Predicting Externalizing Behavior in Children with An Autism Spectrum Disorder Using the Child Routines Questionnaire

Background: There is a widely held belief that providing daily routines reduces acting out behaviors for individuals with an autism spectrum disorder (ASD).  In the literature, this idea is supported by numerous qualitative accounts of the effectiveness of routines in decreasing behavior problems.  The use of routines has also been incorporated as a part of interventions that attempt to decrease the symptoms of autism (for example:  Marquenie, et al., 20011;  Laushey, et al., 2009).  One measure that provides quantitative data about routines is the Child Routines Questionnaire (CRQ; Jordan, 2003; Sytsma et al., 2001).  In typically developing children this measure has been shown to effectively predict externalizing behaviors (e.g., aggression, defiance).  In one of the only quantitative studies of routines in autism, a group of typically developing children was compared to a group of children with an ASD.  The researchers found that the CRQ score was not associated with less externalizing behavior in children with an ASD relative to the typical developing children (Henderson et al., 2011).  

Objectives: This study builds on previous research by Henderson et al. by using the CRQ to investigate the relation between daily routines and externalizing behaviors in children with an ASD.  It is especially interesting to understand how routines are important in various psychopathologies in children, as it has been shown that routines decrease symptomatology in children receiving psychological services (Ivanova & Israel, 2006) Thus, ADHD has been used as a comparison group for a sample of individuals with PDD NOS since children with ADHD often show higher levels of externalizing behavior secondary to their diagnosis.

Methods: Children admitted to a child psychiatric inpatient unit and their families were invited to participate in the study.  The sample consisted of 58 individuals with PDD NOS and a comparison group  of children with ADHD that was randomly selected and matched for age and sex to the PDD NOS group.

Results: Multiple regression analyses were used to examine the relation between CRQ, diagnostic status, and mother's irascibility to predict externalizing behavior.  The results suggested that all three variables were significant predictors of child externalizing behavior.   Thus, the CRI was examined further as a moderator of the relation between diagnostic status and externalizing behavior problems.  More specifically, it was found that the PDD group responded to increased routines as measured by the CRI with less externalizing behavior relative to the children with ADHD .  It was also found that mother's irascibility was a partial mediator of the relationship between diagnosis and CRI score. 

Conclusions: While it remains unclear if routines decrease externalizing behaviors in typically developing children more than in children with ASD, it is clear that routines do have an effect on externalizing behaviors especially when those with ADHD are compared to children with ASD.  In addition the emotional distress, specifically, irascibility of mothers is an important aspect of the relation between routines and externalizing behaviors.  More research is needed to clearly explain these relations using objective measures of routines and externalizing behaviors in children with ASD.