Which Aspects of Challenging Behaviour Are Associated with Anxiety across two Age Groups of Young Males with an Autism Spectrum Disorder?

  • Vicki Bitsika
  • Christopher F Sharpley


Children with Autism Spectrum Disorder (ASD) also often exhibit elevated anxiety and Challenging Behaviour (CB) but relatively little is known about the detailed association between CB and anxiety. To investigate this issue, the Aberrant Behavior Checklist (ABC) and the Child and Adolescent Symptom Inventory subscale for Generalised Anxiety Disorder (CASI-GAD) were completed by 150 parents about their sons with ASD to determine the overall association between CB and GAD. Correlational and regression models were used to describe the links with the total scores, subscales, and the specific items of the ABC and CASI-GAD. Results indicated that only the Irritability subscale of the ABC was significantly associated with of GAD. Seven of the eight symptoms of GAD were significantly associated with only one of the ABC Irritability subscale items—the need for demands to be met immediately and/or temper tantrums. This association was most powerful for the GAD symptoms of restlessness and irritability. These data indicate that CB and GAD were linked via relatively discrete subsets of each construct, with an underlying connection based upon insistence on sameness and intolerance of uncertainty, and that intervention protocols need to identify the presence of those parts of these constructs in order to most effectively tailor treatments to individual needs.


Autism Anxiety Challenging behaviour Young males 


Compliance with Ethical Standards

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Conflicts of Interest

Author Bitsika declares that she has no conflict of interest. Author Sharpley declares that he has no conflict of interest.


