Problem Behaviors in Autism Spectrum Disorder: Is Communication a Specialized Adapting/Coping Mechanism?

Background: The inability of an individual to clearly communicate wants/needs is thought to lead to problem behaviors such as self-injurious behavior (SIB), aggression, temper tantrums, and noncompliance (Ganz et al., 2009; Hartley et al., 2008). Even though a number of studies support the association between problem behaviors and language/communication skills in children with autism spectrum disorder (ASD), this has not been a universal finding (e.g., Chiang, 2008). Problem behaviors have also been characterized as “coping behaviors” (Groden et al., 1994), meaning they are not necessarily externally-directed communication but are responses to perceived increases in undesirable physiological reactions. According to this framework, development of a more appropriate means of communication would be considered as establishing a specialized adapting/coping mechanism (Ladd, 2007).

Objectives: Data from the Autism Inpatient Collection (AIC) was used to examine the proposal that communication is a specialized adapting/coping behavior with the related expectation that measures of socially-acceptable coping skills would be inversely related to the frequency of problem behaviors and would be more predictive of the severity and frequency of problem behaviors than communication ability.

Methods: Participants were 346 psychiatric inpatients with ASD supported by research-reliable ADOS-2, divided into verbal-ability groups based on their required ADOS-2 module [169 minimally-verbal (MV; Modules 1 and 2) and 177 fluently-verbal (FV; Modules 3 and 4)], aged 4 to 21-years [MV Mean = 13.0 (SD 3.7); FV Mean = 12.8 (SD 2.8)]. Dependent measures included the Repetitive Behavior Scale-Revised, Aberrant Behavior Checklist Stereotypy and Irritability subscales, and Vineland Adaptive Behavior Scale-II Externalizing subscale (VABS-II). Independent measures, in addition to verbal ability category and age, included NVIQ (Leiter International Performance Scale – Third Edition), and VABS-II Adapting/Coping subdomain (30-item scale including items such as manners, adherence to rules, and flexibility; higher scores indicate greater ability to flexibly adapt to environmental demands.) ANCOVA was used to compare the mean of problem behavior severity for each dependent variable between MV and FV participants with NVIQ and age as covariates. A series of hierarchical linear regressions were conducted to determine the incremental explanatory power of each independent variable, which were entered separately in their own step, in the following order: age, NVIQ, verbal ability, and VABS Adapting/Coping.

Results: The severity of SIB, stereotyped behavior, and irritability (including aggression and tantrums) did not significantly differ between MV and FV, when controlling for age and NVIQ. Adapting/coping was a significant predictor in every regression model, accounting for a significant amount of variance above and beyond age, NVIQ, and verbal ability. Lower adapting/coping scores were associated with greater problem behaviors. Verbal ability accounted for an additional 21.3% of the variance in Externalizing problems above and beyond age and NVIQ IQ, but it did not account for a significant amount of additional variance for any other problem behavior.

Conclusions: Increasing severity of each type of problem behavior was significantly associated with lower adapting/coping scores, even when accounting for verbal ability. Interventions may need to focus on the development of adapting/coping mechanisms to mitigate problem behaviors in individuals with ASD.