VOLUME 01
ISSUE 05
Addressing Challenging
Behavior
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ON THE SPECTRUM IN
ADULTHOOD
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A NEWSLETTER PROVIDING RESOURCES FOR THE
ADULT AUTISM COMMUNITY
Brought to you by the
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A MESSAGE FROM
THE DIRECTOR
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Admit it, we all have engaged in a form of challenging behavior at some point in our lives. Perhaps you went to an expensive restaurant, which required a reservation be made at least three months in advance. Upon arriving to the restaurant (on time) for your reservation, the maitre'd informs you that while your reservation is in their system, your table will not be ready for another hour. You may, in response to this news, lose your temper and raise your voice to express how upset you are about not getting your table on time. As a result of your behavior, the restaurant manager may come out to work with the maitre'd to find you a table right away, apologize for the error, and offer you free dessert for your troubles.
The reality is, sometimes challenging behavior can work to help get the things you want. In the above example, the person who raised their voice (challenging behavior) upon being told their table wasn't ready (restricted access) resulted in immediate access to a table and a free dessert (positive reinforcement).
Some individuals on the autism spectrum may also display social or communicative deficits. The inability to communicate what they are experiencing could result in challenging behaviors that are socially stigmatizing and/or dangerous. In this issue of our e-newsletter, we hope to start a discussion related to the rights of individuals on the autism spectrum who engage in challenging behavior and considerations for assessment and treatment planning.
Stay well,
James Maraventano, EdD, BCBA-D
Director, RCAAS-SCALE Program
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LIFE, LIBERTY, & THE PURSUIT OF HAPPINESS:
AN ARGUMENT FOR BASIC RIGHTS
Christopher Manente, PhD, BCBA
Executive Director-RCAAS
Clinical Assistant Professor-GSAPP
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This pandemic represents a unique opportunity for neurotypical adults to experience, to a limited extent, what it is like to be an adult on the autism spectrum who does not have the liberty to readily access their community when they wish to do so. In particular, the existence of some form of challenging behavior (e.g., self-injury, aggression, loud vocalization) is often used as justification for stripping an adult on the autism spectrum of their rights to a wide variety of personal liberties frequently associated with being a citizen of the United States. The major difference - for neurotypicals, this pandemic will eventually pass, and they will return to enjoying the many privileges of being neurotypical, including free access to a public community that is designed to meet all their wants and needs, while adults on the autism spectrum, and behavior deemed inappropriate for public settings, will continue to be largely restricted to doing the never-ending loop between their home and day program (for those fortunate enough to have a home and day program in the community).
I am not advocating for haphazard free access to the community for all adults on the autism spectrum who present complex/severe challenging behavior. Challenging behavior in community settings can be really dangerous, and even when it does not represent an immediate threat to safety, it can infringe upon the personal liberties of others. While all adults on the autism spectrum should be entitled to the same basic rights and liberties afforded to other citizens, this would require the creation of a workforce of highly trained direct-service practitioners prepared to maintain safety and encourage success in the community despite challenging behavior. This endeavor could not happen overnight (effective support staff require extensive training) or be inexpensive in the short term (incentivizing early career practitioners to pursue this difficult line of work would necessitate offering a living wage). However, there are many long term benefits that could be realized in not relying solely on reactive measures implemented after challenging behavior has already reached crisis levels (e.g., use of law enforcement, hospitals, and other institutional settings) as in the current system.
Challenging behavior is not a choice. For many adults on the autism spectrum, challenging behavior is a manifestation of their disability that is largely out of their control and should not be used as the basis to justify restrictions of their basic personal liberty. The RCAAS exists to ensure ALL adults with autism get the chance to be active participants in their communities to the extent possible.
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UNDERSTANDING THE "WHY" BEHIND CHALLENGING BEHAVIOR
Robert H. LaRue, PhD, BCBA-D
Director of Behavioral Services-DDDC
Clinical Professor-GSAPP
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Challenging behavior is not unique to any specific population or diagnosis. Neurotypical people display challenging behavior all the time. We have all seen a toddler crying for a toy in a department store or a child at the mall who wants to be carried by a parent rather than walk. These types of challenging behaviors are a normal part of development and usually resolve on their own without any systematic intervention. However, some individuals on the autism spectrum with communication deficits tend to be at-risk for developing more persistent behavioral problems. This is because challenging behavior is often a form of communication. If we want to effectively treat the challenging behavior, we need to understand what it is the individual is trying the communicate (the “function” of the behavior). The process used to identify the function of challenging behavior is called a functional behavior assessment (FBA).
