Chapter III

RESULTS

Introduction

Participants’ data were collected throughout New York City through the Healthy Brain

Network study. The Healthy Brain Network was established by the Child Mind Institute as an

ongoing initiative focused on creating and sharing a biobank of data from 10,000 New York area

participants. Data is released openly to scientists with appropriate institutional approval to

facilitate the study of multimodal brain imaging, genetics, and biological samples together with a

standardized deep phenotyping protocol that spans a broad range of clinically relevant

psychiatric, behavioral, cognitive, and lifestyle information. 

The chapter begins with a restatement of the research questions addressed in the study,

followed by a description of the demographic characteristics of the patients retrieved from the

research lab data sample. After which, the results of statistical analyses of the findings from the

study are presented. The chapter concludes with a summary providing key points of the study

findings.

Research Questions Addressed

The aim of the study was to answer several research questions that examined results from

participants who have a diagnosis of ASD as their primary, secondary, or tertiary diagnosis and

participants without a diagnosis of ASD. Data analysis will look at comorbidities in participants

diagnosed with ASD. One aim will be to see if there are differences in intelligence, social

communication, and social responsiveness between ASD and non-ASD children and whether

there is a relationship between intelligence, social communication, and social responsiveness in

children diagnosed with ASD. Additionally, data analysis will look if sex, intelligence, social
communication, and social responsiveness predict ASD diagnosis in children. Lastly, this study

will aim to explain if intelligence moderates the relationship between social communication and

social responsiveness. Analysis was chosen to answer research questions based on how data was

distributed.

Demographic Characteristics

Gender

Data for the present study were retrieved from 1,691 patient records. Of the 1,691

patients, only 272 (16.09%) were diagnosed with ASD (see Table 1). Most of the patients

diagnosed with ASD were males (93.75%). Of the participants with a primary diagnosis of ASD,

145 were males and 0 were females. For those who had a secondary diagnosis of ASD, 69 were

males, and 11 were females. Lastly, of those with a tertiary diagnosis of ASD, 0 were males, and

31 were females.

Table 1

Demographic Characteristics of the Patients Retrieved from the Research Lab Data Sample

Non-ASD Diagnosis ASD Diagnosis Total

Sex

Male 940 255 1,195

Female 479 17 496

Total 1,419 272 1,691

Age

The age of patients diagnosed with ASD ranged from 6 to 17, with an average of 9.91

(SD = 2.64). A 2X2 chi-square test of association was conducted between sex and ASD

diagnosis. Sex and ASD diagnosis had a statistically significant association, X2(1) = 83.312,

p < .001. There was a moderately strong relationship between sex and ASD diagnosis, as shown

by a phi value of -.222. The average age of participants diagnosed with ASD was 9.91 ± 2.64,

while the average age of those who did not have ASD was 10.01 ± 2.63 (see Table 2).

Table 2

Average Age Based on ASD Diagnosis and Non ASD Diagnosis

Mean SD

Non-ASD 10.01 2.63

ASD 9.91 2.64

Note. SD = Standard Deviation

A chi-square test of homogeneity was conducted to assess whether there was a

statistically significant difference in participants with an ASD diagnosis between the three age

categories: 6 to 10, 11 to 13, and 14 to 17 years old. The expected frequency for each group

showed an adequate sample size. The probability distributions for those with a diagnosis of ASD

and those without a diagnosis were not statistically different, X2(2) = .741, p = .690. The results

indicated that participants with ASD and those without a diagnosis of ASD had equal probability

distributions in the population. Table 3 presents the observed frequencies and percentages for

each age group.

Table 3

Crosstabulation of Age and ASD Diagnosis

ASD

Age Non- ASD ASD

6 to 10 years old 889a 167a
(62.6%) (61.4%)
11 to 13 years old 343a 72a
(24.2%) (26.5%)
14 to 17 years old 187a 33a
(13.2%) (12.1%)

Note. Each subscript letter denotes a subset of ASD categories whose column proportions do not
differ significantly from each other at the .05 level.

