Health-related Risky Behaviors and Their Risk Factors in Adolescents with High-functioning Autism

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 4 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, < 0.05). Among the associated factors, poor emotional experience (B = -0.268, < 0.001), depression (B = -0.321, < 0.001), low score of intelligence (B = -0.032, = 0.042), low score of Theory of Mind test (B = -1.321, = 0.003) and poor adaptation to school life (B = -0.152, = 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.