The Relationship Between Augmentative and Alternative Communication Use by Pediatric Psychiatric Inpatients With Autism Spectrum Disorder and Interfering Behaviors.

Researchers studied 260 autistic children and young adults in psychiatric facilities to understand how communication difficulties relate to challenging behaviors. They found that children with poorer communication skills showed more repetitive behaviors, especially those who could benefit from communication aids but didn't have access to them. The study suggests that some challenging behaviors might be children's way of trying to communicate when they don't have proper tools or support.

This retrospective study examined 260 autistic inpatients aged 4-20 years to investigate relationships between verbal ability, augmentative and alternative communication (AAC) use, and interfering behaviors. The research found that lower language/communication abilities were associated with increased repetitive behaviors and stereotypies, particularly in individuals who were AAC candidates but lacked access to these tools. While AAC use itself did not predict decreased interfering behaviors, higher receptive vocabulary scores correlated with more interfering behaviors in those with complex communication needs. The findings suggest that unmet communication needs may drive the use of interfering behaviors as alternative communication methods, highlighting the importance of appropriate AAC provision for individuals with autism.

Results suggest comprehensive communication assessments should identify AAC candidates and ensure appropriate access. Interfering behaviors may serve communicative functions and should be evaluated within this context. Clinical teams should consider communication needs when developing behavioral intervention plans for autistic individuals.

Retrospective design limits causal inferences. Sample restricted to psychiatric inpatients may not generalize to broader autism population. No details provided about AAC implementation quality or duration. The study design cannot establish whether communication deficits cause interfering behaviors or vice versa.

Previous research conducted by Williams et al. (2018) using data from the Autism Inpatient Collection (AIC) found a weak and inconsistent association between verbal ability and the severity of interfering behaviors; however, adapting/coping scores were significantly associated with self-injury, stereotypy, and irritability (including aggression and tantrums). The previous study did not account for access to or use of alternative forms of communication in their sample population. This study uses retrospective data to investigate the association between verbal ability and augmentative and alternative communication (AAC) use and the presence of interfering behaviors in individuals with autism who have complex behavioral profiles. The sample included 260 autistic inpatients, ages 4-20 years, from six psychiatric facilities, enrolled during the second phase of the AIC when detailed information about AAC use was collected.

Measures included AAC use, method, and function; comprehension and production of language; receptive vocabulary; nonverbal IQ; severity of interfering behaviors; and the presence and severity of repetitive behaviors. Lower language/communication abilities were related to increased repetitive behaviors and stereotypies. More specifically, these interfering behaviors appeared to be related to communication in those individuals who were candidates for AAC but who were not reported to have access to it. Although the use of AAC did not predict a decrease in interfering behaviors, receptive vocabulary scores-as measured by the Peabody Picture Vocabulary Test-Fourth Edition-were positively correlated with the presence of interfering behaviors in participants with the most complex communication needs.

The communication needs of some individuals with autism may be unmet, prompting the use of interfering behaviors as a form of communication. Further investigation of the functions of interfering behaviors and the related functions of communication skills may provide greater support for an increased focus on the provision of AAC to prevent and ameliorate interfering behaviors in individuals with autism.