Comorbidities

In total, there were 272 participants that have a diagnosis of ASD as their primary,

secondary, or tertiary diagnosis. In addition to the ASD diagnosis, the patients were also

diagnosed with other commodities. Table 4 lists all patient comorbidities, from the most

common to the least. The top five comorbidities of ASD are (a) ADHD-combined type

(10.54%), (b) ADHD-inattentive type (10.02%), (c) oppositional defiant disorder (8.29%), (d)

specific learning disorder with impairment in reading (8.12%), and (e) generalized anxiety

disorder (7.25%).
Table 4

List of ASD Comorbidities Organized in Descending Order from the Most Common Diagnosed

to the Least

Comorbidity Count %
ADHD-Combined Type 61 10.54
ADHD-Inattentive Type 58 10.02
Oppositional Defiant Disorder 48 8.29
Specific Learning Disorder with Impairment in Reading 47 8.12
Generalized Anxiety Disorder 42 7.25
Language Disorder 41 7.08
Specific Phobia 39 6.74
Enuresis 29 5.01
Specific Learning Disorder with Impairment in Mathematics 26 4.49
Social Anxiety (Social Phobia) 21 3.63
Specific Learning Disorder with Impairment in Written 18 3.11
Expression
Separation Anxiety 17 2.94
Persistent (Chronic) Motor or Vocal Tic Disorder 15 2.59
Speech Sound Disorder 13 2.25
Other Specified Anxiety Disorder 11 1.90
Major Depressive Disorder 10 1.73
Obsessive-Compulsive Disorder 8 1.38
ADHD-Hyperactive/Impulsive Type 7 1.21
Developmental Coordination Disorder 7 1.21
Other Specified Attention-Deficit/Hyperactivity Disorder 6 1.04
Persistent Depressive Disorder (Dysthymia) 6 1.04
Adjustment Disorders 5 0.86
Borderline Intellectual Functioning 5 0.86
Encopresis 5 0.86
Agoraphobia 4 0.69
Table 4 Continued

Comorbidity Count %
Intellectual Disability-Mild 4 0.69

Tourette’s Disorder 4 0.69

Excoriation (Skin-Picking) Disorder 3 0.52
Other Specified Tic Disorder 3 0.52
Disruptive Mood Dysregulation Disorder 2 0.35
Intellectual Disability-Moderate 2 0.35
Provisional Tic Disorder 2 0.35
Social (Pragmatic) Communication Disorder 2 0.35
Cannabis Use Disorder 1 0.17
Child Onset Fluency Disorder (Stuttering) 1 0.17
Conduct Disorder-Adolescent-onset type 1 0.17
Conduct Disorder-Childhood-onset type 1 0.17
Other Specified Feeding or Eating Disorder 1 0.17
Other Specified Trauma- and Stressor-Related Disorder 1 0.17
Pica in Children 1 0.17
Posttraumatic Stress Disorder 1 0.17
TOTAL 579 100.00
Note. n = The total number of unique comorbidities diagnosed in all patients. A patient could
have one or more unique comorbidities.

Hypothesis Testing

Differences in Intelligence, Social Communication, and Social Responsiveness Between

Participants With ASD Diagnosis and Those Without

The entire sample of participants was used to answer this research question. The means

for intelligence, social communication, and social responsiveness scores between patients

diagnosed with ASD and patients without the diagnosis of ASD were compared separately. The

intelligence scores for this study were assessed using the Wechsler Intelligence Scale for
Children Full-Scale IQ (WISC-V FSIQ). The Social Communication Questionnaire (SCQ)

assessed the social communication scores, and the Social Responsiveness Scale-Second Edition

(SRS-2) assessed the social responsiveness scores. Table 5 presents the descriptive statistics for

WISC-V FSIQ, SCQ, and SRS-2 for participants with a diagnosis of ASD and participants

without a diagnosis of ASD. The results are presented in mean ± SD format.

