Intervention for Anxiety and Problem Behavior in Children with Autism Spectrum Disorder and Intellectual Disability.

There is little research on the functional assessment and treatment of anxiety and related problem behavior in children with autism spectrum disorder (ASD), particularly those with intellectual and developmental disability (IDD). In a recent study, we evaluated a multimethod strategy for assessing anxiety in children with ASD and IDD (Am J Intellect Dev Disabil 118:419-434, 2013). In the present study, we developed treatments for the anxiety and associated problem behavior in these same children. A multiple baseline design was used to evaluate the effectiveness of a multicomponent intervention package, incorporating individualized strategies from Positive Behavior Support and Cognitive Behavioral Therapy. During intervention, all three participants showed substantial decreases in anxiety and problem behavior and significant increases in respiratory sinus arrhythmia in the situations that had previously been identified as anxiety-provoking.

A multimethod assessment of anxiety and problem behavior in children with autism spectrum disorders and intellectual disability.

Despite the increased risk for anxiety disorders in children with autism spectrum disorders (ASD), there is a lack of research on the assessment and treatment of anxiety in this population, particularly for those with an intellectual disability (ID). The present study evaluated a multimethod strategy for the assessment of anxiety and problem behavior in three children with ASD and ID. Anxiety was operationally defined using: (1) behavioral data from anxious behaviors, (2) affective/contextual data from parent-report and observer ratings of overall anxiety, and (3) physiological data (heart rate [HR] and respiratory sinus arrhythmia [RSA]). A functional assessment of problem behavior during high- and low-anxiety conditions was conducted. Higher levels of problem behavior and HR and lower RSA were found in the high-anxiety than in the low-anxiety conditions.

Behavioral intervention for problem behavior in children with fragile X syndrome.

Parents and professionals typically report problem behavior as a significant concern for children with fragile X syndrome. In the present study, the authors explored whether behaviorally based interventions would result in a reduction in problem behavior and an improvement in quality of life for 3 children with fragile X syndrome and their families. A multiple baseline design was used to demonstrate intervention effects for specific high-priority contexts (i.e., bedtime, running errands, and toileting). A multicomponent intervention plan was developed to teach the parents and child to effectively cope with the particular context. After intervention, there were substantial improvements in problem behavior and family quality of life within the given contexts. Results of this study demonstrated the effectiveness of behavioral intervention for children with fragile X syndrome.

Evaluation, diagnosis, and treatment of gastrointestinal disorders in individuals with ASDs: a consensus report.

Autism spectrum disorders (ASDs) are common and clinically heterogeneous neurodevelopmental disorders. Gastrointestinal disorders and associated symptoms are commonly reported in individuals with ASDs, but key issues such as the prevalence and best treatment of these conditions are incompletely understood. A central difficulty in recognizing and characterizing gastrointestinal dysfunction with ASDs is the communication difficulties experienced by many affected individuals. A multidisciplinary panel reviewed the medical literature with the aim of generating evidence-based recommendations for diagnostic evaluation and management of gastrointestinal problems in this patient population. The panel concluded that evidence-based recommendations are not yet available. The consensus expert opinion of the panel was that individuals with ASDs deserve the same thoroughness and standard of care in the diagnostic workup and treatment of gastrointestinal concerns as should occur for patients without ASDs. Care providers should be aware that problem behavior in patients with ASDs may be the primary or sole symptom of the underlying medical condition, including some gastrointestinal disorders. For these patients, integration of behavioral and medical care may be most beneficial. Priorities for future research are identified to advance our understanding and management of gastrointestinal disorders in persons with ASDs.

Context-based assessment and intervention for problem behavior in children with autism spectrum disorder.

The present study used a context-based model of assessment and intervention to explore whether interventions that modify context result in reduction of problem behavior in ecologically valid settings (i.e., typical routines implemented by typical education personnel in neighborhood schools). The Contextual Assessment Inventory (CAI) and a postassessment interview were administered to parents and teachers of eight children with Autism Spectrum Disorder to identify problem contexts. Then, environmental modification techniques were implemented in three priority contexts: namely, transitions, termination of preferred activities, and presence of a feared stimulus. Our results demonstrated an almost complete elimination of problem behavior in the priority contexts as well as successful completion of activities and routines related to those contexts. We discuss the value of conceptualizing problem behavior as a function of context with respect to facilitating both assessment and intervention, and the need for enhancing breadth of effects to determine the larger impact of a context-based approach on promoting meaningful behavior change in the community.

Functional analysis of precursors for serious problem behavior and related intervention.

Precursor behaviors are innocuous behaviors that reliably precede the occurrence of problem behavior. Intervention efforts applied to precursors might prevent the occurrence of severe problem behavior. We examined the relationship between precursor behavior and problem behavior in three individuals with developmental disabilities. First, a descriptive (correlational) assessment focusing on transitional probabilities, which established that problem behavior typically followed precursor behavior, was conducted. Next, a functional (experimental) analysis was conducted to evaluate the relationship between precursor and problem behavior. Results suggested that these two behaviors served the same function. Finally, in the intervention phase, participants were taught a response that was functionally equivalent to the precursor behavior. Results demonstrated a decrease in the frequency of problem behavior. Collectively, these results suggest that prevention efforts might profitably be focused on precursor behavior. Further implications for the use of functional analysis and functional communication training in prevention are discussed.

