Comparison of Autistic Individuals Who Engage in Self-Injurious Behavior, Aggression, and Both Behaviors

Round 1

Reviewer 1 Report

In the present manuscript, the author presents the results from a survey on relatives of autistic subjects and autistic individuals. The study aimed to confront various characteristics between those patients presenting aggressive behaviors towards themselves, the others, or both. The manuscript is well written and easily readable. Overall I believe it might be considered for publication after some editing. Here it follows my points:

Abstract

The abstract should be rewritten. The way it is presented makes it difficult to get the point of the manuscript. Please, follow the guidelines for the author reported on the pediatric reports website, splitting in background, methods, results, and conclusion.

Introduction

It is good enough.

Methods

Collection of evaluations

The author reports where they did the recruitment, but they do not say how the survey was conducted. Did the author do an online survey? Was it an online survey on autism.com or elsewhere, by using a specific service, or by sending a PDF to be filled by the participants and send back?

Procedure

The author should specify the software used for analyses.

Results

The manuscript lacks a demographic table. Some predicting variables might have an impact on dependent variables. The reader should be able to compare the subgroups (SIB, Aggression, Both, and Neither) and, at least, hypothesize that the four groups were sufficiently comparable on relevant demographic and clinical data, to do not think that the results might derive prom a distortion of a hidden modifying variable. The table can be much improved to reduce the extent of space used, eventually by indicating in four different columns the subgroups (SIB, Aggression, Both and Neither) and the specific questions (such: “During the child’s first 2 years, did he like to be held? Notably stiff and awkward to hold”) on the first column. I also suggest indicating the statistic test results in the last column and remove from the text. In the main text result section, the author might report some demographics of the whole sample.

Discussion

The discussion is adequately argued, but it lacks the limitations section. Please consider those in the following paragraph.

Limitations

The author must indicate that they had some missing data that they omitted. Recall bias must be Author should point that the impact of other variables on results is lacking because no multinomial regression was conducted. Then some distortion might arise from the

Author Response

Abstract

The abstract should be rewritten. The way it is presented makes it difficult to get the point of the manuscript. Please, follow the guidelines for the author reported on the pediatric reports website, splitting in background, methods, results, and conclusion.

• The abstract was rewritten and divided into categories.

Introduction

It is good enough.

Methods

 Collection of evaluations

The author reports where they did the recruitment, but they do not say how the survey was conducted. Did the author do an online survey? Was it an online survey on autism.com or elsewhere, by using a specific service, or by sending a PDF to be filled by the participants and send back?

• Recruitment and information on the survey were clarified.

Procedure

The author should specify the software used for analyses.

• Software is now listed.

Results

The manuscript lacks a demographic table. Some predicting variables might have an impact on dependent variables. The reader should be able to compare the subgroups (SIB, Aggression, Both, and Neither) and, at least, hypothesize that the four groups were sufficiently comparable on relevant demographic and clinical data, to do not think that the results might derive prom a distortion of a hidden modifying variable. The table can be much improved to reduce the extent of space used, eventually by indicating in four different columns the subgroups (SIB, Aggression, Both and Neither) and the specific questions (such: “During the child’s first 2 years, did he like to be held? Notably stiff and awkward to hold”) on the first column. I also suggest indicating the statistic test results in the last column and remove from the text. In the main text result section, the author might report some demographics of the whole sample.

• Information on demographics has been added, and the tables have been reformatted.

Discussion

The discussion is adequately argued, but it lacks the limitations section. Please consider those in the following paragraph.

• Section on limitations was added.

Limitations

The author must indicate that they had some missing data that they omitted. Recall bias must be Author should point that the impact of other variables on results is lacking because no multinomial regression was conducted. Then some distortion might arise from the [remainder of the text was cut-off].

• The range of missing data was reported, and a list of other variables that may have affected the results was mentioned.