Table 5

Descriptive Statistics for WISC-V FSIQ, SCQ, and SRS-2 for Participants Diagnosed with ASD

and without ASD

Non-ASD ASD
(Mean ± SD) (Mean ± SD)
Intelligence (WISC-V FSIQ) 100 ± 17 96 ± 19

Social Communication (SCQ) 7±5 10 ± 6

Social Responsiveness (SRS-2) 49 ± 28 65 ± 32

Initially, the data analysis plan was to use the independent samples t-test to compare the

means of WISC-V FSIQ, SCQ, and SRS-2 scores separately. However, the Shapiro-Wilk test

showed that the mean scores for WISC-V FSIQ, SCQ, and SRS-2 were not normally distributed,

p ≤ .05. For this reason, the Mann-Whitney U test was used instead of the independent samples t-

test. According to Field (2018), the Mann-Whitney U test is appropriate for comparing

differences between two independent groups when data are not normally distributed.

Intelligence

The differences in intelligence scores between participants diagnosed with ASD and

participants not diagnosed with ASD children were assessed using the Mann-Whitney U test.

The test was selected since non-ASD intelligence scores were not normally distributed, as
assessed by Shapiro-Wilk, p ≤ .05. The Mann-Whitney U test showed statistically significant

differences between participants with ASD (n = 272, Median = 98) and participants without ASD

(n = 1691, Median = 100), U = 172,821.50, z = -2.73, p = .006. The results indicated that

children with ASD had lower intelligence scores when compared to children without ASD.

Social Communication

The Mann-Whitney U test was used to assess the differences in social communication

scores between ASD and non-ASD children. The test was selected because the SCQ scores for

ASD and non-ASD groups were not normally distributed, as assessed by Shapiro-Wilk, p ≤ .05.

The Mann-Whitney U test showed statistically significant differences in social communication

scores between ASD (n = 272, Median = 8) and non-ASD (n = 1691, Median = 6) groups, U =

249,505.50, z = 7.68, p < .001. In addition, participants with a diagnosis of ASD were found to

have higher social communication scores when compared to participants without a diagnosis of

ASD.

Social Responsiveness

The Mann-Whitney U test was used to assess the differences in social responsiveness

between ASD and non-ASD children. The test was selected because the SRS-2 scores for both

groups did not meet the assumption of normality of distribution, as assessed by Shapiro-Wilk, p

≤ .05. The Mann-Whitney U test showed that the social responsiveness scores between ASD (n =

272, Median = 63) and non-ASD children (n = 1691, Median = 44) were statistically

significantly different, U = 251,946.50, z = 7.99, p < .001. Higher SRS-2 scores suggest higher

deficits in regard to social responsiveness. In addition, the results showed that participants with a

diagnosis of ASD had higher SRS-2 scores when compared to participants without a diagnosis of

ASD.
Relationships Between Intelligence, Social Communication, and Social Responsiveness in

Children Diagnosed With ASD

Data from participants who received a diagnosis of ASD as a primary, secondary, or

tertiary diagnosis was selected for analysis to determine relationships between intelligence,

social communication, and social responsiveness. A correlation analysis was conducted to

answer this research question. Initially, the research plan was to use Pearson’s correlation to

assess the association of the variables since all the variables (intelligence, social communication,

and social responsiveness) were measured at a continuous measurement scale. According to

Field (2018), Pearson’s correlation could be used to assess the strength and direction of

association between two continuous variables. However, upon further examination using the

Shapiro-Wilk test, the variables were found to be not normally distributed (non-parametric), as

shown by p ≤ .05. Therefore, Spearman’s rank-order correlation was selected since the test could

be used to assess the association between non-parametric variables (Wilcox, 2017).

Spearman’s rank-order correlation matrix is presented in Table 6. Spearman’s correlation

analysis showed that intelligence (WISC-V FSIQ) statistically significantly correlated with SCQ

(rs = -.289, p < .05) and SRS-2 (rs = -.239, p < .05). These findings suggested that an increase in

intelligence scores (WISC-V FSIQ) was mildly associated with a decrease in SCQ and SRS-2

scores in children diagnosed with ASD. SCQ was also positively and significantly correlated

with SRS, as shown by Spearman’s rho coefficient of rs = .753, p < .05. The findings suggested

that an increase in SCQ scores was strongly associated with an increase in SRS-2 scores in

children diagnosed with ASD.

