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Problem Behaviors in Autism Spectrum Disorder: Association with Verbal Ability and Adapting/Coping Skills

Abstract

Data from the Autism Inpatient Collection was used to examine the relationship between problem behaviors and verbal ability, which have generally, though not universally, been highly associated. In a comparison of 169 minimally-verbal and 177 fluently-verbal 4 to 20-year-old psychiatric inpatients with ASD, the severity of self-injurious behavior, stereotyped behavior, and irritability (including aggression and tantrums) did not significantly differ, when controlling for age and NVIQ. Verbal ability was not strongly related to the severity of problem behaviors. However, lower adapting/coping scores were significantly associated with increasing severity of each type of problem behavior, even when accounting for verbal ability. Interventions to develop adapting/coping mechanisms may be important for mitigation of problem behaviors across the spectrum of individuals with ASD.

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References

  • Allik, H., Larsson, J. O., & Smedje, H. (2006). Health-related quality of life in parents of school-age children with Asperger Syndrome or High-Functioning Autism. Health and Quality of Life Outcomes, 4, 1. doi:10.1186/1477-7525-4-1.

    Article  PubMed  PubMed Central  Google Scholar 

  • Aman, M. G., Singh, N. N., Stewart, A. W., & Field, C. J. (1985a). The Aberrant Behavior Checklist: A behavior rating scale for the assessment of treatment effects. American Journal of Mental Deficiency, 89, 485–491.

    PubMed  Google Scholar 

  • Aman, M. G., Singh, N. N., Stewart, A. W., & Field, C. J. (1985b). Psychometric characteristics of the Aberrant Behavior Checklist. American Journal of Mental Deficiency, 89, 492–502.

    PubMed  Google Scholar 

  • American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders: DSM-5 (5th edn.). Washington, DC: Author.

    Book  Google Scholar 

  • Anderson, D. K., Maye, M. P., & Lord, C. (2011). Changes in maladaptive behaviors from mid-childhood to young adulthood in autism spectrum disorder. American Journal on Intellectual and Developmental Disabilities, 116(5), 381–397.

    Article  PubMed  PubMed Central  Google Scholar 

  • Ando, H., & Yoshimura, I. (1979). Speech skill levels and prevalence of maladaptive behaviors in autistic and mentally retarded children. Child Psychiatry and Human Development, 10(2), 85–90.

    Article  PubMed  Google Scholar 

  • Baghdadli, A., Pascal, C., Grisi, S., & Aussilloux, C. (2003). Risk factors for self-injurious behaviours among 222 young children with autistic disorders. Journal of Intellectual Disability Research, 47(8), 622–627.

    Article  PubMed  Google Scholar 

  • Benson, P. R. (2010). Coping, distress, and well-being in mothers of children with autism. Research in Autism Spectrum Disorders, 4, 217–228.

    Article  Google Scholar 

  • Blacher, J., & McIntyre, L. L. (2006). Syndrome specificity and behavioural disorders in young adults with intellectual disability: Cultural differences in family impact. Journal of Intellectual Disability Research, 50(3), 184–198. doi:10.1111/j.1365-2788.2005.00768.x.

    Article  PubMed  Google Scholar 

  • Brenner, E., & Salovey, P. (1997). Emotion regulation during childhood: Developmental, interpersonal, and individual considerations. In P. Salovey & D. Sluyter (Eds.), Emotional literacy and emotional development (pp. 168–192). New York: Basic Books.

    Google Scholar 

  • Carr, E. G., Reeve, C. E., & Magito-McLaughlin, D. (1996). Contextual influences on problem behavior in people with developmental disabilities. In L. K. Koegel, R. L. Koegel & G. Dunlap. (Eds.), Positive behavioral support: Including people with difficult behavior in the community (pp. 403–423). Baltimore: Paul H. Brookes.

    Google Scholar 

  • Carver, C. S., Scheier, M. F., & Weintraub, J. K. (1989). Assessing coping strategies: A theoretically based approach. Journal of Personality and Social Psychology, 56(2), 267.

    Article  PubMed  Google Scholar 

  • Chiang, H. M. (2008). Expressive communication of children with autism: the use of challenging behavior. Journal of Intellectual Disability Research, 52, 966–972.

