One of the biggest challenges in working with children with autism is the severe behavior problems they exhibit. These behavior problems not only make it difficult for their parents to care for them but also make it difficult to take them out in public. Many of these children have unpredictable behavior and will tantrum when encountered with various stimuli such as loud noises, crowded places, or small enclosed areas such as elevators. Countless parents have stated that one of the biggest problems they encounter when raising a child with autism is the sense of isolation they feel. Because of the behavior problems exhibited by their children it is difficult to invite people to their house, go to social functions, or simply run errands. Additionally, teachers have a difficult time teaching these children new skills because of behavior problems such as tantrums, self-stimulatory behavior, aggression, and/or self-injurious behavior. The following are simple points to help a parent or teacher understand why the behaviors continue and some simple and effective behavior management techniques that work to reduce and eliminate negative behaviors such as biting and tantrums.
The first and most important step when dealing with behavior problems is to understand the function of the behavior. The easiest way to do this is to collect A → B → C data where the “A” stands for “antecedent,” which is what happens immediately before the onset of the behavior, the “B” stands for “behavior,” and the “C” stands for “consequence,” which is what happens immediately after the onset of the behavior. The reason A → B → C data are collected is because one behavior can have many different functions depending on the child or the context in which it occurs. The three most common functions of behavior when dealing with children with autism are: 1) escape from a demand, 2) attention/alerting an adult to a need (such as hunger), and 3) sensory – engaging in a behavior simply because it “feels good.” The following examples illustrate how one behavior can serve different functions:
- A parent/teacher asks the child to sit down. The child bites him/herself so the parent/teacher removes the request.
- A child sees a cookie on a high shelf. The child bites him/herself so the parent/teacher gives the child the cookie.
- No clear pattern of antecedents. The child bites him/herself. No clear pattern of consequences.
As you can see in example one, the child is engaging in the problem behavior to escape from a demand, in example two the child is engaging in the problem behavior for attention/alerting an adult to a need that needs to be met, and in example three the child is engaging in the problem behavior simply because it feels good. Furthermore, the consequences in examples one and two are reinforcing the problem behavior. In other words, the consequences are making it more likely for the problem behavior to occur in the future since these children are learning that biting themselves is a way for them to get what they want.
There are several techniques that are very effective to reduce or eliminate behavior difficulties. When dealing with problem behavior that serves the purpose of avoidance, it is usually best to try and work through the behavior. This entails NOT removing the demand that triggered the problem behavior in the first place. In the above example, the child is asked to sit down only to have that child bite him or herself. An effective way to intervene is as follows: first, require the child to sit down even if he or she is biting him or herself. The child will then learn that biting him or herself is not going to help him or her escape from the demand. If the child bites him or herself and the parent or teacher withdraws the demand, then the child is given reinforcement (a reward) for the biting and that behavior is likely to continue. Second, give the child a reinforcer (reward) once they sit down to teach them that when they comply with simple requests good things happen.
In example number two the child bites him or herself in order to obtain a cookie. An effective strategy for this example is to teach the child a more appropriate way to communicate, whether it is saying “cookie”, signing “cookie”, pointing to the cookie, or giving the adult a picture of a cookie. Although implementing these strategies is always easier said than done, they will help the child and their caretakers enormously.
When children with autism engage in problem behaviors simply for sensory input (it feels good) it can be very challenging to reduce the problem behavior. Sometimes it is possible to teach children alternative, more socially appropriate ways of occupying themselves but other children may not respond to this type of intervention. They might need their teachers and parents to implement a formal behavior treatment plan.
Regardless of the problem behavior that is being displayed by a child, the most important thing to remember is not to treat it with a “blueprint.” For example, simply because a child is biting him or herself does not automatically mean he or she should be put in time-out. If the child is biting him or herself to escape from a demand, putting the child in time-out will reinforce the biting behavior and make it more likely to occur in the future since the goal of the behavior was to escape from the demand. When the child is placed in time-out, he or she has just accomplished the goal of escaping from the demand. It is also important to collect data on the problem behavior to make sure the strategy being used is working. Keep in mind that the problem behavior will usually increase for the first few days before it starts to decrease. This is known as an “extinction burst” and is quite common when implementing behavioral strategies. Don’t quit your strategy during the extinction burst or else the behavior will continue or possibly stay even worse than it originally was.
Finally, regardless of what the problem behavior is or what type of intervention is used, remember that the intervention must be practiced in various settings (home, school, community) by everyone involved in the child’s life in order to promote generalization of the newly-learned skill. This is done because many children with autism are unable to generalize skills taught in one setting to a different setting. For example, teaching a child not to tantrum at home does not guarantee he or she will not tantrum in the car, supermarket, or school. Thus, the more people and settings the child has access to during the intervention, the more successful the child and caretakers will be.