Observational Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Aug 6, 2021; 9(22): 6329-6342
Published online Aug 6, 2021. doi: 10.12998/wjcc.v9.i22.6329
Health-related risky behaviors and their risk factors in adolescents with high-functioning autism
Ya-Jing Sun, Ling-Zi Xu, Zeng-Hui Ma, Yu-Lu Yang, Ting-Ni Yin, Xiao-Yun Gong, Zi-Lin Gao, Yan-Ling Liu, Jing Liu
Ya-Jing Sun, Ling-Zi Xu, Zeng-Hui Ma, Yu-Lu Yang, Ting-Ni Yin, Xiao-Yun Gong, Jing Liu, Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing 100191, China
Zi-Lin Gao, Quanzhou Children’s and Women’s Hospital, Quanzhou 362000, Fujian Province, China
Yan-Ling Liu, Department of Mathematics, Changzhi Medical College, Changzhi 046000, Shanxi Province, China
Author contributions: Sun YJ, Xu LZ, Ma ZH, Yang YL, Yin TN, Gong XY and Gao ZL performed the study; Sun YJ and Liu YL analyzed the data; Sun YJ wrote the manuscript; Xu LZ, Ma ZH and Liu J revised the manuscript; all authors have read and approved the final manuscript.
Supported by National Key R&D Program of China, No. 2017YFC1309900; and Beijing Municipal Science & Technology Commission, No. Z171100001017088 and No. Z161100000116098.
Institutional review board statement: This study was approved by Ethics Committee of Peking University Sixth Hospital (No. 2016-11-7-1).
Informed consent statement: All study participants provided written informed consent prior to study enrollment.
Conflict-of-interest statement: All authors declare no conflicts of interest in this study.
Data sharing statement: Statistical code and data are available from the corresponding author.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jing Liu, MD, Chief Physician, Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), No. 51 Huayuan North Road, Haidian District, Beijing 100191, China. ljyuch@bjmu.edu.cn
Received: May 15, 2021
Peer-review started: May 15, 2021
First decision: May 23, 2021
Revised: May 25, 2021
Accepted: June 2, 2021
Article in press: June 2, 2021
Published online: August 6, 2021
Abstract
BACKGROUND

Health-related risky behaviors generally refer to behaviors that have a negative impact on health and quality of life. Health-related risky behaviors in adolescents with high-functioning autism (HFA) have not been well understood so far. Adolescents with HFA may have more health-related risky behaviors than neurotypical adolescents.

AIM

To investigate health-related risky behaviors and their risk factors with HFA.

METHODS

This is an observational study. Our study enrolled 110 adolescents aged 12-19-years-old meeting Diagnostic and Statistical Manual of Mental Disorders 4th edition criteria for HFA. They were recruited from Peking University Sixth Hospital. There were also 110 age, sex and nationality matched controls enrolled who came from a public school in Beijing, China. Both groups completed the Adolescents Health-related Risky Behavior Inventory. Nonparametric tests were carried out for comparison of the Adolescents Health-related Risky Behavior Inventory scores between the two groups. Expression recognition, the Inventory of Subjective Life Quality for Child and Adolescent, Chinese Wechsler Intelligence Scale for Children, Wechsler Intelligence Scale for Adult-Chinese Revised, Theory of Mind test and Autism Spectrum Screening Questionnaire were assessed in the autism group to explore factors associated with health-related risky behaviors. Multivariate regression analysis was conducted to explore the risk factors of health-related risky behaviors in the HFA group.

RESULTS

The results showed that the total score of the Adolescents Health-related Risky Behavior Inventory and scores of “aggression and violence,” “suicide and self-injury,” “health compromising behavior” and “unprotected sex” subscales in the HFA group were significantly higher than those in the control group (Z range -4.197 to -2.213, P < 0.05). Among the associated factors, poor emotional experience (B = -0.268, P < 0.001), depression (B = -0.321, P < 0.001), low score of intelligence (B = -0.032, P = 0.042), low score of Theory of Mind test (B = -1.321, P = 0.003) and poor adaptation to school life (B = -0.152, P = 0.006) were risk factors. These risky behaviors may promote the occurrence of health-related risky behaviors in adolescents with HFA.

CONCLUSION

This study showed that adolescents with HFA were more likely to be involved in health-related risky behaviors. Different health-related risky behaviors have different reasons.

Keywords: High-functioning autism, Adolescents, Health-related risky behaviors, Associated factors, Risk factors, Cross-sectional study

Core Tip: We comprehensively explored health-related risky behaviors in a large sample of adolescents with high-functioning autism. These risky behaviors can be detrimental to the physical and mental status of individuals with high-functioning autism. Low cognitive function, unhealthy emotional state, etc. may be related to health-related risky behaviors in autistic adolescents. Through this study, we provide better understanding of health-related risky behaviors in adolescents with high-functioning autism.