{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,16]],"date-time":"2026-03-16T16:09:21Z","timestamp":1773677361121,"version":"3.50.1"},"reference-count":57,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,3,16]],"date-time":"2026-03-16T00:00:00Z","timestamp":1773619200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Psychol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Autism spectrum disorder (ASD) is a complex neurodevelopmental disability that typically appears early in life. ASD is frequently associated with challenging behaviors (CBs), which can be categorized into aggressive or disruptive, stereotypic and self-harming behaviors. The prevalence and patterns of challenging behaviors in ASD children have not been reported in the Malaysian population. Challenging behaviors may influence caregiver demands and parental quality of life. Understanding how prevalent challenging behaviors are, the types of behaviors exhibited, what factors contribute to them, and how they affect the quality of life of parents with ASD children are important aspects of ASD management.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>This study was conducted to determine the prevalence and types of challenging behaviors in children with ASD, and factors that predict them. The quality of life in parents of children with ASD, and predictors for these, were also assessed. Finally, the association between challenging behaviors and quality of life in parents was determined.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this purposive consecutive study, a total of 166 parents of children with ASD aged between 2 to 18 years old were recruited from the Child Development Centre (CDC) in Universiti Kebangsaan Malaysia over a period of 11 months between 1st June 2021 and 31st May 2022. The Autism Spectrum Disorders \u2013 Behavior Problem for Children (ASD-BPC) questionnaire was translated to the Malay language and used to assess prevalence and subtypes of challenging behaviors in ASD children. The quality of life of parents was ascertained using the Quality of Life in Autism (QoLA) questionnaire and described in median and IQR. Univariate and multivariate regression was performed to assess predictors for challenging behaviors and parental quality of life. Mann-Whitney test was utilized to determine the association between challenging behaviors and parental quality of life.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The overall prevalence of challenging behaviors in ASD children was 89.8%, with the highest prevalence seen for stereotypic behaviors (75.9%). The predictors for challenging behaviors were child age and family income. The median quality of life score in parents of ASD children in this study was 103.0 (IQR:25). Challenging behaviors in ASD children were found to be associated with parental quality of life, with lower quality of life scores observed in ASD children who have \u201caggressive\/disruptive\u201d behaviors (\n                      <jats:italic>p<\/jats:italic>\n                      = 0.041) and \u201cself-injurious\u201d behaviors (\n                      <jats:italic>p<\/jats:italic>\n                      = 0.042).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The prevalence of challenging behaviors amongst ASD children was high (89.8%), of which the most prevalent type was stereotypic behavior. Presence of aggressive or disruptive and self-injurious behaviors were linked to lower quality of life in parents, highlighting the need for tailored support and interventions to improve family wellbeing.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpsyg.2026.1569087","type":"journal-article","created":{"date-parts":[[2026,3,16]],"date-time":"2026-03-16T14:34:52Z","timestamp":1773671692000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Challenging behaviors in children with autism spectrum disorders and quality of life in their parents: association between challenging behaviors and parental quality of life"],"prefix":"10.3389","volume":"17","author":[{"given":"Nur Hidayah","family":"Yahya","sequence":"first","affiliation":[{"name":"Hospital Tunku Ampuan Besar Tuanku Aishah Rohani, Hospital Pakar Kanak-Kanak Universiti Kebangsaan Malaysia","place":["Kuala Lumpur, Malaysia"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wai Wai","family":"Yang","sequence":"additional","affiliation":[{"name":"Hospital Tunku Ampuan Besar Tuanku Aishah Rohani, Hospital Pakar Kanak-Kanak Universiti Kebangsaan Malaysia","place":["Kuala Lumpur, Malaysia"]},{"name":"Department