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Does the Collaborative and Proactive Solutions Model Explain Aggressive Behavior in Children with Autism Spectrum Disorder without Intellectual Disability?
Aggression in children with autism spectrum disorder (ASD) is common, with 68% showing aggression toward family members and 49% toward non-family members at some point during their lifetime. Importantly, IQ is not correlated with aggression, highlighting that children with ASD without an intellectual disability (ID) exhibit high levels of aggression. This is a significant problem as aggressive behavior requires higher levels of psychiatric care and places both the aggressor and their target at risk for physical injury. In school-age children without ASD or ID, there is an evidence-based cognitive behavioral treatment for aggression – Collaborative & Proactive Solution (CPS) – that posits a model of five lagging skills that contribute to aggressive and challenging behaviors. This model specifies impairments in executive function (EF), language, emotion regulation (ER), cognitive flexibility, and social skills as contributors to aggression. No studies have looked at whether the CPS model explains aggression in school-age children with ASD without ID.
Objectives:
To evaluate the CPS model in school-age children with ASD without ID.
Methods:
A sample of 147 children with ASD participated in this study (Mean age=9 years, 2 months; Full-Scale IQ=101.37). ASD was diagnosed using DSM-IV criteria and confirmed with ADI-R/ADOS. All measures are parent-report. Aggression was quantified using the Behavioral Assessment System for Children, Second Edition (BASC-2) Aggression subscale. The EF domain included the Behavior Rating Inventory of Executive Function (BRIEF) Inhibition, Shifting, Working Memory, and Planning scales. The Language domain included the Vineland Adaptive Behavior Scales, 2nd Edition Receptive and Expressive Language scales. The ER domain included the BRIEF Emotional Control scale and the BASC-2 Anxiety and Depression scales . The Cognitive Flexibility domain included the Repetitive Behaviors Scale-Revised Compulsive, Ritual, and Sameness scales. The Social Skills domain included the BRIEF Monitor scale, BASC-2 Social Skills scale, and the Social Responsiveness Scale’s Total score. We examined whether each domain successfully predicted aggression above and beyond age and IQ. We also examined the independent contribution of each domain, relative to the other four domains.
Results:
Children with ASD had a mean Aggression T-score of 52.22 (Range 35-97; SD=10.91), with 23.8% having scores in the borderline range (T>60) and 6.8% in the clinical range (T>70). Linear regressions showed that all CPS domains explained significant variance in aggression above age and IQ (R2Δs=.09 to .39). The total CPS model explained almost half of the variance related to aggression (R²=.473, Adjusted R²=.402), and showed significance for unique variance in EF (R²Δ=.041) and ER (R²Δ=.147). Within these two domains, the BRIEF Inhibit Scale and BASC-2 Depression Scale explained a significant amount of variance.
Conclusions:
This study shows that impairments in EF and ER domains relate to aggression in school-age children with ASD without ID. Our results validate the CPS model of aggression. Future studies should test whether the CPS treatment is effective for reducing aggression and challenging behaviors in children with ASD without ID.