  1. Aman, M., Singh, N., Stewart, A., & Field, C. (1985). The aberrant behavior checklist: a behavior ratings scale for the assessment of treatment effects. American Journal of Mental Deficiency, 89, 485–491.PubMedGoogle Scholar
  2. APA (2013). Diagnostic and statistical manual of mental disorders-5. Washington, DC: American Psychiatric Association.Google Scholar
  3. Bitsika, V., & Sharpley, C. (2015). Variation in the profile of anxiety disorders in boys with an ASD according to method and source of assessment. Journal of Autism and Developmental Disorders, 45, 1825–1835.CrossRefPubMedGoogle Scholar
  4. Bitsika, V., Sharpley, C., Andronicos, N., & Agnew, L. (2015). A test of the ‘parent distortion’ hypothesis when assessing generalised anxiety disorder in boys with an autism Spectrum disorder. Research in Autism Spectrum Disorders, 15-16, 42–52.CrossRefGoogle Scholar
  5. Boulter, C., Freeston, M., South, M., & Rodgers, J. (2014). Intolerance of uncertainty as a framework for understanding anxiety in children and adolescents with autism Spectrum disorders. Journal of Autism and Developmental Disorders, 44, 1391–1402.CrossRefPubMedGoogle Scholar
  6. Buhr, K., & Dugas, M. (2009). The role of fear of anxiety and intolerance of uncertainty in worry: an experimental manipulation. Behaviour Research and Therapy, 47, 215–223.CrossRefPubMedGoogle Scholar
  7. Buhr, K., & Dugas, M. (2012). Fear of emotions, experiential avoidance, and intolerance of uncertainty in worry and generalised anxiety disorder. International Journal of Cognitive Therapy, 5, 1–17.CrossRefGoogle Scholar
  8. Carek, P., Laibstain, S., & Carek, S. (2011). Exercise for the treatment of depression and anxiety. International Journal of Psychiatry in Medicine, 41, 15–28.CrossRefPubMedGoogle Scholar
  9. CDC. (April 30 2015). Child development. Retrieved from
  10. Chrousos, G. (2009). Stress and disorders of the stress system. Nature Reviews Endocrinology, 5, 374–381.CrossRefPubMedGoogle Scholar
  11. Clark, L., & Watson, D. (1991). Tripartite model of anxiety and depression: psychometric evidence and taxonomic implications. Journal of Abnormal Psychology, 100, 316–335.CrossRefPubMedGoogle Scholar
  12. Cohen, J. (1988). Statistical power for the behavioural sciences. Hillsdale, NJ: Erlbaun.Google Scholar
  13. Cohen, J., Cohen, P., West, S., & Aiken, L. S. (2003). Applied multiple regression/correlation analysis for the behavioral sciences. Mahwah, NJ: Lawrence Erlbaum Associates.Google Scholar
  14. Gabriels, R., Agnew, J., Pan, Z., Holt, K., Reynolds, A., & Laudenslager, M. (2013). Elevated repetitive behaviors are associated with lower diurnal salivary cortisol levels in autism spectrum disorder. Biological Psychology, 93, 262–268.CrossRefPubMedGoogle Scholar
  15. Gadow, K., Devincent, C., Pomeroy, J., & Azizian, A. (2005). Comparison of DSM-IV symptoms in elementary school-age children with PDD versus clinic and community samples. Autism, 9, 392–415.CrossRefPubMedGoogle Scholar
  16. Gadow, K., & Sprafkin, J. (2010). Child and adolescent symptom inventory 4R: screening and norms manual. Stony Brook, NY: Checkmate Plus.Google Scholar
  17. Gadow, K., Sprafkin, J., Carlson, G., Schneider, J. A., Nolan, E., Mattison, R., & Rundberg-Rivera, V. (2002). A DSM-IV-referenced adolescent self-reporting scale. Journal of the American Academy of Child and Adolescent Psychiatry, 41, 671–679.CrossRefPubMedGoogle Scholar
  18. Groden, J., Cautela, J., Prince, S., & Berryman, J. (1994). The impact of stress and anxiety on individuals with autism and developmental disabilities. In E. Shopler & G. Mesibov (Eds.), Behavioral issues in autism (pp. 177–194). New York: Springer.CrossRefGoogle Scholar
  19. Jansen, C., Schuengel, C., & Stolk, J. (2002). Understanding challenging behavior in people with severe and pfofound intellectual disability: a stress-attachment mode. Journal of Intellectual Disability Research, 46, 445–453.CrossRefGoogle Scholar
  20. Kaat, A., Lecavalier, L., & Aman, M. (2014). Validity of the aberrant behaviour checklist in children with autism Spectrum disorder. Journal of Autism and Developmental Disorders, 44, 1103–1116.CrossRefPubMedGoogle Scholar
  21. Kim, J., Szatmari, P., Bryson, S., Streiner, D., & Wilson, F. (2000). The prevalence of anxiety and mood problems among children with autism and Asperger syndrome. Autism, 4, 117–132.CrossRefGoogle Scholar
  22. Leger, E., Ladouceur, R., Dugas, M., & Freeston, M. (2003). Cognitive-behavioral treatment of generalised anxiety disorder among adolescents: a case series. Journal of the American Academy of Child and Adolescent Psychiatry, 42, 327–330.CrossRefPubMedGoogle Scholar
  23. Lord, C., Rutter, M., DiLavore, P., Risi, S., Gotham, K., & Bishop, S. (2012). Autism diagnostic observation schedule, second edition (ADOS-2). Los Angeles, CA: Western Psychological Services.Google Scholar
  24. McIntyre, J., Blacher, J., & Baker, B. (2002). Behavior/mental health problems in young adults with intellectual disabilities: the impact on families. Journal of Intellectual Disability Research, 46, 239–249.CrossRefPubMedGoogle Scholar
  25. Minshew, N., Turner, C., & Goldstein, G. (2005). The application of short forms of the Wechsler intelligence scales in adults and children with high functioning autism. Journal of Autism and Developmental Disorders, 35, 45–52.CrossRefPubMedGoogle Scholar
  26. Murphy, G., Beadle-Brown, J., Wing, J., Gould, J., Shah, A., & Holmes, N. (2005). Chronicity of challenging behaviors in people with severe intellectual disabilities and/or autism: a total population sample. Journal of Autism and Developmental Disorders, 35, 405–418.CrossRefPubMedGoogle Scholar
  27. Murphy, O., Healy, O., & Leader, G. (2009). Risk factors for challenging behaviors among 157 children with autism spectrum disorder in Ireland Research in Autism Spectrum Disorders, 3, 474–482.Google Scholar
  28. Sharpley, C., Bitsika, V., & Efremidis, B. (1997). Influence of gender, parental health and perceived expertise of assistance upon stress, anxiety and depression among parents of children with autism. Journal of Intellectual and Developmental Disability, 22, 19–28.CrossRefGoogle Scholar
  29. Sigafoos, J., Arthur, M., & O’Reilly, M. (2003). Challenging behavior and developmental disability. London: Whurr.Google Scholar
  30. Stevens, J. (1996). Applied multivariate statistics for the social sciences. Mahwah, NJ: Lawrence Erlbaum.Google Scholar
  31. Tabachnick, B., & Fidell, L. (2007). Using multivariate statistics (5th ed.). NY: Pearson.Google Scholar
  32. van Steensel, F., Bogels, S., & Perrin, S. (2011). Anxiety disorders in children and adolescents with autistic Spectrum disorders: a meta-analysis. Clinical Child and Family Psychology Review, 14, 302–317.CrossRefPubMedPubMedCentralGoogle Scholar
  33. Waters, P., & Healy, O. (2012). Investigating the relationahip between self-injurious behavior, social deficits, and coocurring behaviors in children with autism spectrum disorder. Autism Research and Treatment, 1–7.Google Scholar
  34. Weisbrot, D., Gadow, K., DeVincent, C., & Pomeroy, J. (2005). The presentation of anxiety in children with pervasive developmental disorders. Journal of Child and Adolescent Psychopharmacology, 15, 477–496.CrossRefPubMedGoogle Scholar
  35. White, S. W., Oswald, D., Ollendick, T., & Scahill, L. (2009). Anxiety in children and adolescents with autism spectrum disorders. Clinical Psychology Review, 29(3), 216–229. doi: 10.1016/j.cpr.2009.01.003.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  1. 1.Centre for Autism Spectrum DisordersBond UniversityRobinaAustralia
  2. 2.Brain-Behaviour Research GroupUniversity of New EnglandArmidaleAustralia

Personalised recommendations