Conceptualizing Autism as a Behavioral Network: Transdiagnostic Associations with Co-occurring Psychiatric Conditions

Abstract

Autism is characterized by marked heterogeneity in behavioral presentation and high rates of co-occurring psychiatric symptoms, which hinder diagnostic precision, personalized intervention, and long-term quality of life. Approach and withdrawal behaviors—subserved by core motivational systems underlying action and emotion—may serve as transdiagnostic processes linking autism with common co-occurring conditions in childhood. Guided by this framework, we examined how autism-related approach–withdrawal behaviors interrelate and connect to internalizing and externalizing symptoms. Using data from 280 autistic children aged 6 to 11 years enrolled in the Autism Biomarkers Consortium for Clinical Trials, we constructed a Gaussian graphical model of approach–withdrawal behaviors. Core behaviors were identified using expected influence centrality. Autism, when conceptualized as a system of interconnected approach–withdrawal behaviors, was positively associated with common co-occurring psychiatric conditions, with strongest associations observed for anxiety and attention-deficit/hyperactivity disorder. Affect regulation–related nodes were most relevant to internalizing symptoms, whereas arousal regulation and sensory nodes were uniquely related to externalizing symptoms. These findings integrate transdiagnostic theories of approach-withdrawal motivation with network analysis and highlight clinically relevant targets for diagnostic refinement and intervention.