Autism spectrum disorders (ASDs) comprise a class of neurodevelopmental disorders first apparent in early childhood, characterized by deficits in socialization, communication, and the presence of repetitive behavior or restricted interests (Matson et al., 1996, Matson and Boisjoli, 2008, Matson et al., 2007 and Matson and Wilkins, 2007). ASDs result in lifelong impairments, resulting in lasting difficulties and a need for support across the lifespan. Early identification and treatment of ASDs portends the best outcomes (Eikeseth, 2009 and Hattier and Matson, 2012). The value and need for such interventions is underscored by numerous comorbid physical conditions (Efstratopoulou et al., 2012, Hattier and Matson, 2012, Lin et al., 2012 and Matson et al., 2011b). Additionally, ASD is a risk factor for psychopathology and a host of learning issues and challenging behaviors (Mashal and Kasirer, 2012, Matson et al., 2012a, Poon, 2012, Smith and Matson, 2010a, Smith and Matson, 2010b and Smith and Matson, 2010c). A litany of challenging behaviors have been reported in the literature including, self-injury, aggression, feeding problems, and property destruction (Matson et al., 2009a, Matson et al., 2012c, Matson and Turygin, 2012 and Medeiros et al., 2012). Among the most debilitating of these challenging behaviors are tantrums, which restraint attempts at normalization and development and impede learning.
Tantrum behaviors are those which involve a cluster of behaviors including defiance, oppositional behavior, screaming, crying, aggression, and property destruction, which may be difficult to stop once they have begun (Green, Whitney, & Potegal, 2011). Tantrum behaviors are developmentally appropriate in very young children and commonly observed in typically developing children prior to the development of emotion regulation. However, in typically developing children, when tantrums are excessive or continue into later childhood, they are associated with negative outcomes (Caspi et al., 1987, Green et al., 2011, Stevenson and Goodman, 2001 and Stoolmiller, 2001). Tantrum behaviors are associated with expressions of negative emotions, particularly anger and sadness (Green et al., 2011), and are often characterized by attention, escape, and tangible functions (Matson, Sipes et al., 2011). Tantrums of older children in inpatient settings have been observed to be functionally similar to those of young typically developing children (Potegal, Carlson, Marguiles, Gutkovich, & Wall, 2009).
Tantrum behaviors are often observed in children and adults with ASD. Tantrum behaviors in children with ASD may be similar in nature to those observed in typically developing children, but tend to be more severe and persistent in children with ASD. Given the host of communication, socialization, and other deficits these children display, tantrums further compound an already complicated picture. The inability of children with ASD to effectively communicate their needs, or understand and relate to the social cues of others may predispose the child to tantrum behaviors as a means of causing a social response.
Tantrums are more common in children with ASD compared to children without autism who have comparable levels of intellectual functioning (Ando & Yoshimura, 1979). However, this cannot be completely accounted for by language deficits. Children with ASD have been found to also exhibit more tantrum behavior compared to children with language deficits. Sipes, Matson, Horovitz, and Shoemaker (2011) found that children with ASD are more likely to exhibit tantrum and conduct problems, but that communication does not function as a moderating variable for these behaviors, but may differentially effect tantrum behavior expression as a function of other variables, including age and functioning. Greater impairments in social skills in children with ASDs are related to greater expression of aggression/destruction and stereotypic behavior (Matson, Neal, Fodstad, & Hess, 2009). The implementation of a social story has been observed to alleviate some tantrum behaviors for children who frequently engaged in tantrum behavior, suggesting that social deficits play a role in the expression of tantrum behavior in this population (Kuttler, Myles, & Carlson, 1998).
As deficits in socialization, communication, and the presence of repetitive or stereotyped behaviors may contribute to the presence of behavior problems in children with and without ASD, we investigated whether this occurs within the diagnostic categories that generally relate to the severity and presentation of the disorder. Although the Autism Spectrum Disorder – Diagnostic Child Version (ASD-DC) includes three diagnostic groups; Autistic disorder (AD), Asperger's Syndrome (AS), Pervasive Developmental Disorder – Not Otherwise Specified (PDD-NOS) for ASDs the current study will only analyze them collectively as a single ASD category. The current categorization was selected due to the impending changes in the ASD category proposed by the DSM-5 ( Beighley et al., in press, Matson et al., 2012b, Mayes et al., 2013 and Wilson et al., in press). The authors hypothesized that as ASD symptomology increases, so does the frequency and severity of tantrum behaviors. The present study examined the relationship between ASD symptom severity and the severity of tantrum behaviors.