Challenging behaviors (e.g., aggression, self-injury, and disruption) are prevalent among individuals diagnosed with an autism spectrum disorder (ASD; Hartley, Sikora, & McCoy, 2008). These behaviors are a common referral concern for treatment because they can cause injury, interfere with adaptive development, and increase familial stress (Herring et al., 2006).
Behavioral treatment techniques are an effective way of addressing challenging behavior for individuals with ASD exhibiting a range of challenging behavior (e.g., Horner, Carr, Strain, Todd, & Reed, 2002). The basis of behavioral treatments focuses on three factors: 1) the antecedent or what occurs before challenging behavior; 2) the behavior itself; and 3) the consequence or what happens after the behavior. Through careful consideration of these three elements, a clinician can determine the behavior’s function, or reason “why” the individual engages in challenging behavior. For example, some individuals engage in problem behavior to get attention while others may engage in the same behavior to get out of doing work. By determining the reason challenging behavior occurs, therapists can tailor treatment to address the individual’s specific needs. The majority of these techniques address the consequence aspect of behavior by ensuring that, following the challenging behavior, the individual does not receive the preferred outcome that motivated that behavior and instead receives the preferred outcome for more adaptive/appropriate responding.
These consequence-based strategies are extremely important and effective, but it is also important to consider how antecedents can guide treatment, especially for individuals who engage in challenging behavior infrequently (e.g., only engages in challenging behavior once a month) or at variable rates (e.g., a lot of problem behavior for two days followed by a week with none). In these situations, it may be especially important to consider antecedents to identify when problem behavior is most likely and develop a treatment that will work specifically during these times.
Several variables may serve as antecedents for problem behavior in that, when these variables are present, they increase the likelihood of problem behavior in a certain context. For example, a child may become aggressive every so often when asked to do homework. When this happens his mother may give him breaks to allow him to calm down. When the child is tired, homework is likely to be even less enjoyable than normal (or more aversive). Thus, if homework is more aversive and aggression results in avoiding homework, aggression might be more common during homework time when the child is tired. In another example, a child who engages in aggressive behavior to gain access to food (e.g., when the child aggresses caregivers assume he/she is hungry and offer a snack) may be more likely to aggress if he/she is particularly hungry. In this case, being hungry makes food even more preferred and is therefore likely to increase aggression that often results in food. Variables that make an event more or less preferred or reinforcing are referred to as motivating operations.
Physiological states may frequently serve as motivating operations by changing preferences for certain items or activities. Past research suggests that individuals experiencing pain and discomfort may exhibit more problematic behavior, especially when problem behavior results in escape (or a break) from aversive activities such as homework or chores. For example, Kennedy & Meyer (1996) found an individual’s self-injurious behavior was more likely when he was exhibiting allergy symptoms, and this increase was most commonly observed during academic work.
The physiological effects of medications may also result in certain activities being more or less preferred. For example, Northup, Fusilier, Swanson, Roane, & Borrero (1997) found that access to food and activities was less reinforcing when a child was on methylphenidate (e.g., Ritalin, Concerta). In another study, methylphenidate was found to specifically decrease disruptive behavior when an individual was given attention following this behavior (Dicesare, McAdam, Toner, & Varrell, 2005). Research has also suggested that menses (Taylor, Rush, Hetrick, & Sandman, 1993), ear infections (Carr & Smith, 1995), and sleep deprivation or fatigue (Kennedy & Meyer, 1996) are all physiological states that may increase the likelihood of problem behavior in certain contexts.
In addition, environmental variables may serve as motivating operations. Kennedy and Itkonen (1993) found that one individual with a developmental delay engaged in more self-injury and aggression when she woke-up late and had a hurried morning routine, whereas another individual with similar problem behavior was more likely to exhibit this behavior when encountering traffic on the way to school. For both of these individuals, behavioral treatments based on why the behavior occurred were attempted, but it was not until strategies to address these specific environmental antecedents were implemented that problem behavior was consistently decreased. Horner, Day, and Day (1997), identified that delaying or cancelling a planned activity (e.g., school events and outings) increased the likelihood of problem behavior, specifically during academic work, for two individuals with developmental delays. For both individuals, the treatment included specific components (e.g., 10 minutes access to a preferred activity or rescheduling the event on a calendar) to prevent problem behavior during days that these antecedents occurred.
In summary when treating problem behavior, it is crucial to focus on how one can alter the consequences of problem behavior when developing interventions, but it is as important to consider antecedent events. In all of the studies discussed above, antecedents were strategically assessed, meaning that data were collected on a daily basis regarding problematic behaviors and specific antecedents. This type of assessment is crucial to determine if and how antecedent events are playing a role in an individual’s challenging behavior. Following this assessment, strategies can be put into place to reduce the effects these variables have on problem behavior. It is important that these treatment components are used strategically before the occurrence of problem behavior. For example, if a child is found to be more likely to engage in problem behavior to get out of homework when he/she is tired, it may be beneficial to allow for a nap or decrease the amount of work on days that he/she is tired before problem behavior occurs. Reactive strategies, such as allowing a child to stop working following problem behavior and take a nap because the child is tired should be avoided, as this is likely to exacerbate the problem by teaching the child that problem behavior results in a break from work. Instead, caregivers/teachers should take data on sleep and problematic behaviors to determine if a relationship exists between them, and if it does then strategically plan for changes in the environment prior to starting homework on these days. Environment-behavior relationships are crucial in understanding challenging behaviors exhibited by individuals diagnosed with ASD, and best practice is to consider both antecedents and consequences in behavioral assessments and treatments.
Mindy Scheithauer, PhD, BCBA, is a Postdoctoral Fellow, Joanna Lomas Mevers, PhD, BCBA-D, is Assistant Professor, and Nathan A. Call, PhD, BCBA-D, is Assistant Professor at the Marcus Autism Center at Emory University School of Medicine. For more information, please visit www.marcus.org.
References
Carr, E. G., & Smith, C. E. (1995). Biological setting events for self-injury. Mental Retardation and Developmental Disabilities Research Reviews, 1, 94-98. doi: 10.1002/mrdd.1410010204
Dicesare, A., McAdam, D. B., Toner, A., & Varrell, J. (2005). The effects of methylphenidate on a functional analysis of disruptive behavior: A replication and extension. Journal of Applied Behavior Analysis, 38, 125-128. doi: 10.1901/jaba.2005.155-03.
Hartley, S.L., Sikora, D.M., & McCoy, R. (2008). Prevalence and risk factors of maladaptive behaviour in young children with Autistic Disorder. Journal of Intellectual Disability Research 52(10), 819–829. doi: 10.1111/j.1365-2788.2008.01065.x
Herring, S., Gray, L., Taffe, J., Tonge, G., Sweeney, D., & Einfield, S. (2006). Behaviour and emotional problems in toddlers with pervasive developmental disorders and developmental delay: Association with parental mental health and family functioning. Journal of Intellectual Disability Research, 50, 874–882. doi: 10.1111/j.1365-2788.2006.00904.x
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Kennedy, C. H., & Meyer, K. A. (1996). Sleep deprivation, allergy symptoms, and negatively reinforced problem behavior. Journal of Applied Behavior Analysis, 29, 133–135. doi: 10.1901/jaba.1996.29-133
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Taylor, D. V., Rush, D., Hetrick, W. P., & Sandman, C. A. (1993). Self-injurious behavior within the menstrual cycle of women with mental retardation. American Journal on Mental Retardation, 97, 659–664.
