Research Summary

What May Be Behind Challenging Behavior in Autism?

Marina Sarris | Interactive Autism Network at Kennedy Krieger Institute
A study found that the verbal ability was not a major factor associated with problem behaviours, but rather such behavioural issues may reflect difficulty coping and adapting. The link between speech, coping, and behaviours is still being explored.


Marina Sarris

Interactive Autism Network at Kennedy Krieger Institute


Date Published in Interactive Autism Network: November 14, 2017

Date Revised and Republished in AIDE Canada: September 4, 2019


As parents know, behavior and speech are intertwined. "Use your words," we tell toddlers when they misbehave. Solve your problems by talking it out, not fighting, we say when they get older.

Autism often limits someone's ability to speak or communicate in other ways, causing frustration. So it's assumed by families and professionals alike that speech problems fuel the challenging behaviors often found in youth with autism: hitting oneself or others, tantrums, throwing things, running away, screaming, or being disruptive.

But a study of youth with autism in psychiatric hospitals calls that "prevailing assumption" into some question. Researchers found that the ability to speak was not a major factor in severe behaviors in those children, teens and young adults. Instead, the biggest influence was the person's ability to cope and adapt.1


“Many times people responded positively to improved communication skills, but for some kids, it wasn't reducing problem behaviors as much as I would have liked.”

Those findings are surprising, suggested the study's lead author, speech-language pathologist Diane L. Williams PhD. In her field, "there were very strong feelings that communication equals behavior, and if we increase a person's communication skills, that will decrease his behavioral problems," said Dr. Williams, who leads the Communication Sciences and Disorders Department at Pennsylvania State University.

Yet, from her own experience with patients, she knew that learning to speak did not eliminate behavioral problems in everyone with autism. "Many times people responded positively to improved communication skills, but for some kids, it wasn't reducing problem behaviors as much as I would have liked."

Her study involved 346 youth ages 4 to 20 in the Autism Inpatient Collection (AIC), a study of inpatients at special psychiatry units at six sites in the United States. They all had behavioral or emotional problems that were serious enough to require a hospital stay. But they varied greatly on other measures, such as levels of speech and intelligence. Roughly half of the youth in the study had little or no speech, and half spoke fluently. Two out of five youth had intellectual disability, with most of those youth also having limited speech.1

In their analysis, the researchers took the youth's ages and nonverbal intelligence scores into account because those factors could influence problem behaviors. Despite their verbal differences, both groups – those who could speak in sentences and those who had few words – had similar levels of irritability and repetitive behaviors, such as hand flapping and rocking. The youth who could speak fluently, surprisingly, had more externalizing behavior, that is, aggression and angry outbursts.1

"A lot of people think one of the reasons some kids act out so much is because they can't communicate," said child psychiatrist Matthew Siegel, a principal investigator with the Autism Inpatient Collection who worked on this study. "That might be true, but in terms of acting out in the form of aggression, that's not what we found."


"Aggression," Dr. Siegel said, "is a big deal." Indeed. In another study, two-thirds of families reported that their child with autism had shown aggression toward caregivers, and nearly half reported aggression toward non-caregivers. Those findings came from the Simons Simplex Collection (SSC), a study of families who each had one child with autism.2 The SSC study, like the one involving autism inpatients, did not find a link between aggression and having lower language or communication abilities. It did find a greater risk of aggression in children who were younger and who had more ritualistic behaviors, a greater resistance to change, and more self-injury.2

"We need to pay attention to aggression. We know that aggression is the biggest cause of stress in parents," said Dr. Siegel, who directs the Developmental Disorders Program at Spring Harbor Hospital in Maine.

In interviews with the Interactive Autism Network, some parents have said they worry that aggression and self-injury could prevent their son or daughter from staying safe, keeping a job, or living independently or with others in adulthood.

The autism inpatient study did not find a clear path from verbal skills to problem behavior, and its authors note that the results may not apply to youth with fewer behavior challenges. But some parents and professionals, as well as other research studies,3-5 say there is a connection between lower verbal skills and challenging behavior.


One teacher told the Interactive Autism Network, through a Facebook message, "Most students in my class are nonverbal, but I have seen enormous behavioral strides made once these students are able to communicate their needs. Behavior always has a function, and if the student isn't able to communicate with words, they need to express themselves in some way. Some learn that challenging behaviors help them have their needs met early on, and this sticks with them," he said.

Dr. Jennifer Zarcone, a senior behavior analyst at Kennedy Krieger Institute, said she has noticed a link between limited speech and behavioral problems. She works with inpatients on the Institute's Neurobehavioral Unit, which specializes in treating self-injury and severe behaviors in youth with autism and developmental disorders. "I'm more likely to see kids with more communication difficulties who are having more problem behaviors," she said. To help address that, speech-language pathologists help patients learn to communicate with picture exchange systems, mobile devices, and assistive technology, she said.