of Paediatrics, Universiti Kebangsaan Malaysia Faculty of Medicine","place":["Kuala Lumpur, Malaysia"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nur Azah","family":"Isa","sequence":"additional","affiliation":[{"name":"Hospital Tunku Ampuan Besar Tuanku Aishah Rohani, Hospital Pakar Kanak-Kanak Universiti Kebangsaan Malaysia","place":["Kuala Lumpur, Malaysia"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wan Syanaz","family":"Wan Ghazali","sequence":"additional","affiliation":[{"name":"Hospital Tunku Ampuan Besar Tuanku Aishah Rohani, Hospital Pakar Kanak-Kanak Universiti Kebangsaan Malaysia","place":["Kuala Lumpur, Malaysia"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Norazlin","family":"Kamal Nor","sequence":"additional","affiliation":[{"name":"Hospital Tunku Ampuan Besar Tuanku Aishah Rohani, Hospital Pakar Kanak-Kanak Universiti Kebangsaan Malaysia","place":["Kuala Lumpur, Malaysia"]},{"name":"Department of Paediatrics, Universiti Kebangsaan Malaysia Faculty of Medicine","place":["Kuala Lumpur, Malaysia"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,3,16]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"954","DOI":"10.1111\/j.1467-8624.2006.00912.x","article-title":"The early childhood aggression curve: development of physical aggression in 10- to 50-month-old children","volume":"77","author":"Alink","year":"2006","journal-title":"Child Dev."},{"key":"B2","doi-asserted-by":"publisher","first-page":"7303205010p1","DOI":"10.5014\/ajot.2019.030015","article-title":"Parent-mediated interventions for children with autism spectrum disorder: A systematic review","volume":"73","author":"Althoff","year":"2019","journal-title":"Am. J. Occup. Ther."},{"key":"B3","doi-asserted-by":"publisher","first-page":"9861","DOI":"10.3390\/ijerph18189861","article-title":"Quality of life and child's autism-specific difficulties among malaysian main caregivers: a cross-sectional study","volume":"18","author":"Asahar","year":"2021","journal-title":"Int. J. Environ. Res. Public Health"},{"key":"B4","unstructured":"World Health Organization\n          \n          2025"},{"key":"B5","doi-asserted-by":"publisher","first-page":"650","DOI":"10.3109\/01612840.2012.671441","article-title":"Resilience in family members of persons with autism spectrum disorder: a review of the literature","volume":"33","author":"Bekhet","year":"2012","journal-title":"Issues Mental Health Nurs."},{"key":"B6","doi-asserted-by":"publisher","first-page":"4039","DOI":"10.1007\/s10803-019-04121-x","article-title":"Self-compassion: a novel predictor of stress and quality of life in parents of children with autism spectrum disorder","volume":"49","author":"Bohadana","year":"2019","journal-title":"J. Autism Dev. Disord."},{"key":"B7","doi-asserted-by":"publisher","first-page":"212","DOI":"10.1176\/appi.focus.24022005","article-title":"Prevalence of autism spectrum disorder and co-morbidities in children and adolescents: a systematic literature review","volume":"22","author":"Bougeard","year":"2024","journal-title":"Focus"},{"key":"B8","doi-asserted-by":"publisher","first-page":"A197","DOI":"10.1136\/archdischild-2017-313087.491","article-title":"Quality of life of parents of children with autism spectrum disorder aged 3 to 18 years living in an urban area","volume":"102","author":"Calonge-Torres","year":"2017","journal-title":"Arch. Dis. Child."},{"key":"B9","unstructured":"Clinical testing and diagnosis for autism spectrum disorder.\n          \n          2025"},{"key":"B10","doi-asserted-by":"publisher","first-page":"1244164","DOI":"10.3389\/fpsyt.2023.1244164","article-title":"Problem behaviours and caregiver burden among children with Autism Spectrum Disorder in Kuching, Sarawak","volume":"14","author":"Chua","year":"2023","journal-title":"Front. Psychiatry"},{"key":"B11","unstructured":"Centers for Disease Control and Prevention\n          \n          2025"},{"key":"B12","doi-asserted-by":"publisher","first-page":"652","DOI":"10.1111\/j.1365-2788.2006.00815.x","article-title":"Prevalence and types of aggressive behaviour among adults with intellectual disabilities","volume":"50","author":"Crocker","year":"2006","journal-title":"JIDR"},{"key":"B13","doi-asserted-by":"publisher","first-page":"73","DOI":"10.3109\/13668250.2017.1310812","article-title":"A pilot study of social inclusion and quality of life for parents of children with autism spectrum disorder","volume":"43","author":"Due","year":"2017","journal-title":"J. Intellect. Dev. Disab."