Table 6

Correlation Matrix of Intelligence, Social Communication, and Social Responsiveness Scores (N

= 272) of Children Diagnosed With ASD

WISC-V FSIQ SCQ SRS

WISC-V FSIQ rs -
SCQ rs -.289** -
SRS rs -.239** .753** -

**p < .01 (2-tailed).

Prediction of ASD Diagnosis From Sex, Intelligence, Social Communication, and Social

Responsiveness

A binomial logistic regression analysis was conducted to answer this research question.

The binomial logistic regression is a model for predicting dichotomous outcomes based on one

or more categorical or continuous predictor variables (Field, 2018). The predictor variables were

sex, intelligence (WISC-V FSIQ), social communication (SCQ), and social responsiveness

(SRS-2). WISC-V FSIQ, SCQ, and SRS-2 scores are measured using a continuous scale. Sex is a

categorical variable (male = 0, female = 1). The outcome variable was ASD diagnosis (non-ASD

= 0, ASD = 1).

Assumptions

Before running the binomial logistic regression analysis, several assumptions were

checked to ensure that the data could be assessed using the test. The assumptions were: (a)

linearity between the continuous predictor variables (WISC-V FSIQ, SCQ, and SRS-2) and the

logit of the outcome variable (ASD diagnosis), (b) multicollinearity, and (c) unusual points. The

following subsections discuss the results of assumption tests.

 Linearity of the Logit. A logistic regression was run to test the assumption of linearity

of the logit by including the interaction between each continuous predictor variable and the log

itself (Hosmer et al., 2013). The test results are available in Table 7. The initial alpha level

was .05. Since eight terms were assessed in the model, a Bonferroni correction was applied,

resulting in the alpha level being .05/8 = .00625. The three interactions (WISC-V FSIQ by

ln_FSIQ, SCQ by ln_SCQ, and SRS-2 by ln_SRS-2) had significance values greater than .00625,

suggesting that all continuous independent variables were related to the logit of the dependent

variable (ASD diagnosis).

Table 7

Logistic Regression Results for the Assumption of Linearity of Logit

95% CI for
EXP(B)
B S.E. Wald df Sig. Exp(B) Lower Upper
Step Sex - .260 52.405 1 .000 .153 .092 .254
1a 1.880
WISC-V FSIQ -.419 .178 5.559 1 .018 .657 .464 .932
SCQ .067 .140 .229 1 .632 1.069 .813 1.405
SRS .061 .044 1.897 1 .168 1.063 .974 1.159
WISC-V FSIQ by .074 .032 5.435 1 .020 1.077 1.012 1.147
ln_FSIQ
SCQ by ln_SCQ -.001 .042 .001 1 .972 .999 .919 1.084
SRS-2 by ln_SRS -.010 .009 1.424 1 .233 .990 .973 1.007
Constant 4.629 3.098 2.233 1 .135 102.41
1
Note. a Variable(s) entered on step 1: Sex, WISC-V FSIQ, SCQ, SRS, WISC-V FSIQ * ln_FSIQ,
SCQ * ln_SCQ, SRS-2 * ln_SRS-2.

Multicollinearity. Linear models, including binomial logistic regression, are sensitive to

the biasing effect of collinearity (Field, 2018). Therefore, it is important to assess whether the

data had multicollinearity issues. Multicollinearity was assessed using the VIF values. Variables
with VIF values larger than 10 indicate a collinearity problem (Montgomery, 2017). All of the

variables had VIF values ranging from 1.02 to 2.01, indicating no multicollinearity issue (see

Table 8).

Table 8

Collinearity Diagnostics

Model VIF
1 Sex 1.020
WISC-V FSIQ 1.051
SCQ 2.046
SRS 2.005
Note. Dependent variable: ASD

Outliers. Additionally, the data were also assessed for outliers. The outliers were

detected using case-wise diagnostics, and there were 52 standardized residuals with values

ranging from 2.006 to 2.699. While these scores are high, they were kept in the analysis since

they fell within the standard deviations of the mean.

