A Structured Indirect Assessment of Problem Behavior Severity

Background:  

The severity of problem behavior is a key factor in triage and placement decisions for programs that serve children with autism who exhibit severe problem behaviors.  Without an appropriate method to identify which services would be most appropriate, individuals are at risk for being placed within a program that is either not equipped to treat the problematic behavior or resources are spent on treating behaviors that could have been decreased with less intensive services .  Currently, there are only a few standardized rating scales that provide information about the severity of problem behavior; however, they are not ideally suited to evaluate individuals with autism who exhibit severe problem behavior.  Absent such a standardized assessment, clinicians must rely on the reports of caregivers, which are often unreliable, or expend precious resources on other in vivo observations or functional assessments.  A standardized assessment would not only provide an objective measure of severity of problem behavior, but would and decrease the amount of resources required to make objective decisions regarding program placement.

Objectives:  

The Problem Behavior Severity Scale (PBSS) was developed to provide an objective measure of the severity of problem behavior as it relates to injury to self or others, property destruction, and the level of intervention or staff required to safely intervene. 

Methods:  

A clinician who conducts assessments to determine placement within a continuum of behavioral services interviewed parents and conducted a structured observation within an individual’s home for the purposes of determining appropriate placement into treatment services.  The clinician then made a clinical referral to the most appropriate program using best clinical judgment, as well as completed a PBSS.  A scale was developed based upon scores on the PBSS to determine the most appropriate level of intervention according to the score on the PBSS.  Clinician referrals and PBSS ratings were completed with 285 individuals.  Clinician referrals and PBSS ratings were compared. 

Results:  

The clinician ratings and PBSS produced the same recommendation for 87% of the individuals.  Disagreements were analyzed to determine which recommendation (PBSS or clinician) was more appropriate, as determined by successful completion of one program or a referral to a different program.  Recommendations from the clinicians were more appropriate for 6%, where as the severity score from the PBSS was more appropriate for 1%.

Conclusions:  

The quantification of problem behavior exhibited by individuals with autism is important for ensuring individual receive the most appropriate treatments.  This behavior is often difficult to measure without expending vast resources.  The PBSS appears to be an adequate instrument for satisfying this need.