Gender effects on challenging behaviors in children with autism spectrum disorders

https://doi.org/10.1016/j.rasd.2011.12.011Get rights and content

Abstract

Challenging behaviors are extremely prevalent within the autism spectrum disorder (ASD) population. To date, numerous factors affecting the rates of challenging behaviors within the ASD population have been examined including age, gender, ethnicity, and intellectual functioning. Controversy has arisen in regard to the effect of gender on challenging behaviors rates in individuals with ASD with some researchers finding differences while others do not. The aim of the current study was to examine the gender effects of children and adolescents with ASD on challenging behavior rates in an effort to assist in clarifying this relationship. Three hundred ninety-one children ages 2 through 17 years participated in the current study and were assigned to one of four groups: male with ASD, male without ASD, female with ASD, and female without ASD. Differences in rates of challenging behaviors between the groups were examined using the Autism Spectrum Disorder-Behavior Problems for Children. Overall, gender was not found to have an effect on the rates of challenging behaviors among children and adolescents with or without ASD. The implications of this finding are discussed along with possible future avenues of investigation.

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

References (64)

  • J.L. Matson et al.

    Reliability of the Autism Spectrum Disorders-Diagnostic for Children (ASD-DC)

    Research in Autism Spectrum Disorders

    (2008)
  • J.L. Matson et al.

    Characteristics of stereotypic movement disorder and self-injurious behavior assessed

    Research in Developmental Disabilities

    (1997)
  • J.L. Matson et al.

    Comorbid psychopathology in infants and toddlers with autism and Pervasive Developmental Disorder – Not Otherwise Specified (PDD-NOS)

    Research in Autism Spectrum Disorders

    (2010)
  • J.L. Matson et al.

    The effect of stereotypies on adaptive skills as assessed with the DASH-II and Vineland Adaptive Behavior Scales

    Research in Developmental Disabilities

    (1997)
  • J.L. Matson et al.

    Identifying feeding problems in mentally retarded persons: Development and reliability of the Screening Tool of fEeding Problems (STEP)

    Research in Developmental Disabilities

    (2001)
  • J.L. Matson et al.

    Effect of developmental quotient on symptoms of inattention and impulsivity among toddlers with autism spectrum disorders

    Research in Developmental Disabilities

    (2010)
  • J.L. Matson et al.

    Convergent validity of the Autism Spectrum Disorder-Diagnostic for Children (ASD-DC) and Childhood Autism Rating Scale (CARS)

    Research in Autism Spectrum Disorders

    (2010)
  • J.L. Matson et al.

    Assessing challenging behaviors in children with autism spectrum disorders: a review

    Research in Developmental Disabilities

    (2007)
  • J.L. Matson et al.

    Current status of intensive behavioral interventions for young children with autism and PDD-NOS

    Research in Autism Spectrum Disorders

    (2008)
  • J.L. Matson et al.

    Antypsychotic drugs for aggression in intellectual disability

    The Lancet

    (2008)
  • A. McTiernan et al.

    Analysis of risk factors and early predictors of challenging behavior for children with autism spectrum disorder

    Research in Autism Spectrum Disorders

    (2011)
  • O. Murphy et al.

    Risk factors for challenging behaviors among 157 children with autism spectrum disorder in Ireland

    Research in Autism Spectrum Disorders

    (2009)
  • T.R. Paclawskyj et al.

    A comparison of the Diagnostic Assessment for the Severely Handicapped-II (DASH-II) and the Aberrant Behavior Checklist (ABC)

    Research in Developmental Disabilities

    (1997)
  • N. Peters-Scheffer et al.

    Low intensity behavioral treatment supplementing preschool services for young children with autism spectrum disorders and severe to mild intellectual disability

    Research in Developmental Disabilities

    (2010)
  • J. Rojahn et al.

    The Aberrant Behavior Checklist and the Behavior Problems Inventory: convergent and divergent validity

    Research in Developmental Disabilities

    (2003)
  • K.R.M. Smith et al.

    Behavior problems: differences among intellectually disabled adults with co-morbid autism spectrum disorders and epilepsy

    Research in Developmental Disabilities

    (2010)
  • K.R.M. Smith et al.

    Psychopathology: differences among adults with intellectually disabled, comorbid autism spectrum disorders and epilepsy

    Research in Developmental Disabilities

    (2010)
  • K.R.M. Smith et al.

    Social skills: differences among adults with intellectual disabilities, co-morbid autism spectrum disorders and epilepsy

    Research in Developmental Disabilities

    (2010)
  • S.L. Ward et al.

    The Autistic Behavioural Indicators Instrument (ABII): development and instrument utility in discriminating autistic disorder from speech and language impairment and typical development

    Research in Autism Spectrum Disorders

    (2010)
  • A.M. Wichnick et al.

    The effect of a script-fading procedure on unscripted social initiations and novel utterances among young children with autism

    Research in Autism Spectrum Disorders

    (2010)
  • L.R.A. Alink et al.

    The early childhood aggression curve: development of physical aggression in 10–50-month-old children

    Child Development

    (2006)
  • A. Baghdadli et al.

    Risk factors for self-injurious behaviours among 222 young children with autistic disorders

    Journal of Intellectual Disability Research

    (2003)
  • Cited by (0)

    View full text