Results of Binomial Logistic Regression Analysis

Model Fit. A binomial logistic regression analysis was conducted to predict ASD

diagnosis from sex, intelligence (WISC-V FSIQ), social communication (SCQ), and social

responsiveness (SRS-2). The logistic regression model showed statistically significant results,

X2(4) = 166.22, p < .001 (see Table 9). These results suggested that the model is good for

predicting the outcome (ASD diagnosis).

Table 9

Omnibus Tests of Model Coefficients to Predict ASD

Chi-square df p
Step 1 Step 166.216 4 .000
Block 166.216 4 .000
Model 166.216 4 .000

Note. Predictor variables: intelligence (WISC-V FSIQ), social communication (SCQ), and social
responsiveness (SRS-2)

Effect Size. In addition to assessing model fit, the effect size of the model was also

assessed using Nagelkerke’s pseudo-R2. The Nagelkerke’s pseudo-R2 for the model was 16%.

The value suggested that the predictor variables accounted for 16% of the variance in ASD

diagnosis.

Outcome Prediction. The classification table (see Table 10) shows whether an ASD

diagnosis was accurately predicted based on the predictor variables. The model correctly

classified 84.3% of overall cases. Additionally, several prediction measures assessed are (a)

sensitivity, (b) specificity, (c) positive predictive value (PPV), and (d) negative predictive value

(NPV). Sensitivity refers to the percentage of cases with ASD that this model correctly predicted.

The model’s sensitivity was 4.4% because it only correctly predicted 12 out of 272 ASD cases.

Specificity refers to the percentage of cases without ASD that this model correctly predicted. The

specificity was 99.6% because it correctly predicted 1,413 out of 1,419 non-ASD cases. The PPV

refers to the likelihood that a participant predicted to have a diagnosis of ASD truly has ASD.

The PPV was 100%*(12/18) = 66.67%, which suggested that of all participants predicted to have

ASD, 66.67% were correctly predicted. The NPV refers to the likelihood that a participant

predicted not to have ASD truly does not have one. The negative predictive value (NPV) was
100%*(1413/1673) = 84.46%, which suggested that of all participants predicted not to have

ASD, 84.46% were correctly predicted.

Table 10

Observed and Predicted Classifications

Predicted a
ASD Percentage
Observed Non-ASD ASD Correct
Step 1 ASD Non-ASD 1413 6 99.6
ASD 260 12 4.4
Overall Percentage 84.3
Note. The cut value is .500
a.

Variables in the Model. Only three out of the four predictors in the model were

statistically significant: sex, social communication, and social responsiveness (see Table 11).

Intelligence, however, was not found to be a significant predictor in the model. The odds ratio

for sex (male = 0, female = 1) was .146, suggesting that females had 1/.146 = 6.85 times lower

odds of being diagnosed with ASD than males. The odds ratio for SCQ and SRS-2 were 1.052

and 1.003, respectively. These values indicated that increasing SCQ and SRS-2 scores were

associated with an increased likelihood of being diagnosed with ASD.

Table 11

Binary Logistic Regression Predicting Likelihood of Being Diagnosed with ASD Based on Sex,

Intelligence, Social Communication, and Social Responsiveness

B S.E. Wald df p Odds 95% C.I.for Odds

Ratio Ratio
Lower Upper
Sex -1.926 .259 55.337 1 .000 .146 .088 .242
WISC-V -.005 .004 1.434 1 .231 .995 .987 1.003
FSIQ
SCQ .050 .019 6.985 1 .008 1.052 1.013 1.092
SRS .009 .003 7.998 1 .005 1.009 1.003 1.016
Constant -1.774 .454 15.257 1 .000 .170
Note. Sex is for females compared to males.

Moderation Relationship Between Intelligence and Social Communication and Social

Responsiveness

Data from participants who have a diagnosis of ASD were used for the following

analysis. A moderation analysis was conducted to assess the moderating role of intelligence

(WISC-V FSIQ) on the relationship between social communication (SCQ) and social

responsiveness (SRS-2). According to Hayes (2017), the following needs to be assessed to

determine whether intelligence moderates the relationship between social communication and

social responsiveness: (a) whether social communication predicts social responsiveness, (b)

whether intelligence predicts social responsiveness, and (c) whether the interaction of social

communication and intelligence predict SRS-2.