    Article  PubMed  Google Scholar 

  • Dominick, K. C., Davis, N. O., Lainhart, J., Tager-Flusberg, H., & Folstein, S. (2007). Atypical behaviors in children with autism and children with a history of language impairment. Research in Developmental Disabilities, 28(2), 145–162. doi:10.1016/j.ridd.2006.02.003.

    Article  PubMed  Google Scholar 

  • Duerden, E. G., Oatley, H. K., Mak-Fan, K. M., McGrath, P. A., Taylor, M. J., Szatmari, P., & Roberts, S. W. (2012). Risk factors associated with self-injurious behaviors in children and adolescents with autism spectrum disorders. Journal of Autism and Developmental Disorders, 42(11), 2460–2470.

    Article  PubMed  Google Scholar 

  • Estes, A. M., Dawson, G., Sterling, L., & Munson, J. (2007). Level of intellectual functioning predicts patterns of associated symptoms in school-age children with autism spectrum disorder. American Journal on Mental Retardation, 112, 439–449.

    Article  PubMed  Google Scholar 

  • Farmer, C. A., & Aman, M. G. (2011). Aggressive behavior in a sample of children with autism spectrum disorders. Research in Autism Spectrum Disorders, 5(1), 317–323.

    Article  Google Scholar 

  • Fox, L., Vaughn, B. J., Wyatte, M. L., & Dunlap, G. (2002). “We can’t expect other people to understand”: Family perspectives on problem behavior. Exceptional Children, 68(4), 437–450.

    Article  Google Scholar 

  • Frost, L., & Bondy, A. (2002). Picture exchange communication system. Newark, DE: Pyramid Educational Products.

    Google Scholar 

  • Ganz, J. B., Parker, R., & Benson, J. (2009). Impact of the picture exchange communication system: Effects on communication and collateral effects on maladaptive behaviors. Augmentative and Alternative Communication, 25, 250–261. doi:10.3109/07434610903381111.

    Article  PubMed  Google Scholar 

  • Gotham, K., Pickles, A., & Lord, C. (2009). Standardizing ADOS scores for a measure of severity in autism spectrum disorders. Journal of Autism and Developmental Disorders, 39(5), 693–705.

    Article  PubMed  Google Scholar 

  • Gray, K., Keating, C., Taffe, J., Brereton, A., Einfeld, S., & Tonge, B. (2012). Trajectory of behavior and emotional problems in autism. American Journal on Intellectual and Developmental Disabilities, 117, 121–133. doi:10.1352/1944-7588-117-2.121.

    Article  PubMed  Google Scholar 

  • Groden, J., Cautela, J., Prince, S., & Berryman, J. (1994). The impact of stress and anxiety. In E. Schopler & G. B. Mesibov (Eds.), Behavioral issues in autism (pp. 177–194). New York: Plenum Press.

    Chapter  Google Scholar 

  • Hartley, S. L., Sikora, D. M., & McCoy, R. (2008). Prevalence and risk factors of maladaptive behavior in young children with autistic disorder. Journal of Intellectual Disability Research, 52, 819–829.

    Article  PubMed  Google Scholar 

  • Kaat, A. J., & Lecavalier, L. (2013). Disruptive behavior disorders in children and adolescents with autism spectrum disorders: A review of the prevalence, presentation, and treatment. Research in Autism Spectrum Disorders, 7, 1579–1594. doi:10.1016/j.rasd.2013.08.012.

    Article  Google Scholar 

  • Kanne, S., & Mazurek, M. O. (2011). Aggression in children and adolescents with ASD: Prevalence and risk factors. Journal of Autism and Developmental Disorders, 41, 926–937. doi:10.1007/s10803-010-1118-4.

    Article  PubMed  Google Scholar 

  • Khor, A. S., Melvin, G. A., Reid, S. C., & Gray, K. M. (2014). Coping, daily hassles and behavior and emotional problems in adolescents with high-functioning autism/Asperger’s Disorder. Journal of Autism and Developmental Disorders, 44, 593–608.

