Many children with autism spectrum disorder display challenging behaviors. These behaviors are not limited to those with cognitive and/or language impairments. The Collaborative and Proactive Solutions framework proposes that challenging behaviors result from an incompatibility between environmental demands and a child’s “lagging skills.” The primary Collaborative and Proactive Solutions lagging skills—executive function, emotion regulation, language, and social skills—are often areas of weakness for individuals with autism spectrum disorder. The purpose of this study was to evaluate whether these lagging skills are associated with challenging behaviors in youth with autism spectrum disorder without intellectual disability. Parents of 182 youth with autism spectrum disorder (6–15 years) completed measures of their children’s challenging behaviors, executive function, language, emotion regulation, and social skills. We tested whether the Collaborative and Proactive Solutions lagging skills predicted challenging behaviors using multiple linear regression. The Collaborative and Proactive Solutions lagging skills explained significant variance in participants’ challenging behaviors. The Depression (emotion regulation), Inhibit (executive function), and Sameness (executive function) scales emerged as significant predictors. Impairments in emotion regulation and executive function may contribute substantially to aggressive and oppositional behaviors in school-age youth with autism spectrum disorder without intellectual disability. Treatment for challenging behaviors in this group may consider targeting the incompatibility between environmental demands and a child’s lagging skills.
American Psychiatric Association (APA) (2000) Diagnostic and Statistical Manual of Mental Disorders. 4th ed. (text revision). Washington, DC: APA.
2.
American Psychiatric Association (APA) (2013) Diagnostic and Statistical Manual of Mental Disorders. 5th ed.Washington, DC: APA.
3.
BearssKLecavalierLMinshawiNet al. (2013) Toward an exportable parent training program for disruptive behaviors in autism spectrum disorders. Neuropsychiatry3(2): 169–180.
4.
BodfishJWSymonsFJParkerDEet al. (2000) Varieties of repetitive behavior in autism: comparisons to mental retardation. Journal of Autism and Developmental Disorders30(3): 237–243.
5.
ConstantinoJNGruberCP (2005) Social Responsiveness Scale (SRS). Los Angeles, CA: Western Psychological Services.
6.
CorbettBAConstantineLJHendrenRet al. (2009) Examining executive functioning in children with autism spectrum disorder, attention deficit hyperactivity disorder and typical development. Psychiatry Research166(2–3): 210–222.
7.
CorrellCUCarlsonHE (2006) Endocrine and metabolic adverse effects of psychotropic medications in children and adolescents. Journal of the American Academy of Child and Adolescent Psychiatry45(7): 771–791.
8.
CorrellCUPenznerJBParikhUHet al. (2006) Recognizing and monitoring adverse events of second-generation antipsychotics in children and adolescents. Child and Adolescent Psychiatric Clinics of North America15(1): 177–206.
9.
De CastroMJFraguasDLaitaPet al. (2008) QTc changes after 6 months of second-generation antipsychotic treatment in children and adolescents. Journal of Child and Adolescent Psychopharmacology18(4): 381–383.
10.
ElliottCD (2007) The Differential Abilities Scale. 2nd ed.San Antonio, TX: Harcourt Assessments, Inc.
11.
FrickPJ (2001) Effective interventions for children and adolescents with conduct disorder. Canadian Journal of Psychiatry46(7): 597–608.
12.
GadowKDDeVincentCJPomeroyJet al. (2005) Comparison of DSM-IV symptoms in elementary school-age children with PDD versus clinic and community samples. Autism9(4): 392–415.
13.
GhanizadehAMoghimi-SaraniE (2013) A randomized double blind placebo controlled clinical trial of N-Acetylcysteine added to risperidone for treating autistic disorders. BMC Psychiatry13: 196.
GordonCTStateRCNelsonJEet al. (1993) A double-blind comparison of clomipramine, desipramine, and placebo in the treatment of autistic disorder. Archives of General Psychiatry50(6): 441–447.
16.
GranaderYWallaceGLHardyKKet al. (2014) Characterizing the factor structure of parent reported executive function in autism spectrum disorders: the impact of cognitive inflexibility. Journal of Autism and Developmental Disorders44(12): 3056–3062.
17.
GreeneRW (2010) Collaborative problem solving. In: MurrihyRCKidmanADOllendickTH (eds) Clinical Handbook of Assessing and Treating Conduct Problems in Youth. New York: Springer, pp.193–220.
18.
GreeneRWAblonJSMartinA (2006) Innovations: child and adolescent psychiatry: use of collaborative problem solving to reduce seclusion and restraint in child and adolescent inpatient units. Psychiatric Services57(5): 610–612.
19.
GreeneRWAblonJSMonuteauxMet al. (2004) Effectiveness of collaborative problem solving in affectively dysregulated youth with oppositional defiant disorder: initial findings. Journal of Consulting and Clinical Psychology72(6): 1157–1164.
20.
GreeneRWDoyleAE (1999) Toward a transactional conceptualization of oppositional defiant disorder: implications for assessment and treatment. Clinical Child and Family Psychology Review2(3): 129–148.
21.
HodgettsSParkE (2017) Preparing for the future: a review of tools and strategies to support autonomous goal setting for children and youth with autism spectrum disorders. Disability and Rehabilitation39(6): 535–543.
22.
JaselskisCACookEHFletcherKEet al. (1992) Clonidine treatment of hyperactive and impulsive children with autistic disorder. Journal of Clinical Psychopharmacology12(5): 322–327.
23.
JohnsonMÖstlundSFranssonGet al. (2012) Attention-deficit/hyperactivity disorder with oppositional defiant disorder in Swedish children: an open study of collaborative problem solving. Acta Paediatrica101(6): 624–630.
24.