Positive behavior support and applied behavior analysis: a familial alliance.

Positive behavior support (PBS) emerged in the mid-1980s as an approach for understanding and addressing problem behaviors. PBS was derived primarily from applied behavior analysis (ABA). Over time, however, PBS research and practice has incorporated evaluative methods, assessment and intervention procedures, and conceptual perspectives associated with a number of additional disciplines. Recently, there has been some confusion regarding the definition of PBS and, in particular, its relationship to ABA. In this article, it was noted that the practice of PBS and ABA, in some instances, can be indistinguishable but that important differences in definitions and emphases mandate an explicit distinction. The purpose of this article is to address some of the key points of confusion, identify areas of overlap and distinction, and facilitate a constructive and collegial dialog between proponents of the PBS and ABA perspectives.

Physical illness, pain, and problem behavior in minimally verbal people with developmental disabilities.

There is growing interest in the role that physical illness and pain might play in exacerbating problem behavior in individuals with developmental disabilities. Assessment of these factors, however, is often difficult since many individuals have minimal verbal communication skills. In response to this difficulty, we developed a sequential method of assessment involving retrospective and prospective measurement strategies. We found that the frequency and intensity of problem behavior was greater on "sick" days than on "well" days. Further, the higher the level of pain, the greater was the frequency and intensity of problem behavior. We discuss the concept of pain as a setting event for problem behavior and the intervention strategies that follow from this conceptualization.

Multiple effects of joint attention intervention for children with autism.

Joint attention refers to an early developing set of behaviors that plays a critical role in both social and language development and is specifically impaired in children with autism. In a series of three studies, preschool teachers demonstrated the effectiveness of discrete trial instruction and pivotal response training strategies to teach joint attention to 5 children with autism (Study 1). Parents of 2 of the 5 children also taught joint attention at home and in the community (Study 2). Several additional dependent measures demonstrated collateral improvements in expressive language and social-communicative characteristics that were socially validated by parent raters (Study 3). Results are discussed with respect to the importance of addressing different forms of joint attention, the necessity to extend intervention to naturalistic contexts and joint attention partners, the pivotal nature of joint attention, and whether intervention adequately addresses both the form and social function of joint attention.

Classroom intervention for illness-related problem behavior in children with developmental disabilities.

There is growing evidence of an association between physical illness and problem behavior in children with developmental disabilities. Such behavior can compromise school performance. Therefore, the purpose of the present study was to evaluate, using a group design, the effectiveness of medical intervention alone (N = 11) versus behavioral plus medical intervention (N = 10) for illness-related problem behavior in a school setting. Following intervention, the behavioral plus medical intervention group showed lower levels of problem behavior and completed more academic tasks than did the medical intervention alone group. The results are discussed with respect to the concept of illness and pain as a setting event for problem behavior. The need for research to develop algorithms that allow one to select the best combination of medical and behavioral interventions for specific illnesses and contexts is noted.

Menstrual discomfort as a biological setting event for severe problem behavior: assessment and intervention.

Assessment and intervention approaches for problem behavior need to be extended to deal with biological setting events. To meet assessment needs, we developed a strategy involving four components: interview, archival record review, direct observation, and functional analysis. Data indicated that problem behaviors (aggression, self-injury, and tantrums) were linked to both a biological setting event (menstrual discomfort) and certain discriminative stimuli (task demands). To meet intervention needs, we developed a multicomponent strategy that addressed both the biological context (menstrual discomfort) and the psychosocial context (task demands). Intervention reduced problem behaviors to near-zero levels, maintained for 15 to 22 months across 3 participants. We discuss the extension of our approach to other biological setting events as well as multiple motivational variables.

Using mood ratings and mood induction in assessment and intervention for severe problem behavior.

The literature on problem behavior documents the need for developing methods for assessing the impact of broad contextual variables. It has been suggested that the impact of some of these variables can be captured in mood ratings. We examined this possibility by observing whether there was a correlation between mood ratings and subsequent display of problem behavior. Further, we developed an intervention based on mood induction for altering these ratings and observed whether these alterations were correlated with changes in the likelihood of problem behavior. Our data demonstrated that bad mood ratings were highly predictive of problem behavior. Further, when we implemented our induction procedure to improve mood ratings, we subsequently observed dramatic decreases in problem behavior.

Problem behavior interventions for young children with autism: a research synthesis.

This paper provides a summary of research on behavioral interventions for children with autism 8 years of age or younger published between 1996 and 2000. The analysis is divided into four sections: (1) emerging themes in the technology of behavior support, (2) a review of existing research syntheses focusing on behavioral interventions, (3) a new literature review of current pertinent research, and (4) an evaluative discussion of the synthesis results and the field's future needs to develop effective behavioral interventions for young children with autism. The authors offer recommendations for strengthening the existing research base and advancing behavioral technology to meet the needs of the defined target population.