Dr. Zarcone said she understands why the AIC study found that youth with lower adapting/coping skills had more severe behavioral problems. "That makes sense that coping scores are associated with more behavior problems. Children who can't cope with the frustration of being told 'no,' for example, would have more behavioral problems," she said.

To gauge coping skills, the researchers looked at certain scores from the Vineland Adaptive Behavior Scales, which tests how someone functions in everyday life. Among other adaptive skills, it measures coping abilities, such as whether a person follows rules, abides by time limits, controls emotions when upset, and apologizes.6


“She helped him put into words what he was feeling.”

Is there a connection between verbal abilities and coping skills that could explain why some see verbal and behavioral improvements going hand-in-hand?

Perhaps it is because some interventions that increase communication also may improve a person's coping skills, and that may explain why behavior can improve as language does, speculated Dr. Williams' research team. "The reason increasing communication skills can have a positive effect on behavior may be because the child's repertoire of coping skills has increased," their research article said. For example, an intervention that teaches a student how to communicate with others and regulate his emotions also may be broadening his ability to cope with day-to-day frustrations. Those coping skills, in turn, could lead to calmer behavior.

One example of a language-based intervention that could help with coping is the Social Story™, a tool developed by teacher Carol Gray in 1990. A Social Story is a personalized and illustrated story that teaches someone what to expect from, and how to respond to, a new or difficult situation. A Social Story can provide the language that a child needs to understand a situation and adapt his behavior to it, Dr. Williams said. The National Standards Project has rated story-based programs, including Social Stories, as an "established intervention" for children, teens, and young adults with autism. That means there is enough research evidence to say these stories work.7

Some parents intuitively use language in a way that helps their children understand and regulate their behavior, Dr. Williams said. One time she happened to be waiting for an elevator with a mother and her 8-year-old son with autism. "The boy started to run around and touch things, and his mother said to him, 'It's hard to wait for the elevator. The elevator will be here soon, and when it comes, you're going to push all the buttons.' And he stopped running. She never said, 'Settle down.' She never said, 'Stop doing that.' She helped him put into words what he was feeling. I was fascinated by this interaction. The mom explained to me, 'I'm his mediator. He can't put his feelings into words.' By her doing it, that helped him regulate himself."

In addition to targeting communication skills, Dr. Williams and Dr. Siegel said, interventions may also need to teach strategies that help people with autism regulate their emotions. "We might want to focus on improving adapting and coping strategies to address problem behavior," Dr. Siegel said.



1. Williams, D. L., Siegel, M., Mazefsky, C. A. (2018). Problem behaviors in autism spectrum disorder: Association with verbal ability and adapting/coping skills. Journal of Autism and Developmental Disorders, 48(11), 3668-3677. doi:10.1007/s10803-017-3179-0.

2. Kanne, S. M., & Mazurek, M. O. (2011). Aggression in children and adolescents with ASD: Prevalence and risk factors. Journal of Autism and Developmental Disorders, 41(7), 926-937. doi:10.1007/s10803-010-1118-4.

3. Dominick, K. C., Davis, N. O., Lainhart, J., Tager-Flusberg, H., & Folstein, S. (2007). Atypical behaviors in children with autism and children with a history of language impairment. Research in Developmental Disabilities, 28(2), 145-162. doi:10.1016/j.ridd.2006.02.003.

4. Baghdadli, A., Assouline, B., Sonié, S., Pernon, E., Darrou, C., Michelon, C., . . . Pry, R. (2012). Developmental trajectories of adaptive behaviors from early childhood to adolescence in a cohort of 152 children with autism spectrum disorders. Journal of Autism and Developmental Disorders, 42(7), 1314-1325. doi: 10.1007/s10803-011-1357-z

5. Rattaz, Michelon, & Baghdadli. (2015). Symptom severity as a risk factor for self‐injurious behaviours in adolescents with autism spectrum disorders. Journal of Intellectual Disability Research, 59(8), 730-741. doi:10.1111/jir.12177

6. Sparrow, S. S., Cicchetti, D. V., & Saulnier, C. A. (2016). Vineland Adaptive Behavior Scales, Third Edition (Vineland-3). San Antonio, TX: Pearson.

7. National Autism Center. (2015). Findings and conclusions: National standards project, phase 2 [PDF file]. Retrieved from



Reproduced with permission of Kennedy Krieger Institute, Baltimore, MD, USA. This information appeared originally on the Interactive Autism Network Community website at It has been modified from the original with permission, but Kennedy Krieger Institute is not responsible for the modifications.

Photo by Xia Yang on Unsplash

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