},{"key":"B14","doi-asserted-by":"publisher","first-page":"160783","DOI":"10.1155\/2014\/160783","article-title":"Conceptualisation development of a quality of life measure for parents of children with autism spectrum disorder","volume":"2014","author":"Eapen","year":"2014","journal-title":"Autism Res. Treat"},{"key":"B15","doi-asserted-by":"publisher","first-page":"558","DOI":"10.3390\/pediatric13040066","article-title":"Comparison of autistic individuals who engage in self-injurious behavior, aggression, and both behaviors","volume":"13","year":"2021","journal-title":"Pediatr. Rep"},{"key":"B16","doi-asserted-by":"publisher","first-page":"388","DOI":"10.1111\/j.1365-2788.1995.tb00543.x","article-title":"The form and function of challenging behaviours","volume":"39","author":"Emerson","year":"1995","journal-title":"JIDR"},{"key":"B17","doi-asserted-by":"publisher","first-page":"189","DOI":"10.1080\/19315864.2021.1874577","article-title":"Occurrence and predictors of challenging behavior in youth with intellectual disability with or without autism","volume":"14","author":"Esteves","year":"2021","journal-title":"J. Ment. Health Res. Intellect. Disabil."},{"key":"B18","doi-asserted-by":"publisher","first-page":"101474","DOI":"10.1016\/j.rasd.2019.101474","article-title":"Psychometric evaluation of the revised child and family quality of life questionnaire (CFQL-2)","volume":"70","author":"Frazier","year":"2020","journal-title":"Res. Autism Spectr. Disord."},{"key":"B19","doi-asserted-by":"publisher","first-page":"102075","DOI":"10.1016\/j.rasd.2022.102075","article-title":"Age and sex differences in problem behaviours in youth with autism spectrum disorder","volume":"103","author":"Graziosi","year":"2023","journal-title":"Res. Autism Spectr. Disord."},{"key":"B20","doi-asserted-by":"publisher","first-page":"55","DOI":"10.1097\/DBP.0000000000000857","article-title":"Brief report: what diagnostic observation can teach us about disruptive behavior in young children with autism","volume":"42","author":"Hampton","year":"2021","journal-title":"JDBP"},{"key":"B21","doi-asserted-by":"publisher","first-page":"269","DOI":"10.1111\/j.1365-2788.2006.00827.x","article-title":"Psychiatric symptoms and problem behaviours in people with intellectual disabilities","volume":"50","author":"Hemmings","year":"2006","journal-title":"JIDR"},{"key":"B22","doi-asserted-by":"publisher","first-page":"2463","DOI":"10.1016\/j.ridd.2014.06.017","article-title":"Efficacy of behavioral interventions for reducing problem behavior in persons with autism: an updated quantitative synthesis of single-subject research","volume":"35","author":"Heyvaert","year":"2014","journal-title":"Res. Dev. Disabilit."},{"key":"B23","doi-asserted-by":"publisher","first-page":"1224","DOI":"10.1007\/s10803-022-05537-8","article-title":"Adaptation of parents raising a child with ASD: The role of positive perceptions, coping, self-efficacy, and social support","volume":"53","author":"Higgins","year":"2022","journal-title":"J. Autism Dev. Disord."},{"key":"B24","doi-asserted-by":"publisher","first-page":"1121","DOI":"10.1016\/j.rasd.2014.05.006","article-title":"Aggressive behavior problems in children with autism spectrum disorders: Prevalence and correlates in a large clinical sample","volume":"8","author":"Hill","year":"2014","journal-title":"Res. Autism Spectr. Disord."},{"key":"B25","doi-asserted-by":"publisher","first-page":"456","DOI":"10.1016\/j.ridd.2005.06.001","article-title":"A total population study of challenging behaviour in the county of Hedmark, Norway: Prevalence, and risk markers","volume":"27","author":"Holden","year":"2006","journal-title":"Res. Dev. Disabilit."},{"key":"B26","doi-asserted-by":"publisher","first-page":"70","DOI":"10.1111\/jppi.12232","article-title":"Autism spectrum disorders: family demographics, parental stress, and family quality of life","volume":"15","author":"Hsiao","year":"2018","journal-title":"J. Policy Pract. Intellect. Disabilit."},{"key":"B27","doi-asserted-by":"publisher","first-page":"215","DOI":"10.1901\/jaba.1994.27-215","article-title":"The functions of self-injurious behavior: an experimental-epidemiological analysis","volume":"27","author":"Iwata","year":"1994","journal-title":"J. Appl. Behav. Analy"},{"key":"B28","doi-asserted-by":"publisher","first-page":"1028","DOI":"10.1016\/j.rasd.2010.11.008","article-title":"Symptom severity and challenging behavior in children with ASD","volume":"5","author":"Jang","year":"2011","journal-title":"Res. Autism Spectr. Disord."