Unique Behavior Profiles that Specify Mental Distress in Autism

ObjectivePatients with autism spectrum disorder (ASD) often have difficulty describing their emotions, leaving clinicians to infer mental distress from aberrant behaviors. Unfortunately, aberrant behaviors are non-specific and can differ from those of typically developing peers. However, aberrant behavior profiles (ABPs), or weighted combinations of multiple aberrant behaviors, may be specific and recognizable. We thus sought to identify ABPs that correlate with distinct types of mental distress, and also correlate differently in ASD than in typical development (TD). MethodWe integrated three studies that measured diagnostic symptom severity using the Child and Adolescent Symptom Inventory, and aberrant behaviors using the Aberrant Behavior Checklist. We then performed a component analysis to identify maximally non-overlapping severity scores that correlate with ABPs differently in ASD than in TD. ResultsBehaviors associated with impulsivity and distractibility correlated more positively with the severity of specific phobia and social anxiety in ASD than in TD. Hyperactivity and tantrums correlated more positively with attention-deficit hyperactivity disorder and oppositional defiant disorder in ASD than in TD. Emotional reactivity correlated more positively with obsessions and somatization, but social withdrawal and self-injurious behaviors correlated more negatively; the opposite pattern held in a second phenotype of social anxiety. Finally, preoccupation correlated positively with schizophrenia, but depression and inactivity correlated negatively; the opposite pattern held with the severity of post-traumatic stress disorder and a second phenotype of specific phobia. ConclusionPatients with ASD (1) externalize more in attention-deficit hyperactivity disorder and oppositional defiant disorder, (2) exhibit unique signs of internal distress in post-traumatic stress and psychosis, and (3) display highly distinct ABPs in specific forms of anxiety.