Autism spectrum disorder (ASD) frequently co-occurs with additional symptoms of psychopathology and challenging behaviors. While aggressive behaviors are often associated with attention deficits and hyperactivity in children with ASD, there is limited research on the impact that inattention/impulsivity and aggressive behaviors have on the developmental functioning of toddlers with ASD. However, identifying comorbidities is necessary for proper intervention. The aim of the current study was to examine the effects of inattention/impulsivity and aggressive behaviors on several domains of developmental functioning in infants and toddlers with ASD as measured by the Battelle Developmental Inventory, Second Edition (BDI-2). This study compared four groups consisting of 29 toddlers each: without inattention/impulsivity or aggressive behaviors (i.e., -I/-A), with inattention/impulsivity but without aggressive behaviors (i.e., + I/-A), without inattention/impulsivity but with aggressive behaviors (i.e., –I/ + A), and with both inattention/impulsivity and aggressive behaviors (i.e., + I/ + A). The results of the current study revealed significant group differences in Personal-Social, Communication, Motor, and Cognitive domains of the BDI-2. The significance and implications of the present study are discussed.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Price includes VAT (USA)
Tax calculation will be finalised during checkout.
Availability of Data and Material
American Academy of Pediatrics. (2019). ADHD: Clinical practice guideline for the diagnosis, evaluation, and treatment of children and adolescents with attention-deficit/hyperactivity disorder. Pediatrics, 144(4), 1–3.
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (Revised 4th ed). Washington, DC: American Psychiatric Association.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: American Psychiatric Association.
Ashwood, K. L., Tye, C., Bahare, A., Cartwright, S., Asherson, P., & Bolton, P. (2015). Brief report: adaptive functioning in children with ASD, ADHD and ASD + ADHD. Journal of Autism and Developmental Disorders, 45, 2235–2242.
Athanasiadou, A., Buitelaar, J. K., Brovedani, P., Chorna, O., Fulceri, F., Guzzetta, A., & Scattoni, M. L. (2019). Early motor signs of attention-deficit hyperactivity disorder: A systematic review. European Child & Adolescent Psychiatry, 1–14.
Bal, V. H., Fork, M., Lord, C., Smith, I. M., Mirenda, P., Szatmari, P., Vaillancourt, T., Volden, J., Waddell, C., Zwaigenbaum, L., Bennett, T., Duku, E., Elsabbagh, M., Stelios, G., Ungar, W. J., & Zaidman-Zait, A. (2019). Predictors of longer-term development of expressive language in two independent longitudinal cohorts of language-delayed preschoolers with autism spectrum disorder.Journal of Child Psychology and Psychiatry, 1–10.
Bedford, R., Pickles, A., & Lord, C. (2016). Early gross motor skills predict the subsequent development of language in children with autism spectrum disorder. Autism Research, 9(9), 993–1001.
Bejerot, S., Plenty, A., Humble, A., & Humble, M. B. (2013). Poor motor skills: a risk marker for bully victimization. Aggressive Behavior, 39(6), 453–461.
Belanti, C. J., & Bierman, K. L. (2000). Disentangling the impact of low cognitive ability and inattention on social behavior and peer relationships. Journal of Clinical Child Psychology, 29(1), 66–75.
Belardinelli, C., Raza, M., & Taneli, T. (2016). Comorbid behavioral problems and psychiatric disorders in autism spectrum disorders. Journal of Childhood & Developmental Disorders, 2, 1–9.
Bliss, S. L. (2007). Test Reviews: Newborg, J. (2007). Battelle developmental inventory—Second Edition. Itasca, IL: Riverside. Journal of Psychoeducational Assessment, 25(4): 409–415.
Brian, J. A., Smith, I. M., Zwaigenbaum, L., & Bryson, S. E. (2017). Cross-site randomized control trial of the social abcs caregiver-mediated intervention for toddlers with autism spectrum disorder. Autism Research, 10, 1700–1711.
Bronsard, G., Botbol, M., & Tordjman, S. (2010). Aggression in low functioning children and adolescents with autistic disorder.PLoS One, 5(12).
Christensen, D. L., Baio, J., Braun, K. V. N., Bilder, D., Charles, J., Constantino, J. N., Daniels, J., Durkin, M., Fitzgerald, R. T., Kurzius-Spencer, M., Lee, L., Pettygrove, S., Robinson, C., Schulz, E., Wells, C., Wingate, M. S., Zahorodny, W., & Yeargin-Allsopp, M. (2016). Prevalence and characteristics of autism spectrum disorder among children aged 8 years—autism and developmental disabilities monitoring network, 11 sites, united states. Morbidity and Mortality Weekly Reports.
