عملکرد اجرایی به عنوان پیش بینی قربانی شدن همسالان در نوجوانان با و بدون اختلال طیف اوتیسم

The present study examined pragmatic language and executive functions (EF) as predictors of peer victimization in three groups: high-functioning adolescent boys with an Autism Spectrum Disorder (ASD) (n = 30); typically developing adolescent boys (n = 40); and adolescent boys (n = 22) without ASD with special education needs (SN). Controlling for age and bullying others, regression analyses revealed EF as measured by the Behavior Rating Inventory of Executive Functioning (Gioia et al., 2000) to be a significant predictor across all types of peer victimization (physical, social, and verbal) regardless of group membership. It is concluded that EF may play a pivotal role in explaining why some SN adolescents with and without ASD are at-risk for peer victimization.

Over the last three decades Autism Spectrum Disorders (ASD) has become one of the most widely studied disorders of childhood. ASD, which until very recently1 included Autistic Disorder, Asperger's Disorder, and Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS), all share the essential features of qualitative impairment in social interaction and communication, and restricted and repetitive patterns of behavior [American Psychiatric Association (APA), 2000]. An emerging body of research strongly suggests that children and adolescents with ASD are at greater risk of being bullied than their typically developing (TD) peers (Humphrey and Symes, 2010, Humphrey and Symes, 2011 and Kloosterman et al., 2013Little, 2002 and Wainscot et al., 2008). What is less clear, however, are the factors that contribute to the elevated risk of peer victimization in this population. Pragmatic language and executive functioning are two factors linked with social functioning in both TD individuals and individuals with ASD (Gilotty et al., 2002, Jacobson et al., 2011, McKown et al., 2009, Oerlemans et al., 2013 and Reichow et al., 2008). The present study sought to examine relationships among pragmatic language, executive functioning and peer victimization. Although definitions of peer victimization vary in the literature, most include three common characteristics: (1) the act is performed with the intent of causing harm, (2) it is repeated over time, and (3) there is an imbalance in power between those involved (Craig & Pepler, 2003). There are various types of peer victimization, most often categorized as physical, verbal, and relational. Physical victimization is most obvious and includes kicking, pushing, punching, assaulting or beating the victim, whereas verbal victimization includes the psychological attributes of repeated name calling, teasing, and/or making derogatory remarks. Relational victimization is considered a form of social aggression because it interferes with the social relationships between the victim and his or her peers (i.e. excluding individuals from group activities; being humiliated in front of others). This form of peer victimization appears to be more common than physical victimization and has been observed quite early in life with preschool children (Crick et al., 2006). Research with TD adolescents has shown that those individuals who bully others are more likely to have externalizing problems, such as substance abuse and delinquency (Kaltiala-Heino et al., 2000 and Sourander et al., 2006); on the other hand a constellation of internalizing behaviors (i.e. poor self-esteem, shyness, depression, anxiety, loneliness) have been linked to victimization (Craig, 1998, Dyer and Teggart, 2007, Holt et al., 2007, Jantzer et al., 2006, Klomek et al., 2007, Kumpulainen et al., 2001 and Olweus, 1997). Levels of peer victimization appear to vary depending on age and grade of individuals. In the bullying literature, the transition from elementary to secondary school has received much attention as it is during this time that bullying behavior peaks (Nansel et al., 2001, Pepler et al., 2006 and Sumter et al., 2012). Cross-sectional studies indicate that this peak in bullying behavior is followed by decreased rates by the end of secondary school (e.g., Pepler et al., 2006). However, longitudinal research has shown that for a small portion of adolescents, bullying behavior remains stable and persists across the secondary school years. 1.1. Experiences with bullying in individuals with ASD In the first published empirical study on experiences with bullying in ASD, Little (2002) surveyed 411 mothers of children with ASD and/or a non-verbal learning disability and reported that 94% of the children had been bullied by a peer at least once in the past year; when compared to a national internet sample of TD children, the children with ASD were four times more likely to experience peer victimization. In a subsequent study, Wainscot et al. (2008) interviewed 30 adolescents with ASD and found that they experienced almost three times more peer victimization than their TD peers. As well, 40% of the adolescents with ASD in Wainscot et al.’s study reported that they experienced peer victimization on a daily basis, whereas only 14.8% of the TD adolescents reported this same frequency of occurrence. Additionally, Humphrey and Symes (2010) reported that adolescents with ASD experienced significantly more peer victimization in the form of peer rejection than TD adolescents or adolescents with dyslexia. Kloosterman et al. (2013) found that adolescents with ASD were more likely to be physically bullied and experienced more social isolation than their TD peers. Although these findings clearly highlight an elevated risk of peer victimization for children and adolescents with ASD, little empirical research has been conducted to determine why this population may be at risk. It is not clear, for example, whether factors associated with social functioning may contribute to some types of peer victimization more so than others. To the best of our knowledge, the present study is one of the first to examine the association between social-cognitive factors (pragmatic language and executive functioning) and types of peer victimization experienced by adolescent boys with ASD. 1.2. ASD and elevated risk for victimization It has been suggested that