Reviewer 2 Report

Dear Authors,

potentially your paper is interesting. However, in its actual format this paper don't reach the minimal standrd for a scientific contribute. Just an example, in the Methods you have not reported the paragraph titled Data Analysis. 

After Procedures and before Results you have to insert Data Analysis. 

I suggest you to rewrite the paper and then I will be happy to read again it

Author Response

However, in its actual format this paper don't reach the minimal standard for a scientific contribute. Just an example, in the Methods you have not reported the paragraph titled Data Analysis. 

• The format has been improved.

After Procedures and before Results you have to insert Data Analysis. 

• Data analysis has been added.

I suggest you to rewrite the paper and then I will be happy to read again it

• Much of the paper has been rewritten

Reviewer 3 Report

The paper by Edelson explores a relationship between self- injurious behavior and aggression in ASD patients with behavioral features of the patients. Though the paper is examining an interesting topic in the autism field, in its current form it is very hard to comprehend. Additionally, important statistics are missing. Below are specific comments and suggestions for improvements:

• Some parts of the Abstract and Results section are hard to understand. For instance, in the abstract: “Interestingly, numerous characteristics and comorbidities were associated with those who engaged in both challenging behaviors in addition to all three (i.e., only SIB only, only aggression, both behaviors).” As far as I understand the paper, SIB, aggression or both are considered. What does “all three” correspond to? Similarly, the first section of the Results says: “There were no significant results for individuals who engaged in SIB and not aggression. However, there were significant findings regarding those who engaged in SIB and both behaviors.” These two sentences contradict each other: first it is said that SIB only group had no significant findings and then the authors state that SIB and SIB aggression groups had significant differences.
• As an extension of the previous comment, the patient groups being evaluated and compared need to be clearly stated and referred to consistently throughout the paper.
• All statistics (p values) need to be reported for all comparisons and clearly attributed to the groups being compared (e.g. SIB-only vs neither SIB nor aggression).
• No details of statistics used are listed in the paper. Since multiple groups are compared, ANOVA with a post-hoc test can be more appropriate than a chi-square test which (I guess?) authors used.

Author Response

The paper by Edelson explores a relationship between self-injurious behavior and aggression in ASD patients with behavioral features of the patients. Though the paper is examining an interesting topic in the autism field, in its current form it is very hard to comprehend. Additionally, important statistics are missing.

• More statistics have been included in the manuscript

Below are specific comments and suggestions for improvements:

• Some parts of the Abstract and Results section are hard to understand. For instance, in the abstract: “Interestingly, numerous characteristics and comorbidities were associated with those who engaged in both challenging behaviors in addition to all three (i.e., only SIB only, only aggression, both behaviors).” As far as I understand the paper, SIB, aggression or both are considered. What does “all three” correspond to? Similarly, the first section of the Results says: “There were no significant results for individuals who engaged in SIB and not aggression. However, there were significant findings regarding those who engaged in SIB and both behaviors.” These two sentences contradict each other: first it is said that SIB only group had no significant findings and then the authors state that SIB and SIB aggression groups had significant differences.
•  
• The categories under investigation (SIB only, aggression only, both SIB and aggression, and neither) have been clarified.

As an extension of the previous comment, the patient groups being evaluated and compared need to be clearly stated and referred to consistently throughout the paper.

• The patient group being evaluated was mentioned (i.e., had been diagnosed with autism spectrum disorder). In addition, reference to them throughout the manuscript is now consistent

All statistics (p values) need to be reported for all comparisons and clearly attributed to the groups being compared (e.g. SIB-only vs neither SIB nor aggression).

• P values and non-significant results are now included in the manuscript
•  

No details of statistics used are listed in the paper. Since multiple groups are compared, ANOVA with a post-hoc test can be more appropriate than a chi-square test which (I guess?) authors used

• The reasoning for using a chi-square test was mentioned (i.e., categorical data) and a post-hoc test, Bonferroni Correction, was added to the analyses.

Round 2

Reviewer 1 Report

The author responded adequately to my requests and the overall work can now be considered for publication.