Outcomes-Based Intervention Approaches: Supporting Children and Youth with ASD Who Exhibit Challenging Behavior (page 4)
Patterns of challenging behavior have long been associated with the diagnosis of autism spectrum disorders (ASD). Anyone who has experience with such children has likely observed problems with toileting, sleep, excessive activity levels, intense tantrums, self-stimulatory or stereotypic movements (e.g., rocking, hand flapping), and more serious behaviors such as aggression towards others (e.g., hitting, kicking), destruction of materials and the physical environment, and self-injury (e.g., hand biting, head hitting and banging).
Consider Randall (pseudonym), a 7-year-old student diagnosed as having an ASD. Randall has been evaluated as also having severe intellectual disabilities, and does not exhibit any functional verbal communication. He displays a variety of challenging behaviors, including forcefully smacking the backs of his hands on table edges, dropping to his knees on hard floors, and a variety of aggressive behaviors such as hitting, pinching and scratching others. He spends most of his time in a self-contained classroom for students with disabilities, working on a variety of pre-academic and functional skill-training activities (e.g., toileting, dressing, communication skills). Randall’s problem behaviors can have a variety of negative physical, social, educational and economic consequences.
Problem behaviors exhibited by individuals with an ASD can result in significant pain, injury and emotional distress for children, families and teachers providing support to these individuals. Participation in educational and other community settings may be jeopardized, and there is an increased risk of admission to more restrictive public residential facilities. Providing necessary support for individuals in such facilities results in greatly increased costs (e.g., $100,000 or more per year for persons with severe self-injury [NIH, 1991]; see also Jacobson, Mulick, & Green, 1998). Challenging behaviors may place children with ASD at greater risk for abusive treatment by support staff (Bromley & Emerson, 1995). Without intervention, these students are at much greater risk for a variety of negative outcomes.
Interventions for Challenging Behaviors
The two primary intervention approaches for problem behaviors include behavioral intervention and the administration of psychotropic medications; this article focuses on the former. The earlier development and implementation of behavior strategies predominantly focused on reducing challenging behaviors. Over the last 15-20 years, concerns with these traditional behavior modification interventions have led to a more positive and comprehensive approach. This approach includes a more diligent focus on outcomes, selecting intervention strategies based on careful functional assessment of problem behavior, comprehensive programs involving multiple strategies, and consideration of what supports should be in place to support students and others to be successful (e.g., Bambara & Kern, 2005). For students with ASD, these models can include modifications to the environment to reduce the likelihood of problem behavior, behavioral support plans (BSPs) to teach appropriate behaviors to replace problem behavior, a system of minimally intrusive consequences to address problem behavior and, if necessary, a crisis plan.
A Broader Perspective on Outcomes
Along with prioritizing the reduction of challenging behavior, contemporary models of Applied Behavior Analysis (ABA) place equal emphasis on teaching appropriate social behaviors. Rather than simply employing strategies to respond to behavior problems as they occur, these models teach and reinforce the skills students with ASD need to utilize to succeed in the home, educational environment and community. One such model, Positive Behavior Support (Bambara, Dunlap, & Schwartz, 2004; Journal of Positive Behavior Interventions, 1999–present), focuses on other important outcomes, including where students with ASD spend their time (e.g., more inclusive vs. more segregated classrooms), with whom they spend their time (e.g., more time with typical peers vs. paid support staff), and what they spend their time doing (e.g., engaged in more typical educational, domestic, leisure and community activities). In thinking about Randall’s situation described above, reducing problem behavior is of critical importance. However, if this behavior change does not contribute to improvements in what Randall is doing, where he’s doing it and with whom, there may be minimal improvements to quality of life for Randall, his parents and his teachers/caregivers.