},{"key":"B29","doi-asserted-by":"publisher","first-page":"326","DOI":"10.1186\/s12887-025-05682-w","article-title":"Sociodemographic and clinical indicators associated with quality of life among parents of autistic children","volume":"25","author":"John","year":"2025","journal-title":"BMC Pediatr."},{"key":"B30","doi-asserted-by":"publisher","first-page":"71","DOI":"10.1038\/s41398-023-02374-w","article-title":"Comorbidities in autism spectrum disorder and their etiologies","volume":"13","author":"Khachadourian","year":"2023","journal-title":"Transl. Psychiatry"},{"key":"B31","doi-asserted-by":"publisher","first-page":"1214","DOI":"10.1007\/s10803-010-1140-6","article-title":"Assessment of health-related quality of life among primary caregivers of children with autism spectrum disorders","volume":"41","author":"Khanna","year":"2011","journal-title":"J. Autism Dev. Disord"},{"key":"B32","doi-asserted-by":"publisher","first-page":"1339","DOI":"10.1016\/j.rasd.2014.07.002","article-title":"Quality of life for parents of children with autism spectrum disorders","volume":"8","author":"Kuhlthau","year":"2014","journal-title":"Res. Autism Spectr. Disord."},{"key":"B33","doi-asserted-by":"publisher","first-page":"146","DOI":"10.1177\/0145445511427192","article-title":"Vocal stereotypy in individuals with autism spectrum disorders: a review of behavioral interventions","volume":"36","author":"Lanovaz","year":"2012","journal-title":"Behav. Mod."},{"key":"B34","doi-asserted-by":"publisher","first-page":"466","DOI":"10.1016\/j.jaac.2017.03.013","article-title":"What is the male-to-female ratio in autism spectrum disorder? a systematic review and meta-analysis","volume":"56","author":"Loomes","year":"2017","journal-title":"J. Am. Acad. Child Adoles. Psychiatry"},{"key":"B35","author":"Lope","year":"2013"},{"key":"B36","doi-asserted-by":"publisher","first-page":"266","DOI":"10.1016\/j.ridd.2006.01.004","article-title":"Stereotypy in young children with autism and typically developing children","volume":"28","author":"MacDonald","year":"2007","journal-title":"Res. Dev. Disabilit."},{"key":"B37","doi-asserted-by":"publisher","first-page":"2236","DOI":"10.4081\/jphr.2021.2236","article-title":"Factors affecting the ability to speak in children with autism spectrum disorders","volume":"10","author":"Maemonah","year":"2021","journal-title":"J. Public Health Res."},{"key":"B38","doi-asserted-by":"publisher","first-page":"1","DOI":"10.15585\/mmwr.ss7202a1","article-title":"Prevalence and Characteristics of Autism Spectrum Disorder Among Children Aged 8 Years - Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2020","volume":"72","author":"Maenner","year":"2023","journal-title":"MMWR Surveill. Summ"},{"key":"B39","doi-asserted-by":"publisher","first-page":"391","DOI":"10.1016\/j.jpeds.2004.06.014","article-title":"Repetitive arm and hand movements (complex motor stereotypies) in children","volume":"145","author":"Mahone","year":"2004","journal-title":"J. Pediatr."},{"key":"B40","doi-asserted-by":"publisher","first-page":"696","DOI":"10.1016\/j.rasd.2008.02.003","article-title":"Reliability of the autism spectrum disorder-behavior problems for children (ASD-BPC)","volume":"2","author":"Matson","year":"2008","journal-title":"Res. Autism Spectr. Disord."},{"key":"B41","doi-asserted-by":"publisher","first-page":"567","DOI":"10.1016\/j.ridd.2006.08.001","article-title":"Assessing challenging behaviors in children with autism spectrum disorders: a review","volume":"28","author":"Matson","year":"2007","journal-title":"Res. Dev. Disabilit"},{"key":"B42","doi-asserted-by":"publisher","first-page":"336","DOI":"10.1016\/j.rasd.2008.08.001","article-title":"Reliability and item content of the baby and infant screen for children with autism Traits (BISCUIT): Parts 1\u20133","volume":"3","author":"Matson","year":"2009","journal-title":"Res. Autism Spectr. Disord."},{"key":"B43","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.rasd.2011.08.001","article-title":"Explosive, oppositional, and aggressive behavior in children with autism compared to other clinical disorders and typical children","volume":"6","author":"Mayes","year":"2012","journal-title":"Res. Autism Spectr. Disord."},{"key":"B44","doi-asserted-by":"publisher","first-page":"1744","DOI":"10.1037\/dev0000159","article-title":"The development of self-regulation across early childhood, developmental psychology","volume":"52","author":"Montroy","year":"2016","journal-title":"Dev Psychol."