Anger Rumination is Associated with Restricted and Repetitive Behaviors in Children with Autism Spectrum Disorder

Abstract

Children with autism spectrum disorder (ASD) are reported to have greater levels of anger rumination than typically developing children. This study examined anger rumination in children with ASD in comparison to children with disruptive behavior disorder without ASD. We also tested if anger rumination is associated with aggression and the core ASD symptoms of restricted and repetitive behaviors (RRBs). This study included three groups of children aged 8-16 years: 63 had ASD (ASD group), 79 had disruptive behavior disorder (DB group), and 40 healthy controls (HC). ASD and DB groups showed greater anger rumination relative to the HC group. Anger rumination was associated with RRBs in children with ASD, suggesting the link to core ASD symptoms.

Keywords: Aggression; Anger rumination; Autism spectrum disorder; Emotion regulation; Restricted and repetitive behaviors.

Conflict of interest statement

Conflict of interest Dr. Sukhodolsky receives royalties from Guilford Press for a treatment manual on CBT for anger and aggression in children. Other authors (K.I., C.K., C.L.M., A.A., L.G., and K.C.) have no biomedical financial interests or potential conflicts of interest to declare related to this present study.

Figures

Fig. 1

Mean levels of anger rumination across the combined ASD group in comparison to children with disruptive behavior disorders without ASD and healthy controls. Children with ASD (n = 63) showed greater levels of anger rumination relative to healthy control children (n = 44). However, levels of anger rumination were similar between children with ASD and children with disruptive behavior disorders without ASD (n = 79). The figure shows mean anger rumination scale total scores (y-axis). Disruptive behavior group refers to children with disruptive behavior disorders without ASD. Standard error is represented in error bars

Fig. 2

Interaction between ASD diagnosis and restricted and repetitive behaviors is associated with anger rumination in the total sample (N = 186). Restrictive and repetitive behaviors are measured using the social responsiveness scale-second edition (SRS-2) restricted and repetitive behaviors scale. Anger rumination is measured using the Anger Rumination Scale total score. The model controls for gender, aggression using the reactive–proactive aggression questionnaire total score, and the interaction between ASD diagnosis and aggression. High and low levels of restrictive and repetitive behaviors were dichotomized using a median split for visualization purposes. The total sample of participants includes children with ASD (n = 63), children with disruptive behavior disorder without ASD (n = 79), and healthy controls (n = 44)

Fig. 3

Results of a linear regression across the combined ASD group (n = 63). The residual plot shows the association between anger rumination and restricted, repetitive behaviors (RRBs) across the ASD group when both the social responsiveness scale-second edition RRB score and reactive–proactive aggression questionnaire total score were modelled simultaneously while controlling for gender. The anger rumination scale total score is used for analyses