    Article  PubMed  Google Scholar 

  • Kurtz, P. F., Chin, M. D., Huete, J. M., Tarbox, R. S., O’Connor, J. T., Paclawskyj, T. R., & Rush, K. S. (2003). Functional analysis and treatment of self-injurious behavior in young children: A summary of 30 cases. Journal of Applied Behavior Analysis, 36(2), 205–219.

    Article  PubMed  PubMed Central  Google Scholar 

  • Ladd, M. V. (2007). Mitigate and cope: A context-based approach to intervention for problem behavior in home and community settings (Doctoral dissertation). Retrieved from ProQuest. (Publication No. 3334936).

  • Lam, K. S., & Aman, M. G. (2007). The Repetitive Behavior Scale-Revised: Independent validation in individuals with autism spectrum disorders. Journal of Autism and Developmental Disorders, 37(5), 855–866.

    Article  PubMed  Google Scholar 

  • Lecavalier, L. (2006). Behavioral and emotional problems in young people with pervasive developmental disorders: Relative prevalence, effects of subject characteristics, and empirical classification. Journal of Autism and Developmental Disorders, 36(8), 1101–1114.

    Article  PubMed  Google Scholar 

  • Lewis, M. H., & Bodfish, J. W. (1998). Repetitive behavior disorders in autism. Mental Retardation and Developmental Disabilities Research Reviews, 4, 80–89.

    Article  Google Scholar 

  • Liddon, C. J., Zarcone, J. R., Pisman, M., & Rooker, G. W. (2016). Examination of behavioral flexibility and function of severe challenging behavior in individuals with autism and intellectual disability. International Journal of Developmental Disabilities, 62(3), 167–173.

    Article  Google Scholar 

  • Lord, C., Rutter, M., DiLavore, P., Risi, S., Gotham, K., & Bishop, S. (2012). Autism diagnostic observation schedule—2nd edition (ADOS-2). Los Angeles: Western Psychological Corporation.

    Google Scholar 

  • Mandell, D. S. (2008). Psychiatric hospitalization among children with autism spectrum disorders. Journal of Autism and Developmental Disorders, 38(6), 1059–1065.

    Article  PubMed  Google Scholar 

  • Matson, J. L., Boisjoli, J., & Mahan, S. (2009). The relation of communication and challenging behaviors in infants and toddlers with autism spectrum disorders. Journal of Developmental and Physical Disabilities, 21, 253–261.

    Article  Google Scholar 

  • Mayes, S. D., Calhoun, S. L., Aggarwal, R., Baker, C., Mathapati, S., Anderson, R., et al. (2012). Explosive, oppositional, and aggressive behavior in children with autism compared to other clinical disorders and typical development. Research in Autism Spectrum Disorders, 6, 1–10.

    Article  Google Scholar 

  • Mazefsky, C. A., & White, S. W. (2014). Emotion regulation: concepts and practice in autism spectrum disorder. Child and Adolescent Psychiatric Clinics of North America, 23, 15–24.

    Article  PubMed  Google Scholar 

  • Mazefsky, C. A., Borue, X., Day, T. N., & Minshew, N. J. (2014). Emotion regulation patterns in adolescents with high-functioning autism spectrum disorder: Comparison to typically developing adolescents and association with psychiatric symptoms. Autism Research, 7(3), 344–354.

    Article  PubMed  PubMed Central  Google Scholar 

  • Mazefsky, C. A., Herrington, J., Siegel, M., Scarpa, A., Maddox, B. B., Scahill, L., & White, S. W. (2013). The role of emotion regulation in autism spectrum disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 52, 679–688.

    Article  PubMed  PubMed Central  Google Scholar 

  • Mirenda, P. (2003). Toward functional augmentative and alternative communication for students with autism: Manual signs, graphic symbols, and voice output communication aids. Language, Speech, and Hearing Services in Schools, 34, 203–216.

    Article  PubMed  Google Scholar 

  • Mirenda, P., & Brown, K. (2007). Supporting individuals with autism and problem behavior using AAC. Perspectives on Augmentative and Alternative Communication, 16, 26–31.

    Article  Google Scholar 

  • O’Reilly, M., Rispoli, M., Davis, T., Machalicek, W., Lang, R., Sigafoos, J., … Didden, R. (2010). Functional analysis of challenging behavior in children with autism spectrum disorders: A summary of 10 cases. Research in Autism Spectrum Disorders, 4(1), 1–10. doi:10.1016/j.rasd.2009.07.001.

