The Autism Inpatient Collection (AIC): Problem Behaviors and Communication Difficulties

Friday, May 15, 2015: 11:30 AM-1:30 PM
Imperial Ballroom (Grand America Hotel)
D. L. Williams1, K. A. Smith2, C. A. Mazefsky3, R. Gabriels4, C. Peura5 and M. Siegel6, (1)Duquesne University, Pittsburgh, PA, (2)Maine Medical Center Research Institute, Portland, ME, (3)Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, (4)Children's Hospital Colorado, Aurora, CO, (5)Spring Harbor Hospital, Westbrook, ME, (6)Maine Medical Center Research Institute, Westbrook, ME
Background: Problem behaviors are linked to the level of language/communication skills in children with autism spectrum disorders (ASD). Previous studies, however, have primarily included school-enrolled children with limited representation of children with a range of skills. The Autism Inpatient Collection (AIC) provides rigorous phenotypic and biological data on a large cohort of children and adolescents with the full spectrum of ASD characteristics, allowing a more full examination of the relationship between problem behaviors and communication skills in ASD.

Objectives: The language/communication profile and problem behavior rates of inpatients with ASD were examined based on verbal level.

Methods: Participants were 105 children and adolescents aged 4-20 years, admitted to six specialized inpatient psychiatry units and prospectively enrolled in a study performing phenotypic assessment and collection of biological samples.  All subjects scored ≥12 on the Social Communication Questionnaire (SCQ) before study enrollment.  ASD diagnosis was confirmed by ADOS-2 administration by a research-reliable examiner and extensive inpatient observation by expert clinicians.  Other measures included the Aberrant Behavior Checklist (ABC), Repetitive Behavior Scale - Revised, Leiter-3, and Vineland-2. 

Results: Participants were categorized based on the administered ADOS module [Modules 1/2 = Low Verbal (LV), n=58; Modules 3/4 = Verbal (V), n=47]. The groups did not differ significantly in age [LV Mean age 12.58 years (SD 3.61), range 5.77-20.08; V Mean age 12.77 (SD 3.37), range 4.58-17.92, t(103)=-.272, p=.787]. They were similar in gender (LV=25.9%; V=23.4% female), race (LV=77.6%; V = 78.7% Caucasian), and ethnicity (LV=92.2%; V=90.0% non-Hispanic/non-Latino). The groups were significantly different in mean non-verbal IQ [LV Mean 49.47 (SD 17.65), range 30-99; V Mean 94.35 (SD 22.52), range 35-135; t(81)=-10.15, p<.0001]; mean SCQ total score [LV Mean 26.36 (SD 5.34); V Mean 21.52 (SD 5.89); t(90)=4.13, p<.0001]; and, mean Vineland-2 receptive communication score [LV Mean 6.29 (SD 2.89); V Mean 8.13 (SD 1.85), t(69)=-3.09, p=.003] and expressive communication score [LV Mean 4.10 (SD 2.78); V Mean 9.50 (SD 3.07); t(67)=-.759, p>.0001]. Initial analyses of measures of problem behavior indicated that the groups did not differ on mean ABC-Irritability scores [LV Mean 28.13 (SD 10.87); V Mean 24.93 (SD 13.17), t(99)=1.34, p=1.85] but did differ significantly on mean ABC-Stereotypic behavior scores [LV Mean 10.15 (SD 6.36); V Mean 6.04 (SD 5.87), t(99)=3.34, p=.001] and mean for self-injurious behavior subscale from the RBS-R [LV Mean 9.75 (SD 6.02); V Mean 7.00 (SD 5.41), t(88)=2.24, p=.028]. Sixty-three percent of the children who were Low Verbal were reported to use a communication system; 55.2% of these used the Picture Exchange Communication System (PECS); 24.1% used sign language; and, 37.3% used a voice output device.

Conclusions: This cohort of children and adolescents with ASD have a high proportion of significant cognitive and spoken language impairment. Children with more limited verbal skills had more stereotypical and self-injurious behaviors as compared to children with fluent speech. In addition, only about half of the participants with limited verbal skills were reported to use a method of augmented communication, a variable that should be further examined with respect to problem behaviors.