Journal of Autism and Developmental Disorders

, Volume 48, Issue 11, pp 3727–3735 | Cite as

Behavioral Symptoms of Reported Abuse in Children and Adolescents with Autism Spectrum Disorder in Inpatient Settings

  • Jamie BrennerEmail author
  • Zhaoxing Pan
  • Carla Mazefsky
  • Kahsi A. Smith
  • Robin Gabriels
  • for the Autism and Developmental Disorders Inpatient Research Collaborative (ADDIRC)
S.I. : Autism Inpatient Collection - Studying the Severely Affected


The objective of this study was to examine how behavioral manifestations of trauma due to abuse are expressed in youth with autism spectrum disorder (ASD). Analysis of covariance (ANCOVA) compared outcomes between patients with a caregiver reported history of abuse and those without. Findings indicate that patients with ASD and reported abuse (i.e. physical, sexual, and/or emotional) have more intrusive thoughts, distressing memories, loss of interest, irritability, and lethargy than those without reported maltreatment. Those with clinical diagnoses of posttraumatic stress disorder (PTSD) had more severe and externalized symptoms than those with reported abuse not diagnosed with PTSD. Results emphasize the need for trauma screening measures to guide evidence-based treatments for children with ASD.


Autism spectrum disorder (ASD) Posttraumatic stress disorder (PTSD) Psychological trauma Abuse Autism inpatient collection 



The ADDIRC is made up of the co-investigators: Matthew Siegel, MD (PI) (Maine Medical Center Research Institute; Tufts University), Craig Erickson, MD (Cincinnati Children’s Hospital; University of Cincinnati), Robin L. Gabriels, PsyD (Children’s Hospital Colorado; University of Colorado), Desmond Kaplan, MD (Sheppard Pratt Health System), Carla Mazefsky, PhD (Western Psychiatric Institute and Clinics; University of Pittsburgh), Eric M. Morrow, MD, PhD (Bradley Hospital; Brown University), Giulia Righi, PhD (Bradley Hospital; Brown University), Susan L. Santangelo, ScD (Maine Medical Center Research Institute; Tufts University), and Logan Wink, MD (Cincinnati Children’s Hospital; University of Cincinnati). Collaborating investigators and staff: Jill Benevides, BS, Carol Beresford, MD, Carrie Best, MPH, Katie Bowen, LCSW, Briar Dechant, BS, Tom Flis, BCBA, LCPC, Holly Gastgeb, PhD, Angela Geer, BS, Louis Hagopian, PhD, Benjamin Handen, PhD, BCBA-D, Adam Klever, BS, Martin Lubetsky, MD, Kristen MacKenzie, BS, Zenoa Meservy, MD, John McGonigle, PhD, Kelly McGuire, MD, Faith McNeill, BA, Ernest Pedapati, MD, Christine Peura, BA, Joseph Pierri, MD, Christie Rogers, MS, CCC-SLP, Brad Rossman, MA, Jennifer Ruberg, LISW, Cathleen Small, PhD, Kahsi A. Smith, PhD, Nicole Stuckey, MSN, RN, Barbara Tylenda, PhD, Mary Verdi, MA, Jessica Vezzoli, BS, Deanna Williams, BA, and Diane Williams, PhD, CCC-SLP. We gratefully acknowledge the contributions of the coordinating site advisory group: Donald L. St. Germain, MD and Girard Robinson, MD, and our scientific advisory group: Connie Kasari, PhD., Bryan King, MD, James McCracken, MD, Christopher McDougle, MD, Lawrence Scahill, MSN, PhD, Robert Schultz, PhD and Helen Tager-Flusberg, PhD, the input of the funding organizations and the families and children who participated. The autism inpatient collection (AIC) phenotypic database and biorepository is supported by a grant from the Simons Foundation Autism Research Initiative and the Nancy Lurie Marks Family Foundation, (SFARI #296318 to MS).

Author Contributions

JB conceived of the study, participated in its design and coordination and drafted the manuscript; ZP participated in the design of the study and performed the statistical analysis; KAS participated in the design of the study and helped draft the manuscript; CM helped conceive and coordinate the study; RG helped conceive the study, participated in its design and helped with the interpretation of data. All authors read and approved the final manuscript.


