People with autism spectrum disorders can display behaviors that present challenges to educators, parents, and other caregivers such as aggression, self-injury, disruption, property destruction, and elopement. When such problem behaviors are present, the first step is to conduct a functional behavioral assessment (FBA). The goal of the FBA is to identify factors that are maintaining a behavior by examining the antecedents and consequences for a behavior. The FBA results in a hypothesis of behavioral function. In other words, it tells us what purpose the behavior serves for the individual. Behaviors can serve one or more of the following functions:
- The person uses the behavior to gain access to attention or tangible items
- The person uses the behavior to escape or avoid aversive conditions
- The behavior is automatically reinforcing and is not mediated by social consequences.
Interventions based on function tend to be more effective than non-function-based interventions. This article will identify four intervention strategies that can be used when an FBA suggests that problem behaviors serve an escape or avoidance function: extinction, antecedent manipulation, functional communication training, and positive reinforcement of compliance.
Extinction simply means removing reinforcement for the behavior. In the case of behaviors that serve an escape/avoidance function, this entails not allowing escape or avoidance following a problem behavior. If a person is given a time-out or is sent home from a school or work program because of maladaptive behaviors that occur in response to a demand, this inadvertently reinforces the behavior and increases the likelihood that the behavior will be repeated to obtain these same consequences. Therefore, an intervention plan should not include such procedures in the case of escape or avoidant behaviors. If possible, the person should complete the task or remain in the setting even if he or she is engaging in challenging behaviors. When extinction is used, an initial increase in behavior can be expected as the person realizes that the behavior is no longer working and he or she reacts by engaging in worse behaviors to see if they will work. This is known as an “extinction burst.” To maximize effectiveness and to minimize any extinction burst, extinction should be used with other strategies as described below.
Antecedent manipulation involves altering the qualities of the task or setting to make them more attractive to person. When the environment is made more appealing to the individual with autism, there is a lesser chance that he or she will engage in a problem behavior in order to be removed from the environment. Antecedent manipulation strategies are proactive and are meant to prevent problem behaviors from occurring. The following are antecedent manipulation strategies that can be used when an FBA suggests an escape/avoidance function:
Noncontingent Escape: The person is allowed out of a task or setting on a schedule rather than as a result of a problem behavior. This eliminates the connection between the maladaptive behavior and the escape consequence.
Demand Fading with Extinction: Demands are eliminated or significantly decreased until problem behaviors are reduced and then demands are gradually reintroduced.
Intersperse Easy and Difficult Tasks: Allowing the person with autism to experience success is vital to maintaining motivation.
Avoid Repetitive Tasks: Tasks should be mixed and varied within an instructional session rather than presenting the same task or question several times in a row.
Examine Instructional Methods: One study found that it was not the demand itself that produced problem behaviors; rather, it was the type of prompting used that was aversive for the participant (Crockett & Hagopian, 2006). Therefore, it may be worthwhile to explore the contribution of instructional procedures to problem behaviors and make appropriate modifications.
Give the Person Choices: For example, a teacher or caregiver may make a list of different activities and allow the person with autism to choose what he or she would like to do. Ideally, the list would include some preferred activities within the choices. People with autism can spend the majority of their day responding to the demands of others. This can certainly contribute to the desire to escape and avoid tasks or settings. At least a portion of a person’s day should be spent in activities that he or she leads. Examples of intervention approaches that are more self-directed include incidental teaching and DIR/Floortime. Just because an activity is directed by the individual with autism, does not mean that problem behaviors should be allowed to occur, however. Behavior modification procedures still need to be applied.
Incorporate the Person’s Interests: People with autism can have restricted interests. People’s interests can be used to increase the reinforcing value of the task or setting. For example, a child who is interested in searching the Internet, may be taught to spell by typing in search terms. A student who likes Star Wars may have math word problems that include Star Wars characters.
The antecedent manipulations described above are meant to increase the reinforcing value of the environment. Concurrently decreasing the reinforcing value of the escape environment is also advisable. In situations where the individual is not able to be prompted through demands, he or she must be deprived of any other sources of reinforcement such as preferred items or activities or attention from others and the demand has to be reissued until completed. Even consequences that may be thought to be punishing for the individual may not actually be serving as a punisher relative to the task they are avoiding.
Functional Communication Training
People with autism may engage in a problem behavior because they lack more appropriate alternative behaviors. As a result of these skill deficits, engaging in a problem behavior may offer a more efficient means to get what they want. Furthermore, teachers and caregivers may be more responsive to problem behaviors, making them more effective for the person with autism. Functional communication training (FCT) involves teaching the individual to produce communicative behaviors that serve the same function as the problem behaviors. Communication can be verbal (language or voice output device) or nonverbal (sign language or picture exchange). Therefore, FCT is appropriate for individuals with autism at all levels of functioning. Examples of appropriate functional communication responses for behaviors that serve an escape/avoidance function include a.) asking for a break b.) requesting a change in activity c.) asking to leave the room d.) saying finished e.) telling others to wait or f.) asking others to stop. These responses need to be taught using systematic procedures where the person has frequent opportunities to practice. In addition, the responses need to be practiced with multiple people and in varied settings to promote generalization. Given that opting out of a task can be problematic for learning, once a functional communication response is reliably emitted, demand fading as described above can be added. This means that the individual is made to complete a gradually increasing number of tasks between the time they communicate the need for escape and when they are allowed to escape. Functional communication training should be used in conjunction with extinction of problem behaviors.
Differential Positive Reinforcement of Compliance
Another intervention strategy that can be effective at reducing escape or avoidant behaviors is positive reinforcement of compliance. For example, a child who likes Barney would receive access to a Barney doll for a short period of time following the completion of a demand. This strategy may work because the reinforcer has more appeal than escaping or avoiding the task. Pairing reinforcement with a demand may also make it more attractive. If positive reinforcement is not working, a reinforcer assessment should be completed that examines a.) how valuable the reinforcer really is to the person b.) how soon after the desired behavior the reinforcer is provided (immediate reinforcement vs. delayed) and c.) the quantity of the reinforcer (more is not always better and can lead to satiation).
Individuals with autism may engage in problem behaviors as a means to escape or avoid a task or setting. This can be particularly problematic in school and work programs where there are high levels of demands. Fortunately, there are strategies that can increase a person’s motivation to remain engaged in a task or setting. These include eliminating reinforcement of the behaviors by not allowing escape or avoidance, manipulating the antecedents to the behavior, teaching an alternative to the problem behavior, and reinforcing compliance. In practice, a combination of these approaches is likely to produce the best results.