Cortese, S. (2016). Attention-deficit hyperactivity disorder and autism spectrum disorder.In L. Mazzone.& B. Vitiello.(Eds.), Psychiatric symptoms and comorbidities in autism spectrum disorders (pp. 79–92). Springer.
Crick, N. R., & Dodge, K. A. (1994). A review and reformulation of social information-processing mechanisms in children’s social adjustment. Psychological Bulletin Journal, 115(1), 74–101.
Davis, E., Pitchford, N., Jaspan, T., Macarthur, D., & Walker, D. (2010). Development of cognitive and motor function following cerebellar tumour injury sustained in early childhood. Cortex, 46, 919–932.
Dawson, G., Rogers, S., Munson, J., Smith, M., Winter, J., Greenson, J., & Varley, J. (2010). Randomized, controlled trial of an intervention for infants with autism: the early start Denver model. Pediatrics, 125(1), 17–23.
Dionne, G., Tremblay, R., Boivin, M., Laplante, D., & Perusse, D. (2003). Physical aggression and expressive vocabulary in 19-month-old twins. Developmental Psychology, 39(2), 261–273.
Doss, A. J. (2005). Evidence-based diagnosis: incorporating diagnostic instruments into clinical practice. Journal of the American Academy of Child Psychiatry, 44, 947–952.
Field, A. (2013). Discovering statistics using IBM SPSS statistics (4th ed.). Los Angeles: SAGE Publications Ltd.
Fombonne, E., Heavey, L., Smeeth, L., Rodrigues, L., Cook, C., Smith, P., et al. (2004). Validation of the diagnosis of autism in general practitioner records. BMC Public Health, 4(5), 1–9.
Freitag, C. M., Kleser, C., Schneider, M., & Von Gontard, A. (2007). Quantitative assessment of neuromotor function in adolescents with high functioning autism and Asperger syndrome. Journal of Autism and Developmental Disorders, 37, 948–959.
Frontiers. (2018). Childhood aggression linked to deficits in executive function: Primary school children with reduced cognitive skills for planning and self-restraint are more likely to show increased aggression in middle childhood. ScienceDaily. Retrieved April 4, 2020.
Gernsbacher, M. A., Sauer, E. A., Geye, H. M., Schweigert, E. K., & Hill-Goldsmith, H. (2008). Infant and toddler oral- and manual-motor skills predict later speech fluency in autism. Journal of Child Psychology and Psychiatry, 49, 43–50.
Hill, A. P., Zuckerman, K. E., Hagen, A. D., Kriz, D. J., Duvall, S. W., Santen, J. V., et al. (2014). Aggressive behavior problems in children with autism spectrum disorders: prevalence and correlates in a large clinical sample. Research in Autism Spectrum Disorder, 8(9), 1121–1133.
Hodgetts, S., Nicholas, D., & Zwaigenbaum, L. (2013).Home sweet home?Families’ experiences with aggression in children with autism spectrum disorders.Focus on Autism and Other Developmental Disabilities, 1–9.
Iverson, J. M. (2010). Developing language in a developing body: the relationship between motor development and language development. Journal of Child Language, 37(2), 229–261.
Jang, J., Dixon, D. R., Tarbox, J., & Granpeesheh, D. (2011). Symptom severity and challenging behavior in children with ASD. Research in Autism Spectrum Disorders, 5, 1028–1032.
Kanne, S. M., & Mazurek, M. O. (2011). Aggression in children and adolescents with ASD: prevalence and risk factors. Journal of Autism and Developmental Disorders, 41(7), 926–937.
Kasari, C., Freeman, S., Paperella, T., Wong, C., Kwon, S., & Gultrud, A. (2005). Early intervention of core deficits in autism. Clinical Neuropsychiatry, 2(6), 380–388.
Kasari, C., Gulsrud, A., Paparella, T., Hellemann, G., & Berry, K. (2015). Randomized comparative efficacy study of parent-mediated interventions for toddlers with autism. Journal of Consulting and Clinical Psychology, 83(3), 554–563.
Koegel, L. K., Koegel, R. L., Ashbaugh, K., & Bradshaw, J. (2014). The importance of early identification and intervention for children with or at risk for autism spectrum disorders. Journal of Speech-Language Pathology, 16(1), 50–56.
Kogan, M. D., Vladutiu, C. J., Schieve, L. A., Ghandour, R. M., Blumberg, S. J., Zablotsky, B., et al. (2018). The prevalence of parent-reported autism spectrum disorder among US children. Pediatrics, 142(6), 1–11.
Konst, M. J., Matson, J. L., & Turygin, N. (2013). Comparing the rates of tantrum behavior in children with ASD and ADHD as well as children with comorbid ASD and ADHD diagnoses. Research in Autism Spectrum Disorders, 7(11), 1339–1345.
Laerd Statistics. Statistical tutorials and software guides. 2015. Retrieved from https://statistics.laerd.com/.
