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An Investigation of Physiological Arousal in Children with Autism And An Investigation of Physiological Arousal in Children with Autism and Co-morbid Challenging Behaviour Sinéad Lydon A thesis submitted to Trinity College Dublin, the University of Dublin, in partial fulfillment of the requirements for the Degree of Doctor of Philosophy (PhD) in Psychology 2015 Supervisors: Dr. Olive Healy (Trinity College Dublin) and Professor Brian Hughes (National University of Ireland, Galway). Declaration I declare that this thesis has not been submitted as an exercise for a degree at this or any other university and it is entirely my own work. I agree to deposit this thesis in the University’s open access institutional repository or allow the library to do so on my behalf, subject to Irish Copyright Legislation and Trinity College Library conditions of use and acknowledgement. Sinéad Lydon Table of Contents Page Summary i Funding iv Acknowledgements v Publications and conference proceedings arising from this thesis vi List of tables vii List of figures x List of abbreviations xi Chapter 1 General introduction 1 Challenging behaviour in autism spectrum disorder 2 Physiological activity in autism spectrum disorder 9 Theories linking physiological activity and challenging behaviour 12 Empirical investigations of the relation between physiological activity 19 and challenging behaviour Conclusions and research aims 29 Chapter 2 A systematic review of physiological reactivity to 33 stimuli in autism spectrum disorder Abstract 34 Introduction 35 Method 38 Results 45 Discussion 70 Chapter 3 Salivary cortisol levels and challenging behaviour in 79 children with autism spectrum disorder Abstract 80 Introduction 81 Experiment 1 85 Method 85 Results and discussion 91 Experiment 2 94 Method 94 Results and discussion 99 General discussion 103 Chapter 4 Heart rate measurement during stereotyped motor 113 behaviour in autism spectrum disorder Abstract 114 Introduction 115 Method 120 Results 132 Discussion 144 Chapter 5 An examination of the physiological correlates of 155 challenging behaviour in autism spectrum disorder Abstract 156 Introduction 157 Method 161 Results 176 Discussion 207 Chapter 6 General discussion 217 Summary of studies 218 Implications of the research findings 220 Recommendations for future research 230 Limitations 234 Conclusion 239 References 241 Appendix A 299 Appendix B 303 Summary Challenging behaviour is prevalent among individuals with autism spectrum disorders (ASD). While operant theory has allowed for the development of effective behavioural interventions for challenging behaviours such as self-injury and stereotypy, the aetiology of such behaviours remains largely unknown. An abundance of theories exist that posit that these behaviours may be the result of physiological dysregulation or atypical physiological processes. However, there is currently a limited body of research empirically examining the relationship between physiological activity and engagement in challenging behaviour. The purpose of the current program of research was to examine the contribution of psychophysiological measurement to our understanding and assessment of challenging behaviour in ASD. Chapter 1 provides an overview of the extant literature pertaining to challenging behaviour in ASD, physiological functioning among those with the disorder, and the theoretical and empirical work suggestive of a relation between physiological activity and engagement in challenging behaviours by those with ASD. Chapter 2 presents a systematic review of physiological reactivity to sensory, social and emotional, and stressor stimuli among individuals with ASD. The aim of this review was to examine whether physiological reactivity to stimuli is atypical in this population and whether differences in physiological reactions to stimuli may contribute to the atypical behaviours associated with autism. The results reveal that previous research has yielded inconsistent findings across studies reviewed with individuals with autism responding differently to typically developing controls on 78.6%, 66.7% and 71.4% of sensory, social and emotional, and stressor stimuli respectively. It was found that the disparity in outcomes was not attributable to the methodological quality of included studies and that extant research suggests that physiological reactivity is associated with a number of i behaviours and psychological variables related to autism. Chapter 3 investigates cortisol levels among children and adolescents with autism (n=52) as compared to a matched sample of typically developing peers. Further, the relationship between levels of stress- parent-reported and physiological-and challenging behaviour was examined for 61 youths with autism. While not statistically significant, there was a trend towards higher levels of stress among participants diagnosed with autism. Cortisol levels were not correlated with participants’ self-injurious and aggressive behaviours. However, it was found that participants who engaged in high levels of stereotypy had higher cortisol levels (large effect size) than participants who engaged in little or no stereotypy. Chapter 4 examines the relationship between heart rate and motor stereotypy among five children and adolescents with ASD. Our analysis did not suggest that physiological arousal functioned as an antecedent to, or reinforcer for, four of the five participants’ stereotypy. For one participant, stereotypy consistently resulted in heart rate decreases that may have acted as negative reinforcement for this behaviour. The examination of heart rate levels during various mood states in this study suggested that participants presented with an atypical physiological response, suggestive of physiological blunting, to stressors encountered in their natural environment during the recording period. Chapter 5 assesses the contribution of heart rate and electrodermal activity to the experimental functional analysis of repetitive, stereotyped behaviour among six children and adolescents diagnosed with autism. Our analysis revealed little association between physiological activity and engagement in repetitive, stereotyped behaviours for these participants. However, similar to the findings reported in Chapter 4, an apparent blunted physiological response to stressors encountered was noted for a number of the participants. ii The results of the current research program are discussed in Chapter 6 in relation to their implications for behaviour analysts’ understanding, assessment, and treatment of challenging behaviour among individuals with autism. Our results suggest that psychophysiological assessments among persons with autism can offer a valuable contribution to behaviour analysts’ understanding of challenging behaviour and the experiences and wellbeing of persons with autism. However, it was found that these assessments may not yield useful data for all individuals with autism. Future research must therefore establish the behaviours, individuals, or conditions for which these assessments are most useful. Additional directions for further research on the experience of stress among persons with autism, physiological blunting among this population, potential physiological subgroups of autism, and the inclusion of lower functioning individuals with autism in psychophysiological research studies, are also described. iii Funding This research program was funded by the Irish Research Council’s Embark Postgraduate Scholarship Scheme [RS/2012/134]. iv Acknowledgements First and foremost, thank you to my wonderful supervisor Dr. Olive Healy. I feel so very grateful to have had you as a mentor and I can’t adequately express how thankful I am for everything you have done for me, and taught me. This PhD has been such a positive experience for me and that is entirely attributable to your support, kindness, and boundless enthusiasm and good humour. I also owe a wealth of gratitude to a number of others who helped me with my research. Thank you to my co-supervisor Professor Brian Hughes. Your input regarding statistical intricacies and expertise in psychophysiology was invaluable. I will forever carry with me, and passionately espouse, your teachings on the importance of science. I am grateful to Dr. Michelle Roche for her expert assistance with the cortisol analysis for Study 2. Thanks also to Rebecca Henry who took time out of her own busy PhD schedule to spend some long, sweltering, but nonetheless enjoyable, days in the lab with me carrying out the cortisol assays. I must also thank Teresa Mulhern, my very enthusiastic and helpful research assistant. I also wish to express my thanks to the many schools, services, and behaviour analysts that helped me to recruit participants. I am ever grateful and awed that so many people took so much time out of their own hectic schedules to help me. I will never forget these kindnesses. Nor will I forget all of the children, parents, and teachers who took part in my studies. I met over 70 children and teenagers with autism during the past three years. I feel fortunate to have gotten to know each one and wish them all the best in the future. I am lucky to have many brilliant, kind friends who have been there for me throughout this PhD. I am so grateful to all of you! To my best friend, Lizanne: thank you for always being ready to procrastinate with me and for never being more than a message or email away. Billy, thank you for making my life outside of the PhD so wonderfully happy and scenic. I love you. Also, Bill and Kathy- thank you for everything you have done for me over the past few
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