  1. Administration for Children and Families. (n.d.). FAM7. A Child maltreatment: Rate of substantiated maltreatment reports of children ages 0–17 by selected characteristics, 1998–2014. Retrieved July 19, 2016, from
  2. Aman, M. G., Singh, N. N., Stewart, A. W., & Field, C. J. (1985). The aberrant behavior checklist: A behavior rating scale for the assessment of treatment effects. American Journal of Mental Deficiency, 89, 485–491.PubMedGoogle Scholar
  3. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington: American Psychiatric Association.CrossRefGoogle Scholar
  4. Cook, E. H. Jr., Kieffer, J. E., Charak, D. A., & Leventhal, B. L. (1993). Autistic disorder and post-traumatic stress disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 32, 1292–1294.CrossRefGoogle Scholar
  5. Gadow, K. D., & Sprafkin, J. (2013). Child & adolescent symptom inventory (CASI-5) (5th ed.). Stony Brook: Checkmate Plus.Google Scholar
  6. Green, J., Leadbitter, K., Kay, C., & Sharma, K. (2016). Austism spectrum disorder in children adopted after early care breakdown. Journal of Autism and Developmental Disorders, 46, 1392–1402.CrossRefGoogle Scholar
  7. Hall-Lande, J., Hewitt, A., Mishra, S., Piescher, K., & LaLiberte, T. (2015). Involvement of children with autism spectrum disorder (ASD) in the child protection system. Focus on Autism and Other Developmental Disabilities, 30, 237–248.CrossRefGoogle Scholar
  8. Kerns, C., Newschaffer, C. J., & Berkowitz, S. J. (2015). Traumatic childhood events and autism spectrum disorder. Journal of Autism and Developmental Disorders, 45, 3475–3486.CrossRefGoogle Scholar
  9. King, R., & Desaulnier, C. L. (2011). Commentary: Complex post-traumatic stress disorder. Implications for individuals with autism spectrum disorders - part II. Journal on Developmental Disabilities, 17(1), 47–59.Google Scholar
  10. Lord, C., Rutter, M., DiLavore, P. C., Risi, S., Gotham, K., & Bishop, S. L. (2012). Autism Diagnostic Observation Schedule, second edition (ADOS-2). Manual (part I) (2nd ed.). Los Angeles: Western Psychological Services.Google Scholar
  11. Mansell, S., Sobsey, D., & Moskal, R. (1998). Clinical findings among sexually abused children with and without developmental disabilities. Mental Retardation, 36, 12–22.CrossRefGoogle Scholar
  12. Mazefsky, C. A., Kao, J., & Oswald, D. P. (2011). Preliminary evidence suggesting caution in the use of psychiatric self-report measures with adolescents with high-functioning autism spectrum disorders. Research in Autism Spectrum Disorders, 5(1), 164–174.CrossRefGoogle Scholar
  13. Mehtar, M., & Mukaddes, N. (2011). Posttraumatic stress disorder in individuals with diagnosis of autistic spectrum disorders. Research in Autism Spectrum Disorders, 5, 539–546.CrossRefGoogle Scholar
  14. Reiss, S., Levitan, G. W., & Szyszko, J. (1982). Emotional disturbance and mental retardation: Diagnostic overshadowing. American Journal of Mental Deficiency, 86, 567–574.PubMedGoogle Scholar
  15. Roid, G. H., Miller, L. J., Pomplun, M., & Koch, C. (2013). Leiter International Performance Scale, third edition (Leiter-3) manual. Wood Dale: Stoelting Company.Google Scholar
  16. Rutter, M., Andersen-Wood, L., Beckette, C., Bredenkamp, D., Castle, J., Groothues, C., … O’Connor, T. G. (1999). Quasi-autistic patterns following severe early global privation. Journal of Child Psychology and Psychiatry, 40(4), 537–549.CrossRefGoogle Scholar
  17. Rutter, M., Bailey, A., & Lord, C. (2003). Social Communication Questionnaire. Torrance: WPS Publishing.Google Scholar
  18. Shalom, D. B., Mostofsky, S. H., Hazlett, R. L., Goldberg, M. C., Landa, R. J., Faran, Y., … Hoehn-Saric, R. (2006). Normal physiological emotions but difference in expression of conscious feelings in children with high-functioning autism. Journal of Autism and Developmental Disorders, 36, 395–400.CrossRefGoogle Scholar
  19. Siegel, M., Smith, K. A., Mazefsky, C., Gabriels, R. L., Erickson, C., Kaplan, D., … for the Autism and Developmental Disorders Inpatient Research Collaborative (AIC). (2015). The autism inpatient collection: Methods and preliminary sample description. Molecular Autism, 6, 61. doi: 10.1186/s13229-015-0054-8.CrossRefPubMedPubMedCentralGoogle Scholar
  20. Sparrow, S. S., Cicchetti, D. V., & Balla, D. A. (2005). Vineland Adaptive Behavior Scales, second edition (Vineland-II) manual. Circle Pines: AGS Publishing.Google Scholar
  21. Sullivan, P., & Cork, P.M. (1996). Developmental Disabilities Training Project. Omaha, NE: Center for Abused Children with Disabilities, Boys Town National Research Hospital, Nebraska Department of Health and Human Services.Google Scholar
  22. Sullivan, P. M., & Knutson, J. F. (2000). Maltreatment and disabilities: A population-based epidemiological study. Child Abuse and Neglect, 24, 1257–1273.CrossRefGoogle Scholar
  23. Taylor, J. L. & Gotham, K. O. (2016). Cumulative life events, traumatic experiences and psychiatric symptomatology in transition-aged youth with autism spectrum disorder. Journal of Neurodevelopmental Disorders, 8, 3–11.CrossRefGoogle Scholar
  24. U.S. Department of Health and Human Services. (2012). Administration for children and families, administration on children, youth and families, children’s bureau. Child maltreatment 2012 [online]. Washington, DC: Government Printing Office.Google Scholar

Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  • Jamie Brenner
    • 1
    • 4
    Email author
  • Zhaoxing Pan
    • 1
  • Carla Mazefsky
    • 2
  • Kahsi A. Smith
    • 3
  • Robin Gabriels
    • 1
  • for the Autism and Developmental Disorders Inpatient Research Collaborative (ADDIRC)
  1. 1.Children’s Hospital ColoradoUniversity of Colorado School of MedicineAuroraUSA
  2. 2.University of Pittsburgh School of MedicinePittsburghUSA
  3. 3.Tufts University School of MedicineBostonUSA
  4. 4.Insights Colorado Assessment and TherapyDenverUSA

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