Laerd Statistics. Statistical tutorials and software guides. 2018. Retrieved from https://statistics.laerd.com/statistical-guides/one-way-anova-statistical-guide-4.php.
Lai, M. C., Lombardo, M. V., & Baron-Cohen, S. (2014). Autism. Lancet, 383, 896–910.
Landa, R. (2007). Early communication development and intervention for children with autism. Mental Retardation and Developmental Disabilities, 13, 16–25.
LeBarton, E. S., & Landa, R. J. (2019). Infant motor skill predicts later expressive language and autism spectrum disorder diagnosis. Infant Behavior and Development, 54, 37–47.
Lee, C. M., & Bo, J. (2015). Motor functioning in children with autism spectrum disorder. ActaPsychologia, 1(2), 1–3.
Lee, Y., & Jeoung, B. (2016). The relationship between the behavior problems and motor skills of students with intellectual disability. Journal of Exercise Rehabilitation, 12(6), 598–603.
Leitner, Y. (2014). The co-occurrence of autism and attention deficit hyperactivity disorder in children—what do we know? Frontiers in Human Neuroscience, 8, 1–20.
Lloyd, M., MacDonald, M., & Lord, C. (2013). Motor skills of toddlers with autism spectrum disorders. Autism, 17, 133–146.
MacDonald, M., Lord, C., & Ulrich, D. (2013). The relationship of motor skills and adaptive behavior skills in young children with autism spectrum disorders. Research in Autism Spectrum Disorders, 7(11), 1383–1390.
MacDonald, M., Lord, C., & Ulrich, D. (2013b).The relationship of motor skills and social communicative skills in school-aged children with autism spectrum disorder.Adapted Physical Activity Quarterly, 1.
MacDonald, M., Lord, C., & Ulrich, D. (2015). The relationship of motor skills and adaptive behavior skills in young children with autism spectrum disorders. Research in Autism Spectrum Disorders, 7(11), 1383–1390.
Matson, J. L., & Kozlowski, A. M. (2011). The increasing prevalence of autism spectrum disorders. Research in Autism Spectrum Disorders, 5(1), 418–425.
Matson, J. L., Boisjoli, J., & Wilkins, J. (2007). The baby and infant screen for children with aUtIsm traits (BISCUIT). Baton Rouge: Disability Consultants LLC.
Matson, J. L., Boisjoli, J. A., Rojahn, J., & Hess, J. (2009). A factor analysis of challenging behaviors assessed with the Baby and Infant Screen for Children with aUtIsm Traits (BISCUIT-Part 3). Research in Autism Spectrum Disorders, 3, 714–722.
Matson, J. L., Wilkins, J., Sharp, B., Knight, K., Sevin, J. A., & Boisjoli, J. A. (2009). Sensitivity and secificity of the Baby and Infant Screen for Children with aUtism Traits (BISCUIT): Validity and cut-off scores for autism and PDD-NOS in toddlers. Research in Autism Spectrum Disorders, 3, 924–930.
Matson, J. L., Fodstad, J. C., & Mahan, S. (2009). Cutoffs, norms, and patterns of comorbid difficulties in children with developmental disabilities on the baby and infant screen for children with aUtIsm traits (BISCUIT—part 2). Research in Developmental Disabilities, 30, 1221–1228.
Matson, J. L., Wilkins, J., Sevin, J. A., Knight, C., Boisjoli, J. A., & Sharp, B. (2009). Reliability and item content of the baby and infant screen for children with aUtIsm traits (BISCUIT): parts 1–3. Research in Autism Spectrum Disorders, 3, 336–344.
Matson, J. L., Worley, J. A., Neal, D., Mahan, S., & Fodstad, J. C. (2010). The effects of inattention/hyperactivity and ASD symptom severity on social skills in toddlers. Developmental Neurorehabilitation, 13, 408–412.
Matson, J. L., Wilkins, J., & Fodstad, J. C. (2011). The validity of the Baby and Infant Screen for Children with aUtIsm Traits: Part 1 (BISCUIT: Part 1). Journal of Autism and Developmental Disorders, 41(9), 1139–1146.
Matson, J. L., Boisjoli, J. A., Hess, J. A., & Wilkins, J. (2011). Comorbid psychopathology factor structure on the baby and infant screen for children with aUtIsm traits—part 2 (BISCUIT—part 2). Research in Autism Spectrum Disorder, 5, 426–432.
Mazurek, M. O., Kanne, S. M., & Wodka, E. L. (2013). Physical aggression in children and adolescents with autism spectrum disorders. Research in Autism Spectrum Disorders, 7(3), 455–465.
Newborg, J. (2005). Battelle developmental inventory (2nd ed.). Itasca: Riverside.
