Explosive, oppositional, and aggressive behavior in children with autism compared to other clinical disorders and typical children

https://doi.org/10.1016/j.rasd.2011.08.001Get rights and content

Abstract

Maternal ratings of explosiveness, opposition, and aggression were analyzed in 1609 children 6–16 years of age. Behavior problems were common in autism, ADHD-Combined type, and depression, whereas children with ADHD-Inattentive type, anxiety disorder, and acquired brain injury did not differ from typical controls. More than 40% of children with autism, ADHD-Combined type, and depression met criteria for oppositional-defiant disorder (ODD), and less than 15% did in the other groups. Male gender and low SES increased the risk of behavior problems, but correlations were small between behavior problems and age and IQ. Our findings have implications for new DSM-V diagnostic categories and criteria. The DSM-V needs to clarify whether or not an additional diagnosis of ODD should be made in children with autism who meet ODD criteria. The proposed DSM-V states that ADHD and temper dysregulation disorder with dysphoria not be diagnosed in autism, but does not mention ODD. Our study also suggests that diagnoses of temper dysregulation disorder with dysphoria and prepubertal bipolar disorder may be redundant to a diagnosis of ODD.

Highlights

► Behavior problems are common in autism, ADHD-Combined type, and depression. ► Children with ADHD-Inattentive type, anxiety, and brain injury do not differ from controls. ► Behavior problems are associated with male gender and low SES but not IQ and age. ► Our findings have implications for new DSM-V diagnostic categories and criteria.

Section snippets

Comorbidity in autism

Comorbidity is common in autism, and children with autism are at high risk for a variety of problems in addition to the symptoms of autism specified by the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV, American Psychiatric Association, 2000). In comparison to the norm, children with autism have significantly more opposition and aggression (Brereton et al., 2006, Gadow et al., 2005), oppositional-defiant disorder (ODD) symptoms (Guttmann-Steinmetz, Gadow, & DeVincent, 2009),

Purpose

Comorbid psychiatric disorders in individuals with autism are difficult to diagnose and are often unrecognized clinically (Leyfer et al., 2006). Much remains to be learned about comorbidity in autism (Brereton et al., 2006, Leyfer et al., 2006, Matson and Nebel-Schwalm, 2007, Sukhodolsky et al., 2008), particularly understanding the impact of comorbid behavior problems in the phenomenology, treatment, and natural history of autism (Gadow, DeVincent, & Schneider, 2008). Our study is the first to

Sample

The sample of 1609 children 6–16 years of age consists of 302 children with high functioning autism (HFA, IQ ≥ 80), 133 children with low functioning autism (LFA, IQ < 80), 186 typical children, and 988 children with other clinical disorders including ADHD-Combined type (ADHD-C), ADHD-Inattentive type (ADHD-I), anxiety disorders, depression, and acquired brain injury (e.g., closed head injury, brain tumor, or hydrocephalus). IQ tests administered were the Wechsler Intelligence Scale for

Behavior problem scores

Behavior problem scores did not differ significantly between LFA and HFA, ADHD with versus without an IQ < 80, and depression with versus without anxiety (Bonferroni p > .89), so these subgroup pairs were collapsed for the statistical analyses. As shown in Table 2, mean total behavior problem scores were more than one standard deviation above the typical children's mean for children with autism, ADHD-C, and depression. Children with anxiety alone, ADHD-I, and brain injury earned mean scores within

Discussion

Our study is the first to compare behavior problems in a large sample of children with high and low functioning autism, children who have a variety of other clinical disorders, and typical children, yielding some very interesting results that increase our understanding of autism and have implications for the DSM.

Acknowledgements

We wish to thank Autism Speaks (Grant #2529) and the Children's Miracle Network for their support of this study.

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