Abstract

Background: Mental health challenges are common in autism spectrum disorder but there is limited research particularly among pre-school children.

Aims: To ascertain the nature and occurrence of mental health challenges in autistic pre-school children as well as their association with autistic traits, cognitive and adaptive functioning.

Method: We conducted a secondary analysis of data collected from children attending Autism Specific Early Learning and Care Centres across six states in Australia. The primary outcome of mental health challenges was assessed using the Child Behaviour Checklist (CBCL). Severity of autism and autistic traits such as social communication problems and repetitive behaviours, alongside cognitive and adaptive functioning were used as exposure variables. Multivariable linear regression analyses examined the association between mental health challenges, autistic traits, cognitive level and adaptive functioning, and adjusted for key sociodemographic covariates.

Results: Among 760 children, about 76% scored above the clinical range of CBCL total problem scores. Mental health difficulties were significantly associated with greater severity of autistic traits, social communication problems , and repetitive behaviours, and lower verbal developmental functioning and adaptive functioning. Additionally, sociodemographic determinants such as children who were older, female, with an autistic sibling were associated with higher risk of mental health difficulties whereas culturally and linguistically diverse (CALD) status, higher parental education, and family income were protective against mental health challenges.

Conclusions: Findings provide useful insights into the high prevalence of mental health difficulties among autistic pre-school children, highlighting the significant association with autistic traits, cognitive and adaptive functioning levels, and sociodemographic risk factors.

Citation

Wu, W. T., John, J. R., Diaz, A. M., & Eapen, V. (2026). Occurrence of mental health challenges and their association with autistic traits, cognitive level and adaptive functioning in autistic preschool children. British Journal of Psychiatry Open, 12(2), e68. doi:10.1192/bjo.2025.10966