Gender effects on challenging behaviors in children with autism spectrum disorders
Highlights
► Children with autism spectrum disorders (ASD) often exhibit concomitant challenging behaviors (CB), with numerous factors affecting the presence of these behaviors. ► Controversy exists regarding whether gender affects the presence of CB in individuals with ASD. ► We examined the effects of gender and diagnostic group (ASD and non-ASD) on CB in children. ► In general, children with ASD exhibited significantly more CB than those without ASD, but gender did not affect the presence of CB in children overall. ► On CB that did differ, effect size estimates indicated only a minimal to small effect.
Introduction
Autism Spectrum Disorders (ASDs) are a set of neurodevelopmental disorders that are typically diagnosed within the first few years of life. These diagnoses include Autistic Disorder, Asperger's Disorder, Rett's Disorder, Childhood Disintegrative Disorder, and Pervasive Developmental Disorder Not Otherwise Specified (PDD-NOS) (Cederlund et al., 2010, Matson and Dempsey, 2009, Smith and Matson, 2010a, Smith and Matson, 2010b, Smith and Matson, 2010c). The core features of these disorders include marked deficiencies in socialization and communication skills in addition to the presence of restricted interests and repetitive behaviors (Brereton et al., 2006, Chowdhury et al., 2010, Lennen et al., 2010, Matson et al., 2009b, Matson and LoVullo, 2008, Matson et al., 2010c, Tidmarsh and Volkmar, 2003, Ward and Gilmore, 2010, Wichnick et al., 2010). In addition, as discussed by Matson and Nebel-Schwalm (2007), the presence of challenging behaviors is a major component of ASDs and should be considered in the diagnosis and treatment process. Research regarding the prevalence of challenging behaviors has shown that those with a diagnosis of an ASD are more likely to engage in challenging behaviors as compared to typically and atypically developing peers without an ASD diagnosis (Hartley et al., 2008, Horovitz et al., 2011, Matson et al., 2009d). Self-injury, aggression, non-compliance, stereotypies, and compulsions are just some examples of the types of challenging behaviors associated with ASDs that have been described in the literature (Baker et al., 2003, Bodfish et al., 2000, Dawson et al., 1998, Duncan et al., 1999, Matson et al., 1997a, Matson et al., 1997b, Matson and Nebel-Schwalm, 2007, Paclawskyj et al., 1997).
Several types of challenging behaviors and risk factors have been studied in relation to individuals diagnosed with an ASD. Severity of ASD symptoms has been shown to be related to the frequency and intensity of challenging behaviors as well as the presence of multiple challenging behaviors (Matson et al., 2009d), with example prevalence rates reported between 64.3% and 93.7% for the presence of any challenging behavior (McTiernan et al., 2011, Murphy et al., 2009) and rates at or above 50% for self-injurious, aggressive, and stereotyped behaviors (Baghdadli et al., 2003, McTiernan et al., 2011). Factors that have been studied in relation to challenging behaviors in those with ASDs have included gender, race, age, and level of intellectual functioning. Baker et al. (2003) stated that children with developmental delays are three times more likely to be in the clinical range on assessments for problem behaviors and have higher scores for both internalizing and externalizing behaviors than same aged peers. Additional research regarding increases in internalizing and externalizing behaviors in children diagnosed with an ASD support these findings (Brereton et al., 2006, Eisenhower et al., 2005). Comorbid psychopathologies that are common among individuals with ASDs, as well as those with intellectual disability, can also increase the likelihood of challenging behaviors (Crocker et al., 2006, Holtmann et al., 2007, Shattuck et al., 2007).