    Article  Google Scholar 

  • Prizant, B. M., Wetherby, A. M., Rubin, E., Laurent, A. C., & Rydell, P. J. (2006). The SCERTS ® model: Volume I Assessment; Volume II Program planning and intervention. Baltimore: Brookes Publishing.

    Google Scholar 

  • Quek, L. H., Sofronoff, K., Sheffield, J., White, A., & Kelly, A. (2012). Co-occurring anger in young people with Asperger’s Syndrome. Journal of Clinical Psychology, 68, 1142–1148.

    Article  PubMed  Google Scholar 

  • Reeve, C. E., & Carr, E. G. (2000). Prevention of severe behavior problems in children with developmental disorders. Journal of Positive Behavior Interventions, 2, 144–160.

    Article  Google Scholar 

  • Roid, G. H., Miller, L. J., Pomplun, M., & Koch, C. (2013). Leiter international performance scale, (Leiter-3). Los Angeles: Western Psychological Services.

    Google Scholar 

  • Rutter, M., Bailey, A., & Lord, C. (2003). Social communication questionnaire (SCQ). Los Angeles: Western Psychological Services.

    Google Scholar 

  • Saarni, C., Campos, J. J., Camras, L. A., & Witherington, D. (2007). Emotional Development: Action, Communication, and Understanding. Handbook of Child Psychology. III, 5.

    Google Scholar 

  • Schneider, N., Goldstein, H., & Parker, R. (2008). Social skills interventions for children with autism: A meta-analytic application of percentage of all non-overlapping data (PAND). Evidence-Based Communication Assessment and Intervention, 2, 152–162.

    Article  Google Scholar 

  • Shire, S. Y., & Jones, N. (2015). Communication partners supporting children with complex communication needs who use AAC: A systematic review. Communication Disorders Quarterly, 37, 3–15.

    Article  Google Scholar 

  • Siegel, M., Smith, K. A., Mazefsky, C., Gabriels, R. L., Erickson, C., Kaplan, D. … for the Autism and Developmental Disorders Inpatient Research Collaborative (ADDIRC) (2015). The autism inpatient collection: Methods and preliminary sample description. Molecular Autism: The International Journal of Research and Practice, 6, 61–71.

    Article  Google Scholar 

  • Sigafoos, J. (2000). Communication development and aberrant behavior in children with developmental disabilities. Education and Training in Mental Retardation and Developmental Disabilities, 35, 168–176.

    Google Scholar 

  • Sigafoos, J., Reichle, J., & Light-Shriner, C. (1994). Distinguishing between socially and nonsocially motivated challenging behavior: Implications for the selection of intervention strategies. In M. F. Hayden & B. H. Abery (Eds.), Challenges for a service system in transition: Ensuring quality community experiences for persons with developmental disabilities (pp. 147–169). Baltimore: Paul H. Brookes.

    Google Scholar 

  • Sparrow, S. S., Cicchetti, V. D., & Balla, A. D. (2005). Vineland adaptive behavior scales—2nd edition (VABS-II). Livonia, MN: Pearson Assessments.

    Google Scholar 

  • Wacker, D. P., Berg, W. K., Harding, J. W., Derby, M. K., Asmus, J. M., & Healy, A. (1998). Evaluation and long-term treatment of aberrant behavior displayed by young children with disabilities. Journal of Developmental and Behavioral Pediatrics, 19(4), 260–266.

    Article  PubMed  Google Scholar 

  • Williams, D. L., Mazefsky, C. A., Walker, J. D., Minshew, N. J., & Goldstein, G. (2014). Associations between conceptual reasoning, problem solving, and adaptive ability in high-functioning autism. Journal of Autism and Developmental Disorders, 44(11), 2908–2920.

    Article  PubMed  PubMed Central  Google Scholar 

  • Wong, C., Odom, S. L., Hume, K. A., Cox, A. W., Fettig, A., Kucharczyk, S., … Schultz, T. R. (2015). Evidence-based practices for children, youth, and young adults with autism spectrum disorder: A comprehensive review. Journal of Autism and Developmental Disorders, 45(7), 1951–1966.