The moderation analysis was conducted using Model 1 of Hayes’ PROCESS Version 4.0

on SPSS with 5000 bootstrap samples (Hayes, 2017). The moderation analysis tested the three

linear models. The output of the analysis can be seen in Table 12. The moderation analysis

showed that social communication predicted social responsiveness, b = 51.98, t = 101.85, 95%CI
[50.98, 52.98], p <.001. However, intelligence did not significantly predict social responsiveness,

b = -.05, t = -1.70, 95%CI [-.11, .01], p .0892. Further, there was no significant interaction effect

of intelligence and social communication on social responsiveness, b = .01, t = 1.46, 95%CI

[-.003, .020], p = .1447. The findings suggested that intelligence did not moderate the

relationship between social communication and social responsiveness.

Table 12

Linear Model of Predictors of Social Responsiveness

b SE B t p

Constant 51.98 .51 101.85 <.001

[50.98, 52.98]

Social Communication (SCQ) 4.22 .11 39.44 <.001

[4.01, 4.43]

Intelligence (WISC-V FSIQ) -.05 .03 -1.70 .0892

[-.11, .01]

Social Communication X Intelligence .01 .06 1.46 .1447

[-.003, .020]

Summary

This chapter presents the results of the statistical analysis for the study. Data for the

present study were retrieved from 1,691 patient records. Of the 1,691 patients, 272 were given

the diagnosis of ASD as this primary, secondary, or tertiary diagnosis. The top five comorbidities

of ASD are ADHD-combined type (10.54%), ADHD-inattentive type (10.02%), oppositional

defiant disorder (8.29%), specific learning disorders with impairment in reading (8.12%), and

generalized anxiety disorder (7.25%). Mann-Whitney U tests showed that participants with an

ASD diagnosis and participants without an ASD diagnosis were statistically significantly
different regarding intelligence, social communication, and social responsiveness. Participants

with a diagnosis of ASD were found to have lower intelligence scores when compared to

participants without a non-ASD diagnosis. Conversely, participants without an ASD diagnosis

were found to have higher social communication scores and SRS-2 when compared to non-ASD

diagnosed participants. Binomial logistic regression analysis using sex, intelligence (WISC-V

FSIQ), social communication (SCQ), and social responsiveness (SRS-2) as predictors to predict

ASD diagnosis showed statistically significant results, X2(4) = 166.22, p < .001. The Nagelkerke

R2 showed that the model explained 16% of ASD diagnosis variance and correctly classified

84.3% of cases. The model’s sensitivity was 4.4%, and specificity was 99.6%. The positive

predictive value (PPV) was 66.67%, while the negative predictive value (NPV) was 84.46%. Of

the four predictors in the model, only three were statistically significant: sex, social

communication, and social responsiveness. Females had 6.85 times lower odds of being

diagnosed with ASD than males. Increasing SCQ and SRS-2 scores were associated with an

increased likelihood of being diagnosed with ASD. Spearman’s correlation analysis showed that

intelligence (WISC-V FSIQ) statistically significantly correlated with SCQ (rs = -.289, p < .05)

and SRS-2 (rs = -.239, p < .05). Additionally, SCQ was found to be positively and significantly

correlated with SRS, as shown by Spearman’s rho coefficient of rs = .753, p < .05. Lastly,

moderation analysis showed that intelligence did not moderate the relationship between social

communication and social responsiveness, b = .01, t = 1.46, 95%CI [-.003, .020], p = .1447. The

following discusses the interpretations and implications of the findings reported in this chapter.
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Hayes, A. F., & Rockwood, N. J. (2017). Regression-based statistical mediation and moderation

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Behaviour research and therapy, 98, 39-57. https://doi.org/10.1016/j.brat.2016.11.001

Hosmer Jr, D. W., Lemeshow, S., & Sturdivant, R. X. (2013). Applied logistic regression (Vol.

398). John Wiley & Sons.

Montgomery, D. C. (2017). Design and analysis of experiments. John Wiley & Sons.

Wilcox, R. (2017). Modern statistics for the social and behavioral sciences: A practical

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