individuals with ASD are more vulnerable to peer victimization due to their impairments in communication and social interaction (Fisher et al., 2013, Heinrichs, 2003, Humphrey and Symes, 2011 and Volkmar and Klin, 2000). For example, Cappadocia, Weiss, and Pepler (2012) examined the relationship between peer victimization and social skills deficits and communication difficulties in a sample of 192 youth with ASD. Using data from parental reports, youth were classified according to level of peer victimization (victimized versus not victimized). It was found that those who were victimized were approximately 5 times more likely to have greater communication difficulties than those who were not. No difference was found between the two groups for deficits in social skills, although the youth who were victimized had significantly fewer friends than those who were not. Fisher et al. (2013) also used parental reports to compare social vulnerability and experiences of peer victimization with a group of individuals with ASD to those with William's syndrome, or Down syndrome. The three groups did not differ significantly in the rates and types of peer victimization experienced; however, those with ASD were found to have a diminished peer network with only 50% of the parents reporting that their child had a friend. In addition, those with ASD were rated as having significantly more difficulty than the other two groups in reading social cues (e.g. facial expressions). It is worth noting that both Cappadocia et al. (2012) and Fisher et al. (2013) lacked a TD control group and their findings were based entirely on parental reports. Research with TD adolescents has found that parents are not always aware of the peer victimization experienced by their child/children (Mishna et al., 2006 and Sawyer et al., 2011). Moreover, it is unclear whether children with ASD were bullied more than children with other special needs. The present study addressed this issue by asking adolescents to self-report their experiences regarding peer victimization as well as including an SN control group. To better understand why children and adolescents with ASD are at greater risk of peer victimization than their TD peers, Humphrey and Symes (2011) proposed the reciprocal effects peer interaction model (REPIM). The REPIM suggests that difficulties in social cognition lead to poor social and communication skills. As a consequence, students with ASD fail to develop positive relationships with their peers. A lack of awareness and acceptance of the disorder by their TD peers further hinders the building of quality relationships for ASD students. The end results are ASD students with few, if any, friends. With a diminished social network, ASD students are more vulnerable to peer victimization. Although many researchers and clinicians agree that difficulties in social interaction, a core feature of the REPIM, add to the elevated risk of peer victimization seen in this population, little systematic research has been conducted to identify specific factors that may underlie such difficulties. Identification of underlying factors that lead to social skills deficits would be helpful for clinicians and educators to target intervention goals and strategies at the child level for both those with and without ASD. Two factors that have been associated with social skills in both TD and ASD populations are pragmatic language and executive functioning (Gilotty et al., 2002, Jacobson et al., 2011, McKown et al., 2009, Oerlemans et al., 2013 and Reichow et al., 2008). For the current study, it is hypothesized that the elevated risk of peer victimization for individuals with ASD is a consequence of impairments in pragmatic language and executive functioning. These impairments lead to maladaptive social skills that in turn produce diminished peer networks, increased social isolation, and an increased vulnerability to peer victimization. 1.3. Pragmatic language difficulties in ASD Research on ASD has linked difficulties in social interaction and communication to a deficit in language abilities, most notably pragmatic language (Capps, Kehres, & Sigman, 1998). Pragmatic language refers to the use of language socially to achieve a purpose and is related to the understanding of subtle social and linguistic cues (e.g., knowing the rules for taking turns and the style and tone of speech appropriate for different listeners when conversing; interpreting the meaning of gestures and facial expressions). Although individuals with ASD may be able to verbalize words and construct grammatically correct sentences, they often struggle in initiating and maintaining conversations. Their lack of awareness about the social rules of language is considered one reason for such difficulties in discourse (Kelley, Paul, Fein, & Naigles, 2006). Individuals with ASD have difficulties in interpreting nonliteral uses of language, such as jokes and metaphors (Martin and McDonald, 2004 and Mitchell et al., 1997), as well as sarcasm and figures of speech (Happé, 1995 and Jolliffe and Baron-Cohen, 1999) – difficulties which can lead to the misunderstanding of communicative intent and interpersonal problems. Given their difficulty with understanding these aspects of pragmatic communication, individuals with ASD may not know how to act or what to say in unstructured situations such as the playground or the lunchroom and as a result they may be ridiculed and/or exploited by their peers 1.4. Executive functioning in individuals with ASD Although not part of diagnostic criteria, deficits in executive functioning (EF) have long been noted in children and adolescents with ASD (Pennington & Ozonoff, 1996). The construct of EF refers to the processes necessary for the attainment of future goals (Welsh & Pennington, 1988). It encompasses a number of skills involving mental control and self-regulation of behavior and emotions that include planning, inhibition, organization, cognitive flexibility, emotional control, self-monitoring, initiation, and working memory. Over the past two decades, various studies have examined EF deficits in ASD; however, comparisons across studies are problematic, since the range of EF domains under study has varied greatly, as has the