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Many autistic children experience changes in core symptom severity across middle childhood, when co-occurring mental health conditions emerge. We evaluated this relationship in 75 autistic children from 6 to 11 years old. Autism symptom severity change was evaluated for total autism symptoms using the autism diagnostic observation schedule calibrated severity score, as well as social-communication symptoms calibrated severity score, and restricted/repetitive behaviors calibrated severity score. Children were grouped based on their symptom severity change patterns. Mental health symptoms (attention-deficit hyperactivity disorder, anxiety, disruptive behavior problems) were assessed via parental interview and questionnaire and compared across the groups. Co-occurring mental health symptoms were more strongly associated with change in social-communication symptom or restricted/repetitive behavior severity than with total autism symptom severity. Two relevant groups were identified. The social-communication symptom-increasing-severity-group (21.3%) had elevated and increasing levels of anxiety, attention-deficit hyperactivity disorder, and disruptive behavior problems compared with children with stable social-communication symptom severity. The restricted/repetitive behavior-decreasing-severity-group (22.7%) had elevated and increasing levels of anxiety; 94% of these children met criteria for an anxiety disorder. Autism symptom severity change during middle childhood is associated with co-occurring mental health symptoms. Children that increase in social-communication symptom severity are also likely to demonstrate greater psychopathology, while decreases in restricted/repetitive behavior severity are associated with higher levels of anxiety. For many autistic children, the severity of their autism symptoms changes during middle childhood. We studied whether these changes are associated with the emergence of other mental health challenges such as anxiety and attention-deficit hyperactivity disorder. Children who had increased social-communication challenges had more anxiety and attention-deficit hyperactivity disorder symptoms and disruptive behavior problems than other children. Children who decreased their restricted and repetitive behaviors, on the contrary, had more anxiety. We discuss why these changes in autism symptoms may lead to increases in other mental health concerns. [ABSTRACT FROM AUTHOR]

Background: Executive functioning (EF) varies in children with autism spectrum disorder (ASD) and is associated with clinical symptoms, academic, and adaptive functioning. Here, we examined whether middle‐childhood EF mediates associations between early‐childhood autism symptoms and adolescent outcomes in children with ASD. Methods: The Pathways in ASD Cohort comprising children recruited at the time of ASD diagnosis (at 2–4 years‐of‐age) and followed prospectively across eight subsequent timepoints over ~10 years was used. A subset of Pathways participants (n = 250) with Behavior Rating Inventory of Executive Function (BRIEF)‐Parent Form data from at least one timepoint when participants were school‐aged was analyzed. A mediation framework was used to examine whether BRIEF‐measured EF across age 7–10 years (middle‐childhood) mediated associations between early‐childhood autism symptoms (measured using the parent‐report Social Responsiveness Scale across age 2–6 years) and clinical, academic, and functional outcomes, indexed at age >10–11.8 years (early‐adolescence) using the Child Behavior Checklist (CBCL)‐Internalizing and Externalizing Scales, Academic Performance from the Teacher's Report Form, and Vineland Adaptive Behavior Scales. Models were rerun substituting clinician‐rated and teacher‐rated measures, where possible. Results: Mediation models indicated a significant indirect effect of middle‐childhood EF on associations between early‐childhood autism symptoms and externalizing behavior, academic performance, or adaptive functioning in early adolescence; kappa squared (κ2) effect sizes ranged from large to small. Model findings were stable across raters. Middle‐childhood EF did not mediate associations between early‐childhood autism symptoms and adolescent internalizing behavior. Conclusions: Among children with an ASD diagnosis, middle‐childhood EF may be one pathway through which early‐childhood autism symptoms influence a variety of outcomes in early‐adolescence. An experimental study targeting middle‐childhood EF to improve adolescent academic, emotional/behavioral, and adaptive functioning is needed to evaluate the clinical meaningfulness of these findings. [ABSTRACT FROM AUTHOR]