KanneSMMazurekMO (2011) Aggression in children and adolescents with ASD: prevalence and risk factors. Journal of Autism and Developmental Disorders41(7): 926–937.
25.
KenworthyLAnthonyLGNaimanDQet al. (2014) Randomized controlled effectiveness trial of executive function intervention for children on the autism spectrum. Journal of Child Psychology and Psychiatry55(4): 374–383.
26.
LangRRegesterALauderdaleSet al. (2010) Treatment of anxiety in autism spectrum disorders using cognitive behaviour therapy: a systematic review. Developmental Neurorehabilitation13(1): 53–63.
27.
LawsonRAPapadakisAAHigginsonCIet al. (2015) Everyday executive function impairments predict comorbid psychopathology in autism spectrum and attention deficit hyperactivity disorders. Neuropsychology29(3): 445–453.
28.
LecavalierLLeoneSWiltzJ (2006) The impact of behaviour problems on caregiver stress in young people with autism spectrum disorders. Journal of Intellectual Disability Research50(3): 172–183.
29.
LordCRutterMLe CouteurA (1994) Autism diagnostic interview–revised: a revised version of a diagnostic interview for caregivers of individuals with possible pervasive developmental disorders. Journal of Autism and Developmental Disorders24(5): 659–685.
MachalicekWO’ReillyMFBeretvasNet al. (2007) A review of interventions to reduce challenging behavior in school settings for students with autism spectrum disorders. Research in Autism Spectrum Disorders1(3): 229–246.
32.
MarcusRNOwenRKamenLet al. (2009) A placebo-controlled, fixed-dose study of aripiprazole in children and adolescents with irritability associated with autistic disorder. Journal of the American Academy of Child and Adolescent Psychiatry48(11): 1110–1119.
33.
MazefskyCAHerringtonJSiegelMet al. (2013) The role of emotion regulation in autism spectrum disorder. Journal of the American Academy of Child and Adolescent Psychiatry52(7): 679–688.
34.
MazurekMOKanneSMWodkaEL (2013) Physical aggression in children and adolescents with autism spectrum disorders. Research in Autism Spectrum Disorders7(3): 455–465.
35.
MiyakeAFriedmanNPEmersonMJet al. (2000) The unity and diversity of executive functions and their contributions to complex “frontal lobe” tasks: a latent variable analysis. Cognitive Psychology41(1): 49–100.
36.
OllendickTHGreeneRWAustinKEet al. (2016) Parent management training and collaborative & proactive solutions: a randomized control trial for oppositional youth. Journal of Clinical Child and Adolescent Psychology45(5): 591–604.
37.
OwenRSikichLMarcusRNet al. (2009) Aripiprazole in the treatment of irritability in children and adolescents with autistic disorder. Pediatrics124(6): 1533–1540.
38.
PatelSDayTNJonesNet al. (2016) Association between anger rumination and autism symptom severity, depression symptoms, aggression, and general dysregulation in adolescents with autism spectrum disorder. Autism21: 181–189.
39.
PoseyDJKemDLSwiezyNBet al. (2004) A pilot study of D-cycloserine in subjects with autistic disorder. American Journal of Psychiatry161(11): 2115–2117.
40.
Psychological Corporation (1999) Manual for the Wechsler Abbreviated Scale of Intelligence. San Antonio, TX: Psychological Corporation.
41.
ReavenJBlakeley SmithACulhane ShelburneKet al. (2012) Group cognitive behavior therapy for children with high-functioning autism spectrum disorders and anxiety: a randomized trial. Journal of Child Psychology and Psychiatry53(4): 410–419.
42.
Research Units on Pediatric Psychopharmacology Autism Network (RUPP-AN) (2002) Risperidone in children with autism and serious behavioral problems. New England Journal of Medicine347(5): 314–321.
43.
ReynoldsCRKamphausRW (2004) Behavior Assessment System for Children. 2nd ed.Bloomington, MN: Pearson Education.
44.
RokeYVan HartenPNBootAMet al. (2009) Antipsychotic medication in children and adolescents: a descriptive review of the effects on prolactin level and associated side effects. Journal of Child and Adolescent Psychopharmacology19(4): 403–414.
45.
SaferDJ (2004) A comparison of risperidone-induced weight gain across the age span. Journal of Clinical Psychopharmacology24(4): 429–436.
46.
SamsonACHardanAYLeeIAet al. (2015) Maladaptive behavior in autism spectrum disorder: the role of emotion experience and emotion regulation. Journal of Autism and Developmental Disorders45(11): 3424–3432.
47.
SheaSTurgayACarrollAet al. (2004) Risperidone in the treatment of disruptive behavioral symptoms in children with autistic and other pervasive developmental disorders. Pediatrics114(5): 634–641.
48.
SiegelMGabrielsRL (2014) Psychiatric hospital treatment of children with autism and serious behavioral disturbance. Child and Adolescent Psychiatric Clinics of North America23(1): 125–142.
49.
SimonoffEPicklesACharmanTet al. (2008) Psychiatric disorders in children with autism spectrum disorders: prevalence, comorbidity, and associated factors in a population-derived sample. Journal of the American Academy of Child and Adolescent Psychiatry47(8): 921–929.
50.
SolomonMOnoMTimmerSet al. (2008) The effectiveness of parent-child interaction therapy for families of children on the autism spectrum. Journal of Autism and Developmental Disorders38(9): 1767–1776.
StorchEAArnoldEBLewinABet al. (2013) The effect of cognitive-behavioral therapy versus treatment as usual for anxiety in children with autism spectrum disorders: a randomized, controlled trial. Journal of the American Academy of Child and Adolescent Psychiatry52(2): 132–142.
53.
VismaraLARogersSJ (2010) Behavioral treatments in autism spectrum disorder: what do we know?Annual Review of Clinical Psychology6(1): 447–468.
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