Functional Behavioral Assessment
A seminal research report by Iwata et al. (1982) is credited with sparking a resurgence of attention to the need for conducting systematic analyses as a basis for implementing interventions. Iwata et al. collected data on the occurrence of self-injurious behavior (SIB) of persons with developmental disabilities while systematically manipulating various environmental conditions. These functional analytic manipulations attempted to determine the reinforcement contingencies that were responsible for maintaining the behavior, often referred to as the function of the behavior. In other words, what does the individual appear to be gaining by engaging in the problem behavior (e.g., getting attention, avoiding or escaping less-preferred activities or situations)? Since the publication of the Iwata et al. article, there has been an increasing frequency of pre-intervention experimental and non-experimental analyses (collectively known as functional behavioral assessments [FBAs]) reported in the literature. Basing intervention strategies on functional assessments of behavior has contributed significantly to an increase in the success of those interventions (Hanley, Iwata, & McCord, 2003). This type of success led a National Institutes of Health Consensus Conference panel to recommend that interventions for severe challenging behaviors be based on such pre-intervention assessments (NIH, 1991).
In recent years, a number of states have adopted regulations that explicitly call for an FBA to be conducted prior to implementing significant behavioral interventions. Along with state-level standards, the last two enacted versions of the federal Individuals with Disabilities Education Act (IDEA) explicitly mentioned that an FBA be done in situations involving serious challenging behaviors. This practice has become an expected professional standard (Johnston & O’Neill, 2001; O’Neill et al., 1997).
Coming back to Randall, school consultants and staff working with him conducted functional assessment interviews and structured functional analysis manipulations in his classroom setting. These sessions involved systematically responding in various ways to Randall’s challenging behavior to determine what antecedent and consequence events were instigating and reinforcing the problem behavior. The results indicated that the vast majority of Randall’s challenging behavior was motivated by the desire to escape or avoid un-preferred activities, such as when he was asked to complete various pre-academic activities. This assessment provided a solid foundation for identifying a variety of intervention strategies (see below).
Comprehensive Multi-Element Behavioral Intervention
Plans Students with complex histories of challenging behavior require comprehensive approaches to intervention, including (1) responding to broader setting events such as sleep, diet, medication or social interaction issues (e.g., making sure a child has breakfast before coming to school); (2) more immediate antecedent strategies (e.g., changes in levels of task difficulty); (3) strategies to teach students more appropriate alternative behaviors (e.g., teaching a child to sign “break” when s/he is frustrated with a task or activity); and, (4) providing reinforcing outcomes for appropriate behavior (e.g., honoring requests for breaks, providing preferred activities contingent on task completion), minimizing or preventing reinforcement for challenging behavior (e.g., not allowing a child to escape a non-preferred task), and, in some cases, providing appropriate punishing events contingent on challenging behavior (e.g., saying “no” and blocking aggressive hitting).
In Randall’s case, assessment data indicated that he frequently was allowed to stay up late at night, increasing problem behavior on subsequent days. Classroom staff worked with Randall’s parents to implement an earlier bedtime routine. They also modified curricular activities to more gradually lead to the eventual desired performance (e.g., providing easier tracing activities prior to moving on to more difficult printing activities). They began to provide Randall with choices about which academic or functional skill activities he would work on during a given period. A communication disorders specialist began to teach Randall some basic sign language to communicate his wants and needs in difficult situations (e.g., signing “break,” “help”). Randall was also provided with some graphic picture cards signifying “break” and “help,” and received training in how to use those in situations likely to evoke challenging behavior. Classroom staff frequently and consistently provided desired outcomes when Randall exhibited appropriate communicative behavior (e.g., pointing to his “break” card), and provided breaks and preferred activities (e.g., block building) contingent on periods of problemfree task completion. Staff attempted to minimize or prevent reinforcement for problem behavior by keeping him engaged in task activities. Even if Randall did escape task activities for a brief period, he was redirected to complete them as soon as possible. This comprehensive approach to Randall’s situation produced reductions in problem behavior and an increased frequency of appropriate communicative behavior and engagement in desired tasks and activities (O’Neill & Sweetland-Baker, 2001).
Reprinted with the permission of the Autism Society.
Washington Virtual Academies
Tuition-free online school for Washington students.
- Coats and Car Seats: A Lethal Combination?
- Kindergarten Sight Words List
- Child Development Theories
- Signs Your Child Might Have Asperger's Syndrome
- 10 Fun Activities for Children with Autism
- Why is Play Important? Social and Emotional Development, Physical Development, Creative Development
- The Homework Debate
- First Grade Sight Words List
- Social Cognitive Theory
- GED Math Practice Test 1