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Assessing the Relationship Between Verbal Ability and Problem Behavior Among Children with Autism Spectrum Disorder
The verbal ability of children with Autism Spectrum Disorder (ASD) is an important criterion for clinicians in selecting treatment strategies for problem behaviors. Available research literature has, to date, offered conflicting evidence on the relationship of verbal ability and problem behaviors in children with ASD, with varying results by age and ASD severity. There is also preliminary evidence that self-injury and aggression/tantrums, which are typically lumped together in treatment trial measurement, may have differential responses.
Objectives:
To analyze the relationship between verbal ability and the type, severity and frequency of problem behaviors, and to explore for potential variation of this relationship within models using the Aberrant Behavior Checklist – Irritability subscale (ABC-I) Self-Injurious Behavior (SIB) and Tantrum Behavior (TB) subdomains.
Methods:
Seventy-eight children and adolescents with ASD admitted to a specialized inpatient psychiatry unit were prospectively enrolled and a consistent parent was administered the ABC-I at admission, discharge, and 2-month follow-up. The subject’s verbal ability was coded as non-verbal, limited verbal, or fluent verbal by a speech-language pathologist based upon caregiver information and extensive direct observation. Type and frequency of problem behaviors (i.e., aggression, self-injury, and tantrums) were recorded every 15 minutes by direct care staff. Model testing was conducted using multi-level models repeated measure analyses to examine differences in problem behaviors by verbal ability groups. Covariates included in the model were age, sex, intellectual disability, length of stay, number of behaviors of clinical concern, and number of medications.
Results:
A majority of the subjects were Caucasian (91%) males (81%) averaging 12.4 years old (SD=3.42, range=6-20) with fluent verbal ability (55.1%), limited verbal ability (26.9%) or non-verbal (17.9%) status. Forty-five percent of subjects had Intellectual Disability (ID) and the average length of inpatient stay was 52.27 days (SD=29.41, range=8-174). A significantly lower proportion of subjects with fluent verbal ability had intellectual disability (p=0.049), had a shorter length of stay (p=0.002), presented with fewer behavioral problems (p=0.027) and engaged in fewer self-injurious behaviors (SIB) (p=0.001) and pica (ingesting non-food objects) (p=0.001) than non-verbal and limited verbal groups. Parents reported a significant decrease in their child’s overall problem behavior between admission, discharge and 2-month follow-up, (see Table 1 for complete model results), though this difference did not significantly vary between verbal ability groups, (see Figure 1). Examination of the ABC-I SIB subdomain indicated a significant effect for both time (admission and discharge only) and by verbal ability group with fluent verbal patients having significantly less SIB compared to non-verbal patients (p<0.001). The ABC-I TB subdomain indicated a significant effect for time only (all three time points), p<0.001.
Conclusions:
Findings suggest that children in a specialized inpatient psychiatry unit reported a significant reduction in their child’s overall problem behavior on the ABC-I from admission to 2-months post-discharge, regardless of the child’s verbal ability. There appears to be important differences, however, in the response of self-injurious behavior based on verbal ability, which are not seen in the aggression/tantrum behaviors. Change in the SIB subdomain of the ABC-I is significantly affected by verbal ability.