Unique Behavior Profiles That Specify Mental Distress in Autism

Patients with autism spectrum disorder (ASD), particularly those with limited speech, may not communicate internal distress. Clinicians therefore often infer distress from observable aberrant behaviors, whose clinical significance may differ from that in typically developing (TD) individuals. We identified aberrant behavior profiles (ABPs) that differentially track symptom dimensions across ASD and TD groups, and between minimally verbal ASD (MV-ASD) and fluently verbal ASD (FV-ASD).

We pooled three NIMH Data Archive studies with CASI-5 severities (12 domains) and Aberrant Behavior Checklist (ABC) items (58 behaviors). After adjusting for age and sex, we applied Differentially Supervised Varimax to derive ABPs and tested group differences with permutation testing and false discovery rate control.

In ASD, a disruptive/hyperactive ABP related more strongly than in TD to ADHD-hyperactive and oppositional defiant severity and to generalized anxiety, social anxiety, and specific phobia. Emotional reactivity aligned with obsessions, somatization, and depressive severity, whereas withdrawal/self-injury aligned with social and separation anxiety. Preoccupation aligned with schizophrenia-related severity, whereas hypoactivity/depressed mood aligned with post-traumatic stress and specific phobia; in MV-ASD, passive withdrawal/hypoactivity related more strongly to obsessions, somatization, and depressive severity.

Clinicians can use ABPs to guide next steps: match a patient's predominant behavior pattern to an ABP, then prioritize targeted history, caregiver probing, and symptom measures in the linked domains. For example, prominent withdrawal with self-injury should trigger focused screening for social and separation anxiety, whereas marked emotional reactivity should trigger assessment for obsessive symptoms, somatic distress, and depression.