Descriptive Assessment of Problem Behavior in a Large-Scale Randomized Trial in Young Children with Autism Spectrum Disorder

Background:  Children with autism spectrum disorder (ASD) exhibit high rates of emotional and behavioral problems. These problem behaviors serve a function for the child:  attention, access to a tangible item, escape from demands, or sensory stimulation. Functional analysis (FA), the manipulation of environmental events under experimental conditions, is the gold standard method used to identify the function of problem behaviors. Another less rigorous approach is called descriptive assessment (DA) which involves the direct observation of a target behavior, its antecedents and consequences. FA and DA have been used to assess function of behavior in a wide range of clinical populations and age ranges. However, they typically are administered by experts and in the context of single-subject design studies. The relative ease in implementation of DA makes it a valid option for use by parents and to characterize the function of problem behaviors in large samples. To our knowledge, this is the first study of its kind to use descriptive assessments co-created by parent and therapist in order to characterize the behavior, topography, and function of behaviors in a large group of children with ASD.   

Objectives:  The purposes of this poster are: 1) to describe the process of co-constructing the function of problem behaviors in children with ASD in the context of a structured parent training program; 2) to describe the problem behaviors and topographies that emerged from the parent –therapist collaboration; and 3) to describe the functions of problem behaviors identified in the parent training program.

Methods:  Results were derived from a large-scale multi-site, 24-week, randomized clinical trial of 180 children (age 3 to 6 years, 11 months) with ASD and disruptive behaviors. At baseline, eligible children were randomized to receive either parent training (PT) or parent psychoeducation (PE).  89 children were randomized to PT and 91 children were assigned to PE. Descriptions of the child’s problem behaviors were documented in a “behavior support plan” that was co-constructed by the parent and the therapist over the course of PT.

Results:  To date, 59 of 89 behavior support plans for PT subjects were available for review. Parents reported tantrums in 78.0% (46/59) of the subjects, aggression in 62.7% (37/59) and noncompliance in 39.0% (23/59). Parents reported a total of 175 behavior problems with 53 topographies (e.g. crying, flailing). Of the 175 behavior problems reported, the most common were tantrums (26.3%), aggression (21.1%) and noncompliance (13.1%).  Of the four functions of problem behavior, parents reported that 62.4% of the behaviors had multiple functions followed by access to a tangible (59.4%), attention (47.1%), escape (42.0%), and sensory (11.6%).

Conclusions:  This is the first study to identify the behaviors, topography, and functions of disruptive behaviors using co-constructed parent-clinician descriptive assessments in a large sample of well-characterized young children with ASD. These results suggest that teaching parents to conduct DAs is an effective method to identify the functions of disruptive behavior in young children with ASD.