Internalizing and Externalizing Behaviors in Children with ASD

Saturday, May 19, 2012
Sheraton Hall (Sheraton Centre Toronto)
9:00 AM
C. Manangan1, H. N. Liming1, H. Dauterman1, B. J. Wilson1 and K. Reynolds2, (1)Clinical Psychology, Seattle Pacific University, Seattle, WA, (2)Seattle Pacific University, Seattle, WA

Behavioral profiles of children with clinical disorders are frequently utilized in case conceptualization and treatment.  Problem behaviors are most commonly understood as falling into either externalizing or internalizing categories.  Children with autism spectrum disorder (ASD) commonly present with co-occurring attention deficit/hyperactivity disorder (ADHD) symptoms (Aman & Langworthy, 2000; Ghaziuddin et al, 1998; Lee & Opal, 2006). In comparison to typically developing children, children with ASD-only and children with ADHD-only have increased rates of both internalizing and externalizing behaviors (De Pauw & Mervielde, 2010; Kim, Szatmari, Bryson, Streiner, & Wilson, 2000; Kuhlthau et al, 2010). However no research has been conducted to compare internalizing and externalizing behavior profiles among children with: a) typical development, b) typical development and ADHD symptoms, c) ASD, and  d) ASD and ADHD symptoms.   


This study sought to discern manifestations of internalizing and behavioral symptoms in typically developing children (TD), children with ASD, and TD and ASD children with co-occurring ADHD symptoms. 


Sixty-three children between the ages of 3:0 and 6:11 years old, parents, and teachers participated in this study.  Parents completed the Conners’ Parent Rating Scale – Revised (Conners, 1997) to assess children’s ADHD symptoms.  Teachers completed the Behavior Assessment System for Children, Second Edition (BASC-2) to evaluate externalizing and internalizing symptoms.  Based on developmental status (ASD vs ADHD) and the presence of clinically significant ADHD symptoms, we created four distinct groups: ASD, ASD + ADHD, TD, and TD + ADHD. These groups were then compared on their symptoms of internalizing and externalizing behaviors.


A series of one-way analysis of variance (ANOVA) were conducted to examine group differences in externalizing and internalizing symptoms.  The overall tests for group difference in depressive symptoms (F = [3, 59] = 19.75, p < .001), aggressive behaviors (F = [3, 59] = 6.60, p < .001), and hyperactivity (F = [3, 59 = 11.89, p < .001), were significant.

Post hoc analyses were conducted to examine pairwise differences via Bonferroni test. Group means for depressive symptoms for children in the ASD + ADHD were significantly greater than group means for children in the TD group (p < .001), TD + ADHD group (p < .001), and the ASD group (p = .03).  For aggressive behaviors, group means for the ASD + ADHD group was significantly greater than for the TD group (p < .001).  Hyperactivity mean scores were significantly lower in the TD group than the ASD group (p = .02) and the ASD+ADHD group (p = .003).


These findings support and extend previous research demonstrating that children with ASD combined with ADHD symptoms demonstrate significant challenges in both internalizing (depressive) and externalizing (aggressive and hyperactive) symptoms. Additionally, children with ASD, with and without ADHD symptoms, demonstrate heightened levels of hyperactivity.  These findings contribute to discerning behavioral symptoms associated ASD with and without ADHD symptoms.

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