Problem Behavior In Young Children with Autism Spectrum Disorder

Background: Problem behavior (e.g., aggression toward others, self-injurious behavior, property destruction) is recognized as a significant stressor for caregivers of children with autism (Estes et al., 2009).  Identifying the function of problem behavior using functional analysis (FA) frequently leads to more effective, reinforcement-based treatments (Pelios et al., 1999).  Investigation of FA results for individuals with autism spectrum disorders (ASDs) who engage in problem behaviors has been limited.   In a review of 32 youth with ASDs, Love et al. (2009) reported social-positive reinforcement (i.e., attention and tangible reinforcement) was the most common function.

Objectives: We aim to better understand the function of problem behavior displayed by children with ASDs, with the following variations to the Love et al. (2009) methodology: 

•  All participants will be aged 18 months to 6 years.
•  “Gold standard” diagnostic measures will be used to confirm diagnosis. 
•  Extended FAs (Iwata et al., 1982/1994) will be conducted via telehealth with all participants. 
•  “Social-positive reinforcement” will be separated into attention and tangible categories to isolate the role of these functions in maintaining behavior. 
•  Participants living in relatively rural locations will be included.

Methods: Thirty children aged 18 months to 6 years diagnosed with ASD (confirmed with ADOS and ADI-R) will complete extended FAs of parent-identified problem behavior as part of a larger study of behavioral treatment via telehealth.  The FA is conducted over 2-way teleconferencing connections linking behavioral specialists from a university hospital with a regional university outpatient clinic within 50 miles of the child’s home.  Five minute sessions are conducted within individual single case multi-element designs during one hour periods, once a week, until at least 3 stable sessions are completed for each condition (free play, attention, tangible, and escape).  Behavioral functions are coded as: attention (behavior maintained by verbal or physical attention), tangible (behavior maintained by access to a tangible item), escape (behavior maintained by escape from task demand), and/or automatic (behavior maintained independent of social reinforcement).  Multiple functions can be coded.

Results: To date, 22 children have been identified for study, and 12 have completed the FA (6 with Autistic Disorder and 6 with PDD-NOS).  Another 5 participants are currently completing their FA.  FA results to date are presented in Table 1.

Table 1

Number of Participants with Problem Behavior Maintained by Identified Functions 

                                                                    Diagnosis

Function                            Autistic Disorder              PDD-NOS          Combined

                                                     n =6                           n =6                n=12

1) Attention                                       0                                0                     0 

2) Tangible                                        1                                1                     2 

3) Escape                                          0                                1                     1 

4) Automatic                                      0                                0                     0    

5) Attention & Escape                           1                                0                     1 

6) Tangible & Escape                            4                                2                     6 

7) Attention, Escape, & Tangible             0                                1                     1 

8) No Identified Function                       0                                1                     1 

Conclusions: Results to date suggest multiple functions, particularly a combination of tangible and escape functions, most frequently maintain problem behavior among young children with ASD.  With respect to social-positive reinforcement, problem behavior was more often maintained by tangible reinforcement than attention.