A Window of Opportunity for Preventing Challenging Behavior: Increase in Heartrate Prior to Episodes of Challenging Behavior in Preschoolers with Autism

Background: Almost two thirds of children with Autism Spectrum Disorder (ASD) present with challenging behaviors which are often associated with difficulties in communication; three quarters have difficulty with emotional regulation. The most effective approach to reduce challenging behavior and its consequences require appropriate intervention before onset of the behavior. However, understanding the triggers to challenging behavior is difficult in some children, due to their limited communication abilities generally, and communicating emotions in particular. As physiological indicators such as increase in heart rate are well-established fine-grained measures of emotional regulation and stress, these indicators may provide important insights on the triggers to challenging behavior.

Objectives:  To identify physiological precursors to challenging behavior episodes in pre-schoolers with autism who have frequent challenging behaviours.

Methods:  Whilst wearing a lightweight wireless electrocardiogram (Biopac BioNomadix^®) embedded in a speciality-made vest, 41 children with ASD aged 2-4 years were administered a testing battery including 10 tasks from the Preschool Version of the Laboratory Temperament Assessment Battery (Lab-TAB; Goldsmith, Reilly, Lemery, Longley, & Prescott, 1999). These Lab-TAB tasks were designed to mimic everyday life experiences in which children would need to regulate low-level stress (e.g. waiting for a snack, interacting with a stranger) and experience positive emotion (bubbles, peek-a-boo task), spanning approximately 1 - 1.5 hours. Coders blind to diagnostic group coded challenging behaviors including aggression, self-injury, property destruction, loud noises and non-compliance.

Results:  We were interested in the physiological state of children from the present sample who exhibited frequent challenging behavior. Sixteen children met this criteria and were thus included in the analysis. Analysis of heart rate data (beats per minute) from the first 3 children (physiological data processing is ongoing) indicate a mean of 39.69% (range of 32.89 – 48.31%) increase in heart rate from baseline at a mean of 52.70 secs (range of 33.11 – 71.70 secs) prior to the onset of the challenging behavior episode. These data will be supplemented with physiological (HR variability, skin conductance) and behavioral data from the full sample for presentation at IMFAR in an effort to understand how physiological stress relates to different behavior functions.

Conclusions:  The preliminary data indicate that children with ASD show clear physiological reactivity prior to the onset of challenging behaviors, thus identifying an important window of opportunity during which caregivers may intervene. Wearable biosensors may provide a useful means by which information about the onset of challenging behavior can be communicated, leading to efforts to teach emotional regulation in situations that matter most, such as the classroom.