Previously, researchers have evaluated the rates of challenging behaviors in infants and toddlers with Autistic Disorder, PDD-NOS, and atypical development (Kozlowski & Matson, 2012). Kozlowski and Matson (2012) found no significant differences between genders in endorsements of challenging behaviors. However, for typically developing children, Alink et al. (2006) reported that boys were more aggressive than girls at 24 and 36 months of age. No differences were found between boys and girls at 12 months of age, and physical aggression tended to decrease for both genders after the children's 3rd birthdays, although males tended to maintain higher rates of aggression overall. Other researchers reported that, in typically developing children, girls have a decrease in aggression between the ages of 5 and 11 years with 2.3% and 0.5% prevalence rates, respectively, whereas boys remain relatively stable between the same ages (3.7% prevalence rate) (Lee, Baillargeon, Vermunt, Wu, & Tremblay, 2007).
The results of research studies regarding individuals with an ASD diagnosis have been mixed. In a meta-analytic study of children and adults spanning over 30 years, McClintock, Hall, and Oliver (2003) found that persons with an ASD diagnosis were more likely to display challenging behaviors such as self-injury, aggression, and disruption to the environment when compared to those without an ASD diagnosis. They also found that males with ASD were significantly more likely than females with ASD to display aggressive behaviors. These findings have also been supported by other researchers in regard to aggression in adults with ASD (Tyrer et al., 2006) and overall challenging behaviors in toddlers, school-aged children, adolescents, and adults diagnosed with an ASD (Baghdadli et al., 2003, Baker et al., 2003, Bradley et al., 2004, Eisenhower et al., 2005, Hartley et al., 2008, Horovitz et al., 2011, Matson et al., 2009d). Additional research on challenging behaviors has shown mixed results but with a slightly elevated frequency or severity of maladaptive behaviors in 6–18 year old females with an ASD diagnosis (Gadow et al., 2005, Holtmann et al., 2007, Nyden et al., 2000). Increases in property destruction and sexual aggression for older males and increases in self-injurious behaviors for female adults with an intellectual disability have also been noted (Crocker et al., 2006). Other researchers have reported no differences between genders in rates of challenging behaviors for adults with ID (Hemmings, Gravestock, Pickard, & Bouras, 2006) or in persons with ASD ranging from 1 to 52 years of age (Baghdadli et al., 2003, Hartley et al., 2008, McTiernan et al., 2011, Murphy et al., 2009, Shattuck et al., 2007).
The pattern and development of challenging behaviors in children and adults with ASDs is still not well understood or fully researched. This picture is further distorted due to the high level of comorbid psychopathologies and related disorders associated with ASDs (Matson et al., 2010b, Matson and Shoemaker, 2010). The aim of this current study was to examine the effects of gender on challenging behaviors in children with ASDs and assist in clarifying the discrepancies found between studies.
Section snippets
Participants
Three hundred ninety-one children, ages 2 through 17 years (M = 8.10, SD = 3.55), and their parents/legal guardians participated in the current study. Child participants were recruited from a variety of sources from 16 states in the United States of America, including outpatient clinics, schools, and parent advocacy and support groups. Parents/legal guardians consisted mainly of biological mothers (50.38%), but also included biological fathers (3.32%), adoptive/step parents (1.53%), and
Results
The MANCOVA for the externalizing challenging behaviors had a main effect of group, Wilks’ Λ = 0.751, F (21, 1092) = 5.44, p < 0.001, partial η2 = 0.09. The covariate, age, was also significant, Wilks’ Λ = 0.916, F (7, 380) = 4.96, p < 0.001. Follow-up ANCOVAs were significant for all externalizing challenging behaviors: harming self by hitting, pinching, scratching, etc. [F(3, 386) = 15.20, p < 0.001, partial η2 = 0.11]; kicking objects [F(3, 386) = 8.28, p < 0.001, partial η2 = 0.06]; throwing objects at others [F(3,
Discussion
ASD are not characterized by the presence of challenging behaviors (Matson et al., 2010a, Matson et al., 2010b, Matson et al., 2010d); however, these behaviors are prevalent within the ASD population (Matson and Smith, 2008, Rojahn et al., 2003). It is critical that factors associated with challenging behaviors are documented in an effort to assist in identification and then treatment of these behaviors (Matson et al., 1999, Matson and Wilkins, 2008, Peters-Scheffer et al., 2010). This is
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