Park, H. R., Lee, J. M., Moon, H. E., Kim, B. N., Kim, J., Kim, D. G., & Paek, S. H. (2016). A short review on the current understanding of autism spectrum disorders. Experimental Neurobiology, 25(1), 1–13.
Rao, P. A., & Landa, R. J. (2013). Association between severity of behavioral phenotype and comorbid attention deficit hyperactivity disorder symptoms in children with autism spectrum disorders. Autism, 18(3), 272–280.
Reebye, R. (2005). Aggression during early year: Infancy and preschool. Journal of the Canadian Academy of Child and Adolescent Psychiatry, 14(1), 16–20.
Rohlf, H. L., Holl, A. K., Kirsch, F., Krahe, B., & Elsner, B. (2018). Longitudinal links between executive function, anger, and aggression in middle childhood. Frontiers in Behavioral Neuroscience, 42(2), 257–266.
Rojahn, J., Matson, J. L., Mahan, S., Fodstad, J. C., Knight, C., Sevin, J. A., & Sharp, B. (2009). Cutoffs, norms, and patterns of problem behaviors in children with ASD on the baby and infant screen for children with aUtIsm traits (BISCUIT—part 3). Research in Autism Spectrum Disorders, 3(4), 989–998.
Sikora, D. M., Vora, P., Coury, D. L., & Rosenberg, D. (2012). Attention deficit/hyperactivity disorder symptoms, adaptive functioning, and quality of life in children with autism spectrum disorder. Pediatrics, 130(2), 91–97.
Stadnick, N., Chlebowski, C., Baker-Ericzen, M., Dyson, M., Garland, A., & Brookman-Frazee, L. (2017). Psychiatric comorbidity in autism spectrum disorder: correspondence between mental health clinician report and structured parent interview. Autism, 21(7), 841–851.
Tseng, W., Kawabata, Y., Gau, S. S., Banny, A. M., Lingras, K. A., & Crick, N. R. (2012). Relations of inattention and hyperactivity/impulsivity to preadolescent peer functioning: the mediating roles of aggressive and prosocial behaviors. Journal of Clinical Child & Adolescent Psychology, 41(3), 275–287.
Tureck, K., Matson, J. L., Cervantes, P., & Turygin, N. (2015). Autism severity as a predictor of inattention and impulsivity in toddlers. Developmental Neurorehabilitation, 18, 285–289.
Vora, P., & Sikora, D. (2011). Society for developmental and behavioral. San Antonio: Pediatrics.
Wassenberg, R., Feron, F. J. M., Kessels, A. G. H., Hendriksen, J. G. M., Kalff, A. C., & Kroes, M. (2005). Relation between cognitive and motor performance in children: results from a large-scale cross-sectional study. Child Development, 76, 1092–1103.
Wetherby, A. M., Guthrie, W., Woods, J., Schatschneider, C., Holland, R. D., Morgan, L., & Lord, C. (2014). Parent-implemented social intervention for toddlers with autism: an RCT. Pediatrics, 134(6), 1084–1093.
Woods, J. J., & Wetherby, A. M. (2003). Early identification of and intervention for infants and toddlers who are at risk for autism spectrum disorder. Language, Speech, and Hearing Services in Schools, 34, 180–193.
Xu, G., Strathearn, L., Liu, B., & Bao, W. (2018). Prevalence of autism spectrum disorder among US children and adolescents, 2014–2016. The Journal of the American Medical Association, 319(1), 81–82.
Yerys, B. E., Wallace, G. L., Sokoloff, J. L., Shook, D. A., James, J. D., & Kenworthy, L. (2009). Attention deficit/hyperactivity disorder symptoms moderate cognition and behavior in children with autism spectrum disorders. Autism Research, 2(6), 322–333.
Conflicts of Interest
Mrs. Deann Matson, Dr. Johnny L. Matson’s spouse, is the sole owner of the Baby and Infant Screen for Children with aUtIsm Traits (BISCUIT) and sells the scale. Celeste Tevis, Megan Callahan, Michaela Brown, and Esther Hong declare that they have no conflict of interest.
The use of EarlySteps data in this study was approved by both the Louisiana State University Institutional Review Board (IRB) and the State of Louisiana’s Office for Citizens with Developmental Disabilities (OCDD) IRB and with the 1964 Helsinki declaration.
Both IRB’s determined that informed consent to participate in research was not required, as personal identifiers (e.g., name, date of birth) were removed from the record by OCDD prior to receipt by the researchers.
About this article
Cite this article
Tevis, C., Matson, J.L., Brown, M. et al. The Effects of Inattention/Impulsivity and Aggression on the Development of Toddlers with Autism Spectrum Disorder. J Dev Phys Disabil 33, 741–756 (2021). https://doi.org/10.1007/s10882-020-09770-w
- Developmental functioning