
Procedures Data were collected at two time points, approximately 1 year apart. At the first time point, parents completed mailed paper-and-pencil questionnaires about adolescent/ family characteristics and the strategies they used to mediate the adolescents’ television and video game use. Parents were also asked questions about the adolescents’ siblings, if available, to help address whether there were differences in parental mediation within the same home environment. At the second time point, parents completed similar questions on parental mediation on adolescents with ASD and siblings. Parents received gift cards in appreciation of their participation after the return of questionnaires.
Measures Background information. Parents completed a questionnaire addressing adolescent (age, gender, type of education, comorbidity), sibling (age, gender), and family characteristics (parental education level, employment status, household income). Parental mediation. The television mediation measure (15 items; Valkenburg et al., 1999) and video game mediation measure (14 items; Nikken and Jansz, 2006) were used to evaluate parents monitoring of television viewing and videogaming. Both measures ask about the frequency (0 = never/rarely, 1 = sometimes, 2 = often, or 3 = always) of restrictive (e.g. “How often do you forbid the teen to play certain games?”), active (e.g. “How often do you explain what something on TV really means?”), and social mediation (e.g. “How often do you watch TV together just for fun?”). Average scores for each type of mediation were calculated, with higher scores indicating more frequent usage. Alpha reliabilities at the first time point were 0.89 (television) and 0.86 (video game) for adolescents with ASD and 0.89 for both measures for siblings. At the second time point, reliabilities were 0.87 (television) and 0.90 (video game) for the adolescents, and 0.84 and 0.91 for siblings. Parents also answered an open-ended question about the effective strategies that they had used to regulate television and video game use at the second time point. They also rated how concerned they were about the time spent and content of media use by the adolescent and sibling on a 3-point scale (1 = not concerned to 3 = very concerned). Parental stresses. At both time points, parents were asked: “Do you feel stressed when managing the teen’s media
Downloaded from aut.sagepub.com at Bobst Library, New York University on May 14, 2015
4
Autism
Table 2. Demographic characteristics of adolescents with ASD and siblings (Time 1). Characteristics Age (in years) Mean (SD) Gender (n, %) Male Female Education level (n, %) Grades 6–8 Grades 9–12 Higher than Grade 12 Ungraded special education Education type (n, %) Regular mainstream school Supported within a regular class Special class SCQ autism symptoms (Mean, SD) Time 1 Time 2 CBCL behavior problems T-score (Mean, SD) Time 1 Internalizing problems Externalizing problems Time 2 Internalizing problems Externalizing problems Comorbidityb (n, %) ADHD Anxiety Obsessive-compulsive disorder Depression Other Timeb (h/day) Television Videogaming
Adolescents with ASD
Siblings
Statistica
15.1 (2.3)
14.4 (2.2)
t(43) = 1.09, n.s.
26 (90) 3 (10)
8 (50) 8 (50)
10 (34) 15 (52) 2 (7) 2 (7)
6 (38) 10 (62) 0 0
χ2(3) = 2.45, n.s.
10 (35) 9 (30) 10 (35)
16 (100)
N/A
15.3 (5.8) 12.8 (5.5)
4.8 (4.3) 4.0 (3.6)
t(15) = 7.49, p