},{"key":"B45","doi-asserted-by":"publisher","first-page":"474","DOI":"10.1016\/j.rasd.2008.09.008","article-title":"Risk factors for challenging behaviors among 157 children with autism spectrum disorder in Ireland","volume":"3","author":"Murphy","year":"2009","journal-title":"Res. Autism Spectr. Disord."},{"key":"B46","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1080\/08856257.2019.1607659","article-title":"Prevalence and correlates of challenging behaviour in children and young people in a special school setting","volume":"32","author":"Nicholls","year":"2019","journal-title":"Eur. J. Special Needs Educ."},{"key":"B47","doi-asserted-by":"publisher","first-page":"1272","DOI":"10.1007\/s10803-017-3361-4","article-title":"How do parents manage irritability, challenging behaviour, non-compliance and anxiety in children with autism spectrum disorders? A meta-synthesis","volume":"48","author":"O'Nions","year":"2018","journal-title":"J. Autism Dev. Disord."},{"key":"B48","doi-asserted-by":"publisher","first-page":"2284","DOI":"10.1007\/s10803-024-06377-4","article-title":"Parenting stress in autistic and ADHD children: Implications of social support and child characteristics","volume":"55","author":"Pardo-Salamanca","year":"2025","journal-title":"J. Autism Dev. Disord."},{"key":"B49","doi-asserted-by":"publisher","first-page":"164","DOI":"10.3928\/15394492-20110415-01","article-title":"Leisure and social participation and health-related quality of life in caregivers of children with autism","volume":"31","author":"Rizk","year":"2011","journal-title":"Occ. Therapy J. Res"},{"key":"B50","doi-asserted-by":"publisher","first-page":"1116","DOI":"10.3390\/brainsci14111116","article-title":"The effect of autism spectrum disorder on family mental health: challenges, emotional impact, and coping strategies","volume":"14","author":"S\u00e1nchez Amate","year":"2024","journal-title":"Brain Sci."},{"key":"B51","doi-asserted-by":"publisher","first-page":"151","DOI":"10.1192\/apt.bp.115.014597","article-title":"Drug treatment of autism spectrum disorder and its comorbidities in children and adolescents","volume":"22","author":"Santosh","year":"2016","journal-title":"B. J. Psych Adv."},{"key":"B52","doi-asserted-by":"publisher","first-page":"253","DOI":"10.1080\/19411243.2018.1538842","article-title":"Translation, cross-cultural adaptation and validation of the quality of life in Autism Questionnaire (QoLA) from English into the Malay Language","volume":"12","author":"Shamsudin","year":"2018","journal-title":"J. Occ. Therapy Schools Early Intervent"},{"key":"B53","doi-asserted-by":"publisher","first-page":"48","DOI":"10.1177\/02711214050250010501","article-title":"Relationship between parent satisfaction regarding partnerships with professionals and age of child","volume":"25","author":"Summers","year":"2005","journal-title":"Topics Early Child. Special Educ."},{"key":"B54","doi-asserted-by":"publisher","first-page":"e12391","DOI":"10.1111\/jspn.12391","article-title":"Quality of life of parents of children with Autism spectrum disorder: an integrative literature review","volume":"27","author":"Turnage","year":"2022","journal-title":"JSPN"},{"key":"B55","doi-asserted-by":"publisher","first-page":"36","DOI":"10.1016\/j.rasd.2015.11.008","article-title":"The quality of life of parents of children with autism spectrum disorder: a systematic review","volume":"23","author":"Vasilopoulou","year":"2016","journal-title":"Res. Autism Spectr. Disord."},{"key":"B56","doi-asserted-by":"publisher","first-page":"1403","DOI":"10.1016\/0277-9536(95)00112-K","article-title":"The World Health Organization quality of life assessment (WHOQOL): Position paper from the World Health Organization","volume":"41","year":"1995","journal-title":"Soc. Sci. Med."},{"key":"B57","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-031-19964-6_60","article-title":"\u201cStereotypy,\u201d","author":"Wunderlich","year":"2023","journal-title":"Handbook of Applied Behavior Analysis. Autism and Child Psychopathology Series"}],"container-title":["Frontiers in Psychology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyg.2026.1569087\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,16]],"date-time":"2026-03-16T14:34:54Z","timestamp":1773671694000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyg.2026.1569087\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,16]]},"references-count":57,"alternative-id":["10.3389\/fpsyg.2026.1569087"],"URL":"https:\/\/doi.org\/10.3389\/fpsyg.2026.1569087","relation":{},"ISSN":["1664-1078"],"issn-type":[{"value":"1664-1078","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,16]]},"article-number":"1569087"}}