    Article  PubMed  Google Scholar 

  • Zaidman-Zait, A., Mirenda, P., Duku, E., Szatmari, P., Georgiades, S., Volden, J., … Fombonne, E. (2014). Examination of bidirectional relationships between parent stress and two types of problem behavior in children with autism spectrum disorder. Journal of Autism and Developmental Disorders, 44(8), 1908–1917.

    Article  PubMed  Google Scholar 

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Acknowledgments

The ADDIRC is made up of the co-investigators: Matthew Siegel, MD (PI) (Maine Medical Center Research Institute; Tufts University), Craig Erickson, MD (Cincinnati Children’s Hospital; University of Cincinnati), Robin L. Gabriels, PsyD (Children’s Hospital Colorado; University of Colorado), Desmond Kaplan, MD (Sheppard Pratt Health System), Carla Mazefsky, PhD (Western Psychiatric Institute and Clinics; University of Pittsburgh), Eric M. Morrow, MD, PhD (Bradley Hospital; Brown University), Giulia Righi, PhD (Bradley Hospital; Brown University), Susan L. Santangelo, ScD (Maine Medical Center Research Institute; Tufts University), and Logan Wink, MD (Cincinnati Children’s Hospital; University of Cincinnati). Collaborating investigators and staff: Jill Benevides, BS, Carol Beresford, MD, Carrie Best, MPH, Katie Bowen, LCSW, Briar Dechant, BS, Tom Flis, BCBA, LCPC, Holly Gastgeb, PhD, Angela Geer, BS, Louis Hagopian, PhD, Benjamin Handen, PhD, BCBA-D, Adam Klever, BS, Martin Lubetsky, MD, Kristen MacKenzie, BS, Zenoa Meservy, MD, John McGonigle, PhD, Kelly McGuire, MD, Faith McNeil, BS, Joshua Montrenes, BS, Tamara Palka, MD, Ernest Pedapati, MD, Kahsi A. Pedersen, PhD, Christine Peura, BA, Joseph Pierri, MD, Christie Rogers, MS, CCC-SLP, Brad Rossman, MA, Jennifer Ruberg, LISW, Elise Sannar, MD, Cathleen Small, PhD, Nicole Stuckey, MSN, RN, Barbara Tylenda, PhD, Brittany Troen, MA, R-DMT, Mary Verdi, MA, Jessica Vezzoli, BS, Deanna Williams, BA, and Diane Williams, PhD, CCC-SLP. We gratefully acknowledge the contributions of the coordinating site advisory group: Donald L. St. Germain, MD and Girard Robinson, MD, and our scientific advisory group: Connie Kasari, PhD., Bryan King, MD, James McCracken, MD, Christopher McDougle, MD, Lawrence Scahill, MSN, PhD, Robert Schultz, PhD and Helen Tager-Flusberg, PhD, the input of the funding organizations and the families and children who participated.

Author Contributions

MS and CM conceived of the study and participated in its design and coordination; DW and CM performed the statistical analyses and drafted the manuscript; All authors participated in the interpretation of the data and read and approved the final manuscript. All ADDIRC sites participated in data collection.

Funding

The Autism Inpatient Collection (AIC) phenotypic database and biorepository is supported by a grant from the Simons Foundation Autism Research Initiative and the Nancy Lurie Marks Family Foundation, (SFARI #296318 to MS). This study was also supported a grant from the National Institute of Child Health and Human Development (R01HD079512 to CM) and Dr. Mazefsky received additional support from NICHD (K23HD060601).

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Correspondence to Carla A. Mazefsky.

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All procedures performed involving human participants were in accordance with the ethical standards of the institutional research committees where the data was collected and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in this study.

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Williams, D.L., Siegel, M., Mazefsky, C.A. et al. Problem Behaviors in Autism Spectrum Disorder: Association with Verbal Ability and Adapting/Coping Skills. J Autism Dev Disord 48, 3668–3677 (2018). https://doi.org/10.1007/s10803-017-3179-0

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Keywords

  • Communication
  • Challenging behavior
  • Coping skills
  • Autism spectrum disorder (ASD)
  • Psychiatric inpatients
  • Autism inpatient collection (AIC)