The characteristics and factors of the internalizing and externalizing behaviours of children at high risk for autism spectrum disorder

Abstract Background: Children with autism spectrum disorder (ASD) are at risk of developing internalizing and externalizing problems. However, information on the early development of behavioural problems and the contributing role of parent-child interactions among infants at high risk for ASD is lacking. We tested whether parent-child interactions and parenting characteristics were associated with behavioural problems during the infant and toddler periods and examined the effects of the intervention on behavioural problems.Methods: This study collected data from 91 infants at high for risk ASD and 68 matched typically developing (TD) infants. At baseline, behavioural observation was performed during free play with all the enrolled families, and in the ASD group, a second behavioural observation was performed after 12 weeks of the Play-based Communication and Behavior Intervention (PCBI). The coding of parent-child interactions was based on the behaviour of parents and children during free play. These data included the child’s engagement with each parent and behavioural problems.Results: During free play, infants in the ASD group showed more internalizing behaviours (p<0.001) and externalizing behaviours (p<0.05) and less positive engagement (p<0.01) than TD infants. After 12 weeks of intervention, we found that infants at high for risk ASD had reduced internalizing behaviours (p<0.001), increased parent positive engagement (p<0.001), and improved parent-child interactions (p<0.001). In the regression analysis, we found that parenting stress had an impact on infants’ externalizing behaviours (△R2 = 0.215). Parent negative engagement had an impact on infants’ internalizing behaviours (△R2 = 0.451).Conclusions: The findings on the contribution of both parent negative engagement and parent-child interactions to behavioural problems suggests that the amelioration of parent negative engagement is an important factor for the mitigation of behavioural problems. The amelioration of parenting stress is associated with externalizing behaviours. Early intervention and parental factors are important for preventing behavioural problems and possible comorbidity problems in the future.