Challenging Behavior in Preschoolers with ASD

Background:

Children with ASD often present challenging behaviors (CBs) across home and school contexts. CBs impact caregiver stress and mental health (Davis & Carter, 2008; Hayes & Watson, 2012). CBs in school contexts affect teachers’ instructional efforts (Carr & Robinson, 1991) and predict burnout (Hastings & Brown, 2002).

While there is much literature on CBs with school-aged children and youth (Lecavalier et al, 2006), there is less on preschoolers, particularly those with low rates of communication. These children may be at high risk of exhibiting CBs due to difficulty communicating their wants and needs. Additionally, much of the existing research is cross-sectional, with few examining CBs longitudinally.

Objectives:

1. Characterize parent- and teacher-reported CBs in preschoolers with ASD
2. Examine change in CBs over a 6-month period

Methods:

This study used baseline data from a social communication intervention RCT. Preschoolers (n=145) who used <30 spontaneous words at entry received 6 months of communication interventions. Parents received weekly training in intervention for 2 months. Treatment groups were combined since both targeted communication skills within intervention.

At entry and exit, parents completed the Home Situations Questionnaire-PDD (HSQ, 25 items), which assesses behavioral noncompliance in everyday settings. Parents were asked to endorse whether their child exhibited noncompliance in a range of situations (e.g., when transitioning between activities). Parents were also asked to rate the severity of their child’s behavior for endorsed items (1=mild to 9=severe). In addition to total scores, subscores were calculated for the number and severity of socially inflexible vs. demand-specific CBs (Pelletier et al, 2006). Socially inflexible CBs included situations where children exhibited low adaptability to non-routine situations, while demand-specific CBs occurred when direct demands were placed on the child.

Teachers completed the School Situations Questionnaire (SSQ, 9 items), which is the HSQ analogue for school contexts (e.g., during free-play time in class). Total number of CBs and severity scores were calculated for entry and exit.

Results:

Table 1 includes descriptives for the number and severity of CBs reported by parents and teachers. HSQ and SSQ scores were not correlated.

Paired sample t-tests with corrections were conducted to examine change in number and severity of CBs over time. There were no significant changes in the number of CBs reported by parents or teachers. However, there were significant decreases in HSQ total severity (p=.004), HSQ socially inflexible severity (p=.001), and SSQ total severity (p=.005).

At entry, 50% of children presented clinically severe CBs on HSQ (2 SDs above normative mean from original HSQ; Altepeter & Breen, 1989), which reduced to 39% of children at exit. The change in proportion of children with clinically severe CBs was significant (p<.037).

Conclusions:

Parents and teachers both reported decreases in CB severity over time. Additionally, the decrease in children’s CB at home was clinically significant, with fewer children scoring at elevated levels by exit.

This study confirms that CB is prevalent in preschoolers with ASD and limited language, but shows that CB decreases while children are in intervention to improve their communication.