About 1 in 54 school-age children are diagnosed with autism spectrum disorder (ASD; Maenner et al., 2020). The core symptoms of ASD include impairments in social interaction, difficulties communicating, and restricted and repetitive interests (American Psychiatric Association, 2013). Although not a core symptom, many children with ASD present with challenging behavior (Jang et al., 2011). Challenging behavior often includes aggression (e.g., hitting, biting, choking, pushing), self-injury (e.g., head banging, self-scratching, eye poking), and disruption (e.g., ripping up items, hitting surface, breaking toys) among other topographies. Difficulties with social interaction (e.g., recruiting attention), communicating wants and needs (e.g., asking for a snack), or tolerating changes in routines (e.g., taking a different route to school due to road closures) all have the potential to contribute to challenging behavior.
In most cases, challenging behavior can be conceptualized as a form of communication. Behavior analysts use a scientific learning approach to examine the reason (i.e., function) challenging behavior happens, or what individuals are trying to communicate. When challenging behavior occurs as a form of communication, the reinforcers for challenging behavior are considered social reinforcers. Common functions of challenging behavior are to access:
- Attention (i.e., attention-maintained);
- Preferred items, edibles, or activities (i.e., tangibly maintained); and
- Escape or avoidance of nonpreferred tasks, instructions, or activities (i.e., escape-maintained; Beavers et al., 2013).
Functional behavior assessments (FBAs) isolate these potential maintaining variables, or reinforcers, for challenging behavior (Iwata et al., 1982/1994). Following an FBA, a function-based intervention is established. Interventions based on the results of an FBA are more effective than other interventions (Hurl et al., 2016). Function-based interventions that address challenging behavior often include withholding the functional reinforcer for challenging behavior (i.e., extinction), and delivering this functional reinforcer for an alternative appropriate behavior such as a vocal request (i.e., differential reinforcement of an alternative behavior; see Petscher et al., 2009 and Tiger et al., 2008).
While the approach to treating challenging behavior is similar regardless of the function, the way the procedure looks can differ. For example, a treatment for attention-maintained challenging behavior may involve ignoring challenging behavior and delivering attention when an appropriate alternative behavior occurs instead. The alternative behavior may be a vocal request for attention (e.g., “Excuse me”), raising a hand in a classroom, or tapping someone on the shoulder. A treatment for tangibly maintained challenging behavior may involve withholding preferred items, edibles, or activities when challenging behavior occurs and delivering those when an alternative behavior occurs instead. Again, this often involves reinforcing a communicative response such as asking nicely. Finally, for escape-maintained challenging behavior, treatment would involve working through challenging behavior or continuing the nonpreferred task, instruction, or activity. The alternative response to reinforce in the treatment of escape-maintained challenging behavior may be a request to have a “break” or “leave,” but also can involve delivering a break for compliance with the instruction.
These descriptions are simplistic. Using a behavior-analytic approach to intervention, however, can involve several modifications to ensure long-term effectiveness. Further, reinforcing every instance of an alternative appropriate behavior is not sustainable. For example, caregivers cannot feasibly respond to every bid for attention if those requests are happening several times per minute. There also are many strategies to promote the long-term success of these interventions such as teaching individuals to wait to access attention, tangibles, or escape (e.g., Hagopian et al., 2011); signaling whether or not access to those things is available (e.g., Saini et al., 2016); developing a token system (e.g., Hackenberg, 2018); and programming for times in which challenging behavior is accidentally reinforced (e.g., Trump et al., 2020). It should be noted, as well, that behavioral interventions should be implemented with oversight from a trained Board Certified Behavior Analyst® to monitor treatment efficacy and ensure the safety of all involved (see www.bacb.org for a review of the credentialing process, requirements, and ethics of the Behavior Analyst Certification Board®, as well as direct links to each state’s licensure board and state association).
Dr. Slocum is a doctoral-level behavior analyst for the Intensive Outpatient and Transition Programs at Marcus Autism Center in Atlanta, GA. Dr. Trauschke is a psychologist and doctoral level behavior analyst for parent training, follow-up, and intensive outpatient services and Dr. Bernstein is a clinical postdoctoral fellow in the Intensive Outpatient Program. You may contact the authors at sarah.slocum.freeman@choa.org or (404) 785-3628.
References
American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
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Behavior Analysis Certification Board (2021, August 20). www.bacb.com
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