variety of performance-based and rating measures for the EF domains (for a review see Hill, 2004). Performance-based measures of EF often differ from ratings measures. For example, performance-based measures of EF are more likely to indicate how efficiently an individual can process information in a structured situation (the algorithmic mind), whereas rating measures, such as parental reports, provide information regarding how efficient the individual is in pursuing individual goals and problem-solving (the reflective mind) in everyday situations (Toplak, West, & Stanovich, 2013). Toplak et al. suggest that ratings measures of EF assess issues regarding rational control, “which refers to behavior in the real environment that serves to foster goal achievement” (p. 137). Because peer victimization has been associated with poor problem-solving abilities (Cassidy, 2009) and occurs in everyday life across various situations, the present study employed the Behavior Rating Inventory of Executive Function (BRIEF; Gioia, Isquith, Guy, & Kenworthy, 2000). The BRIEF is a rating measure of EF that focuses on observational reports of overt behavior in children and adolescents by parents and/or caregivers. Using parental reports, it has been shown that individuals with ASD have deficits across multiple EF domains. For example, Zandt, Prior, and Kyrois (2009) used the BRIEF (Gioia et al., 2000) to compare parental reports of adolescents with ASD to a group of TD adolescents and found that the ASD group had significantly poorer abilities across all EF domains, especially for shifting attention. Kenworthy, Black, Harrison, della Rosa, and Wallace (2009) also used the BRIEF to examine EF in a group of 89 children with ASD. Controlling for age and vocabulary, the scale's Behavioral Regulation Index (BRI) was found to be significantly related to each of the disorder's defining criteria: impairments in social interactions and communication, and repetitive and ritualistic patterns of behaviors. The Metacognition Index (MI) was significantly related to impairments in social interactions. In addition, the mean standardized scores for both parent and teacher reports for total EF were found to be in the clinically significant range (t ≥ 65). The BRI from the BRIEF measures a child's ability for inhibition, shifting attention, and emotional control, while the MI measures more sophisticated abilities of EF including initiation, working memory, planning, organizing materials and monitoring. As pointed out by Gioia et al. (2000), behavior regulation can be considered an antecedent of metacognition, as it sets the foundation for effectively guiding problem solving and planning abilities. Thus, deficits in the ability to cognitively switch from one situation or activity to the next, control one's impulses, and regulate one's emotions can ultimately lead to deficits in the ability to initiate, plan, organize and maintain “future-oriented problem solving in working memory” (Gioia et al., 2000, p. 20). Conceptually, it is possible that the three behavioral regulation abilities measured by the BRIEF are both directly and indirectly related to peer victimization. Directly, individuals with ASD who are unable to inhibit or control their behavior may find themselves in a vulnerable situation or participate in behaviors that increase their chances of peer victimization. For example, they may display impulsive behaviors (e.g., speaking out of turn, interrupting others, not following rules, making inappropriate noises or gestures) that their peers find disruptive and/or annoying and which increase their risk of peer victimization (see Rose, Monda-Amaya, & Espelage, 2011). Once in this negative situation, individuals with ASD may be unable to shift or focus their attention where needed. Their lack of emotional regulation results in a response to the peer victimization (e.g., fear or anger) that the perpetrator finds rewarding, and as a result this peer victimization is more likely to be repeated. Indirectly, deficits in behavioral regulation may contribute to poor planning and problem solving abilities – skills needed to generate an adaptive social response when faced with a demanding situation. Difficulties in EF offer a novel explanation as to why adolescents with ASD are at greater risk of peer victimization than their TD peers. Although such difficulties have been associated with aggressive behavior and bullying others in TD populations (Coolidge, DenBoer, & Segal, 2004), the present study is one of the first to investigate whether such deficits may be predictive of the elevated rates of peer victimization found in adolescents with ASD. 1.5. The present study The present study examined the relationships between pragmatic language, EF, and types of traditional peer victimization in three groups of adolescent boys: those with ASD, those with special education needs (SN) without ASD, and those who were TD. Deficits in pragmatic language and EF are not exclusive to ASD and have been noted in other childhood disorders including learning disorders (LD) and Attention-Deficit/Hyperactivity Disorder (ADHD) (Lapadat, 1991, Leonard et al., 2011 and Nyden et al., 1999). A SN control group consisting of adolescents with LD and/or ADHD was included in the present study to allow us to determine whether adolescent boys with ASD are victimized more by their peers because of symptoms central to the disorder or because of associated features (e.g., deficits in pragmatic language and EF) shared with other SN populations. Like adolescents with ASD, research has shown that adolescents with LD and/or ADHD are at greater risk of victimization than their TD peers (Mishna, 2003 and Wiener and Mak, 2009). It is possible that the underlying mechanisms of pragmatic language and EF may offer an explanation as to why some SN populations are at greater risk of peer victimization than others. Given that pragmatic language and EF have been related to social skills in both TD individuals and those with ASD (Gilotty et al., 2002, Jacobson et al., 2011, McKown et al., 2009, Oerlemans et al., 2013 and Reichow et al., 2008), it was expected that both pragmatic language and EF would be predictors of peer victimization across groups.