Children with autism often display higher rates of challenging behaviors, including non-compliance, aggression, self-injurious behavior, and socially inappropriate behavior such as disrobing in public, when compared to typically developing peers (Holden & Gitlesen, 2006). It can be difficult for family members, teachers, service providers, and other important stakeholders to manage these challenging behaviors. In fact, these challenging behaviors can lead to physical and psychological harm, isolation, and caregiver burnout (Autism Speaks, 2012). Consequently, it is imperative that caregivers receive necessary support in order to effectively manage challenging behaviors.
One evidence-based practice for reducing and eliminating challenging behaviors is to identify the function of the behavior, or what purpose the behavior serves for the individual. For example, you may ask yourself, “What is my child trying to get or avoid by doing this?” or “What is she trying to tell me?” Determining the function of the behavior can help guide you toward solutions to reduce the frequency, duration, or intensity of the behavior. This process of identifying the function of a behavior is called a functional behavior assessment (FBA), which includes data collection and analysis.
The data collection portion involves documenting the environmental context for each occurrence of the target problem behavior observed. Also known as narrative recording, this includes documenting the antecedents and consequences each time the behavior occurs. Antecedents are events or actions that occur immediately before the challenging behavior and consequences are events or actions that occur immediately after the challenging behavior. Common antecedents to challenging behavior include demands, lack of attention, transitions, and denied access to preferred items or activities. Common consequences include adult and peer attention, access to preferred items or activities, and escape from non-preferred tasks. In addition to specific antecedents and consequences, it is also beneficial to record the context surrounding the behavior (e.g., date, time, setting, activity, and people present). The more information there is to analyze, the more accurate the function identification will be.
Once the data are recorded, they can be analyzed for patterns in collaboration with a BCBA or related service provider. In general, it is important to look for patterns across the antecedents and consequences. For example, imagine Sammy, a 4-year-old nonverbal boy with autism who frequently engages in aggression. During FBA data collection, he bit his mom on the arm 10 times. This behavior was preceded by a demand to brush his teeth for nine instances and was followed by Sammy receiving extra time to watch TV before brushing his teeth for five of the instances. Following three occurrences of biting, Sammy’s mom reprimanded him and carried him to the bathroom. By looking for patterns in the data, it is clear that Sammy’s aggressive behavior commonly occurs after a demand and is frequently followed by escape from toothbrushing.
After developing a clearer understanding of why a child engages in a particular challenging behavior, it is time to decide how to intervene. One of the most effective ways to do so is through the use of antecedent-based strategies, which are designed to reduce or prevent the likelihood of the challenging behavior. The goal of these strategies is to modify the environment, oftentimes including your own behavior, as a way to change the conditions that typically lead to an occurrence of the challenging behavior (Sam & AFIRM, 2016). The chosen antecedent-based strategy should match the identified function of the behavior. Thinking back to the example of Sammy, an antecedent-based strategy might include changing the way the demand is issued. For instance, Sammy’s mom may decide to give a warning (e.g., “You can watch TV for five more minutes, and then you need to brush your teeth”). Additional antecedent-based strategies (Neitzel, 2010) are listed below.
- Use child preferences during non-preferred activities. If Sammy likes music, it can be a great strategy to incorporate music into a non-preferred activity. His mom could purchase an electric toothbrush that plays music when in use.
- Offer choices. If your child engages in challenging behavior when asked to complete an activity, offer two choices. Sammy’s mom could offer a choice of toothpaste flavor or which bathroom he uses to brush his teeth. Allowing your child to have a sense of autonomy can increase their compliance with tasks.
- Use a visual activity schedule. If your child struggles with transitions between activities, it can be helpful to implement a visual schedule. The schedule should display at least one upcoming activity to be shown to your child before the transition occurs, as Sammy’s mom showed him that after watching TV he would transition to brushing his teeth. It can also be helpful to use a visual timer to show your child how much longer they have during an activity before it is time to move on to the next.
- Enrich the environment with sensory stimuli. If your child frequently engages in sensory-related challenging behavior that interferes with their learning, it is a good idea to identify an alternative item that can help them meet the same sensory function as the challenging behavior. For example, if your child has difficulty sitting still in a typical chair at a table or desk, allow them to use a yoga ball as a chair.
- Establish clear expectations. It is common for children to need reminders about specific expectations before entering a new environment. Be sure to review these expectations before activities that are typically antecedents to challenging behavior. While walking to the bathroom Sammy’s mom could remind him he can exchange a break or help card while brushing his teeth.
Altogether, assessing the function of a child’s challenging behavior can be incredibly beneficial for developing a plan to reduce or eliminate it. By recording data on each of your observed occurrences and then analyzing it for patterns, you can identify the likely function. Afterwards, implementing an antecedent-based intervention that matches the function of the behavior can help prevent the behavior from occurring at all. It may be necessary to try a few different antecedent-based strategies, or a combination of them, before behavior changes are observed. It is also important to remember that some challenging behaviors may have several functions. In addition to utilizing antecedent-based interventions, caregivers should also make sure the child is not getting his needs met by engaging in problem behavior. For instance, Sammy’s mom should not allow him to avoid brushing his teeth the entire day. Always collaborate with a BCBA or other related service provider for guidance and support through this process.
Christina Wood, MEd, RBT, is a Registered Behavior Technician and Jennifer Croner Lauriello, MSEd, BCBA, LBS, is Clinical Director at Lehigh University Autism Services. If you would like more information about Lehigh University Autism Services please contact our office via phone at (610) 758-2441 or visit our website at https://ed.lehigh.edu/center-for-promoting-research-to-practice/autism-services-clinic.
Autism Speaks. (2012). Autism and Challenging Behaviors: Strategies and Support. Retrieved from https://www.autismspeaks.org/sites/default/files/2018-08/Challenging%20Behaviors%20Tool%20Kit.pdf
Holden, B., & Gitlesen, J. P. (2006). A total population study of challenging behaviour in the county of Hedmark, Norway: Prevalence, and risk markers. Research in Developmental Disabilities, 27(4), 456-465.
Neitzel, J. (2010). Antecedent-based interventions for children and youth with autism spectrum disorders: Online training module. (Chapel Hill, NC: National Professional Development Center on Autism Spectrum Disorders, FPG Child Development Institute, UNC-Chapel Hill.) In Ohio Center for Autism and Low Incidence (OCALI), Autism Internet Modules, www.autisminternetmodules.org. Columbus, OH: OCALI.
Sam, A., & AFIRM Team. (2016). Antecedent-based intervention. Chapel Hill, NC: National Professional Development Center on Autism Spectrum Disorder, FPG Child Development Center, University of North Carolina. Retrieved from http://afirm.fpg.unc.edu/antecedent-based-intervention