Video Presentation: Assessing and Treating Challenging Behavior in Individuals with ASD- presented by Lauren Moskowitz, Ph.D.
Lauren Moskowitz, Ph.D., is an Assistant Professor of Psychology at St. John’s University. She received her B.S. from Cornell University and her M.A. and Ph.D. in Clinical Psychology from Stony Brook University. She completed her internship at NYU Child Study Center and Bellevue Hospital and her postdoctoral fellowship at NYU Child Study Center. Her research focuses on behavioral assessment and intervention for children with autism spectrum disorders and other developmental disabilities (DD) in naturalistic contexts, intervention for parents of children with ASD and DD, and cognitive-behavioral therapy with children and adolescents.
Challenging Behaviors: Tips for Success
Written by Stephen M. Edelson, Ph.D.
When I speak to parents and professionals on treating behavioral problems, I typically say up front that there are no easy and quick fixes to reduce or eliminate severe behavioral problems, which include: self-injury, aggressiveness, severe tantrums and destructiveness. There may be, however, a few fixes that may not require an incredible amount of time and effort to implement. I have listed several suggestions below.
Occasionally a child may exhibit a behavior problem at school but not at home, or vice versa. For example, the parent may have already developed a strategy to stop the behavior at home, but the teacher is unaware of this strategy. It is important that the parent and teacher discuss the child’s behavioral problems since one of them may have already discovered a solution to handle the behavior.
If the child’s behavior is worse at school but not at home, there are many possible reasons, such as a lack of consistency. There are, however, several physical causes that should be considered. Two possible causes, which are seldom considered, are cleaning solvents and florescent classroom lighting. Janitors often use powerful chemicals to clean the classroom. Although the smell may be gone by the next day, the chemical residue may still be in the air and on surfaces. Breathing these chemicals may affect sensitive people. During the day students often place their hands and face on the tables and floors, and these chemicals can eventually wind up in the child’s mouth and alter brain functioning and behavior. Many parents and teachers wipe the students’ desks with water or a natural cleaning solution prior to class each morning, and they have reported rather remarkable improvements in the students’ behaviors.
Florescent lighting, which is the most common lighting used in classrooms, may also affect behavior. Many adults with autism report that florescent lights bothered them greatly during their school years. In addition, U.C.L.A. researchers observed more repetitive, self-stimulatory behaviors under florescent lighting compared to incandescent lighting. Teachers may want to turn off the florescent lighting in their classroom for a few days to see if there is a decrease in behavioral problems for some or all of the students. During this trial period, the teacher can use natural light from the windows and/or incandescent lights.
Behavioral problems may also be due to difficulties in expressive language. In fact, many researchers feel strongly that the majority of behavioral problems are simply due to poor expressive communication skills. There are numerous communication strategies, such as the Picture Exchange Communication System and Simultaneous Communication (using speech and sign language at the same time) which can be used to teach expressive communication skills.
Another possible reason for behavioral problems may be difficulties in receptive language. Autistic individuals often have poor auditory processing skills. As a result, they often do not understand what people are saying to them (i.e., they hear the words but they do not understand what the words mean). The person’s lack of understanding can lead to confusion and frustration, which can escalate into behavior problems. Visual communication systems can be useful in teaching and in informing individuals of what is planned and what is expected of them.
It is also important to consider the person’s level of arousal level when formulating a strategy to treat behavioral problems. Sometimes behavioral problems occur when the person is over-excited. This can occur when the person is anxious and/or when there is too much stimulation in the environment. In these cases, treatment should be aimed at calming the person. Some popular calming techniques include: vigorous exercise (e.g., a stationary bicycle) which would act as a release of their high excitement level, vestibular stimulation (e.g., slow swinging), and deep pressure (e.g., Temple Grandin’s Hug Machine).
In some cases, behavioral problems may be due to a low level of arousal such as when the person is passive or bored. Behaviors such as aggression and destructiveness may be exciting, and thus appealing, to some of these individuals. If one suspects behavior problems are due to underarousal, the person should be kept busy or active. Vigorous exercise is another good way to increase arousal level.
Food allergies are an often overlooked cause of behavior problems. Some individuals may have red ears, red cheeks, or dark circles under their eyes. These are often signs of food allergies. The most common allergens are dairy and wheat products, food preservatives, and food coloring. Some of the symptoms associated with food allergies are headaches, tantrums, feelings of nausea or spaciness, and stomach aches. As a result, the child is less tolerant of others; and he/she may be more likely to strike out at others, tantrum, or act out. Since many of these individuals have poor communication skills, the parent and/or teacher may not be aware that the child is not feeling well. The child should be tested if food allergies are suspected; and if the child tests positive for certain foods, then these products should be eliminated from his/her diet.
Many families are giving their children safe nutritional supplements, such as Vitamin B6 with magnesium and Di-methyl-glycine (DMG). Nearly half have reported a reduction in behavioral problems as well as improvements in the child’s general well-being. Sometimes powerful drugs are prescribed to autistic individuals to treat their behavior. Interestingly, the most commonly prescribed drug for autistic children is Ritalin. A survey conducted by the Autism Research Institute in San Diego revealed that 45% of 2,788 parents felt that Ritalin made their child’s behavior worse and only 20% reported improvement (27% of parents of autistic children felt that Ritalin made no difference).
In many instances, a behavior problem is a reaction to a request or demand made by a caregiver/teacher. The individual may have learned that he/she can escape or avoid such situations, such as working on a task, by ‘acting up.’ A functional assessment of the person’s behavior (i.e., antecedents, consequences, context of the behavior) may reveal certain relationships between the behavior and the function the behavior serves. If avoidance is the function the behavior serves, the caregiver/teacher should follow through with all requests and demands he/she makes to the person. If the person is able to escape or avoid such situations, even only some of the time, the behavior problem will likely continue.