Peer-reviewed article
Longitudinal predictors of internalizing and externalizing behaviors in autism: Examining relationships with ritualistic behavior and social diagnostic features.
Madison Surmacz, Marika M Coffman, Susan Faja, Nicole Nadwodny, Geraldine Dawson et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study followed autistic children aged 6 to 11 years over time to understand how their autism-related behaviors predict later mental health problems. Researchers measured ritualistic behaviors (like repetitive actions) and social difficulties at baseline, then tracked internalizing symptoms (anxiety, withdrawal) and externalizing symptoms (aggression, disruption) about 4 years later. Ritualistic behavior at baseline predicted higher internalizing symptoms later, but social difficulties and ritualistic behavior did not predict externalizing symptoms.
Key points
- 139 autistic children were followed from a mean age of 8.5 years to 12.7 years
- Baseline ritualistic behavior predicted later internalizing behaviors
- Baseline social diagnostic features did not predict later internalizing or externalizing behaviors
- Neither ritualistic behavior nor social features predicted externalizing behaviors
- Ritualistic behavior and social diagnostic features were moderately correlated at baseline (r = .590)
Limitations
The sample was predominantly White (68.3%) and male (79.1%), limiting generalizability to other autistic populations. The study is observational and cannot establish causal mechanisms, only predictive associations.
Abstract
Autistic youth commonly experience co-occurring mental health conditions. Core autism features have been linked to internalizing and externalizing symptoms, yet longitudinal pathways remain unclear. This study examined how ritualistic and social diagnostic features predict later internalizing and externalizing behaviors in school-age autistic children. Caregivers reported ritualistic behavior (PDDBI), social diagnostic features (SRS-2), and internalizing and externalizing behaviors (CASI-5; BASC-3) at two time points (baseline Mage = 8.50, SD = 1.62, range = 6.0-11.5; follow-up Mage = 12.67, SD = 1.79, range = 8.7-16.1). Children (n = 139) were 79.1% male (n = 110), 20.9% female (n = 29), 5% African American/Black (n = 7), 0.7% American Indian/Alaska Native (n = 1), 7.2% Asian (n = 10), 17.3% Mixed Race (n = 24), 1.4% Other (n = 2), 68.3% White (n = 95), 17.3% Hispanic/Latinx (n = 24), and 82.7% non-Hispanic/Latinx (n = 115). Ritualistic behavior and social diagnostic features were associated at baseline (r = .590). Baseline ritualistic behavior predicted later internalizing behaviors, while neither social diagnostic features nor ritualistic behavior predicted later externalizing behaviors. Findings underscore the importance of examining specific core autism features, particularly ritualistic behavior, as early indicators of internalizing and externalizing challenges across development.
Findings the Hub has extracted
Each claim below is labelled by its type of design and links back to this report.
- Intervention
- None; this is an observational longitudinal study examining whether baseline autism features predict later behavioral outcomes
- Population
- School-age autistic children (n=139), mean baseline age 8.5 years, mostly male (79.1%) and White (68.3%)
Key finding
Baseline ritualistic behavior significantly predicted later internalizing behaviors