Emotional and Behavioral Profiles in Neurodevelopmental and Neuromuscular Disorders: A Comparative Study Using the Child Behavior Checklist

Abstract

Highlights What are the main findings? Children with ADHD showed the highest overall emotional–behavioral burden, whereas ASD and SLD were characterized by greater internalizing difficulties and DMD by a distinct emotional–behavioral profile. Using the same standardized CBCL/6–18 assessment enabled direct comparison of emotional and behavioral functioning across neurodevelopmental and neuromuscular conditions. What is the implication of the main finding? A transdiagnostic assessment framework may facilitate the identification of both shared and disorder-specific emotional–behavioral patterns across heterogeneous pediatric populations. Integrating standardized behavioral screening with individualized clinical assessment may support more targeted psychosocial care and multidisciplinary decision-making. Abstract Background: Neurodevelopmental disorders, including Autism Spectrum Disorder (ASD), Attention-Deficit/Hyperactivity Disorder (ADHD), and Specific Learning Disorder (SLD), as well as neuromuscular conditions such as Duchenne Muscular Dystrophy (DMD), are frequently associated with emotional and behavioral difficulties that may affect children’s functioning and family well-being. However, direct comparisons across these heterogeneous clinical populations remain limited. This study aimed to compare emotional and behavioral profiles across children and adolescents with ASD, ADHD, SLD, and DMD using the Child Behavior Checklist (CBCL/6–18). Methods: This cross-sectional comparative study included 197 children and adolescents (ASD: 47; SLD: 50; ADHD: 50; DMD: 50) assessed at the Clinical Psychology Unit of the Fondazione Policlinico Universitario Agostino Gemelli IRCCS (Rome, Italy) between 2017 and 2024. Emotional and behavioral functioning was evaluated using the parent-report CBCL/6–18. Group differences were examined using one-way ANOVA or Welch’s ANOVA, as appropriate, followed by Tukey’s HSD or Games–Howell post hoc comparisons. Results: Significant group differences emerged for Internalizing Problems, Externalizing Problems, and Total Problems (all p < 0.001). ADHD showed the highest overall emotional and behavioral burden, with 76% of participants scoring in the clinical range for both Internalizing and Total Problems and 60% for Externalizing Problems. Elevated internalizing difficulties characterized ASD and SLD, whereas children with DMD showed generally lower CBCL scores, although 26% fell within the clinical range for Internalizing Problems. Effect sizes were moderate to large (η2 = 0.168–0.273), supporting the presence of both shared and disorder-specific emotional and behavioral patterns across heterogeneous developmental conditions. Conclusions: The findings highlight the heterogeneity of emotional–behavioral profiles across neurodevelopmental and neuromuscular conditions. The use of a common standardized assessment framework enabled the identification of both shared and disorder-specific patterns, supporting the potential value of a transdiagnostic approach to individualized assessment. Future longitudinal and multi-informant studies are warranted to clarify developmental trajectories and improve the identification of clinically meaningful emotional and behavioral needs across heterogeneous pediatric populations.