People engage in challenging behavior for many reasons. These reasons (or functions) can be grouped into three broad categories:
- To get something: Someone might engage in challenging behavior to get things that they want, such as attention from others or access to preferred items or activities.
- To avoid something: People will also sometimes engage in challenging behavior to avoid unpleasant experiences, such as completing academic demands or to escape noisy environments.
- For nonsocial reasons: Sometimes people will engage in challenging behavior for reasons that are not socially motivated. For example, an individual on the autism spectrum may flap their hands or recite lyrics from their favorite song repeatedly. This kind of behavior occurs even if they are not “getting something” or “avoiding something.”
There are three general strategies you can use to determine the function of challenging behavior. FBAs include some combination of these procedures.
- Indirect Assessments: These involve asking people who know or work with the individual about why they engage in challenging behavior. These strategies don’t take a lot of time and are a great way to develop rapport with staff and family members. However, while often inaccurate, these could inform more formal assessments by helping to define the behavior and to understand when it may be most likely to occur.
- Descriptive Assessments: These involve observing the individual in their natural environment and collecting data on the events related to challenging behavior, to see if there are patterns (e.g., things that precede and follow it). These strategies are useful in that they are more objective and accurate.
- Functional Analyses: These involve manipulating the environment and observing the effects on challenging behavior (e.g., withhold attention briefly and provide it contingent upon challenging behavior). These are the most precise strategies for identifying ways challenging behavior occurs.
The combination of these procedures allows us to determine the function of challenging behavior, which provides us with the information we need to design effective treatments.
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IMPLEMENTING TREATMENT PLANS
Jacqueline Smith,
PsyM
Clinical Psychology Doctoral Candidate-GSAPP
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Now that we know how to identify the function (i.e. the “why”) of a challenging behavior, treatment interventions can now be tailored to improve outcomes for an adult on the autism spectrum. While there are countless variables that can be included in a treatment plan for
Antecedent-Based Strategies: These interventions alter the environment to minimize “triggers” that may lead to challenging behavior. For example, noncontingent reinforcement (i.e., giving it
for free), is a proactive strategy that decreases the motivation to obtain the desired outcome through inappropriate means. Here, you or the person on the autism spectrum in your life is provided the functional outcome of the challenging behavior (i.e., attention, access, a break) independent of behavior (e.g., “Oh, you’re going to give me the iPad every hour anyway? You mean I don’t have to scream to get it? Cool.”) Schedules and timers are a great way to ease transitions if the behavior is maintained by access to preferred items or escape from demands as they can signal the start and end of an activity.
Replacement Skills: It is important that whenever a behavior is being targeted for change, a new adaptive one is taught to replace it. Often, challenging behavior occurs as a result of the individual on the autism spectrum being unable to communicate what they want. Functional Communication Training (FCT) teaches the individual how to appropriately express what they want. In learning the functional communicative response, the challenging behavior is no longer the necessary means of communication.
Here are some strategies
for identifying, tailoring, and teaching/learning FCT responses. Adaptive coping strategies like
deep breathing,
progressive muscle relaxation, and coping statements can be used in place of maladaptive strategies (like challenging behavior), to help you regulate.
Consequence-Based Strategies: What happens after the behavior (i.e., the consequence) can influence how likely the behavior is to occur in the future.
Extinction, for example, is a consequence-based strategy that involves “not listening” to the challenging behavior. If the function of the challenging behavior is attention, don’t provide attention when the behavior occurs (but be sure to provide significant attention when the behavior stops or the individual asks appropriately for attention). Cut off the blood supply. In doing so, you are showing the person that the challenging behavior no longer “works.” Other consequence-based strategies such as reinforcement systems for “positive-opposite” behaviors (i.e., using an appropriate volume for challenging behavior involving screaming) can be useful.
The strategies outlined above are empirically validated and based on best practices in the field, but may not work for every individual. It is important when remediating challenging behavior that safety remain the top priority. If you or someone you know is engaging in dangerous behavior, or if the strategies provided are proving ineffective or overwhelming, please seek assistance from your support team and other qualified professionals such as a Board Certified Behavior Analysts (BCBA). The
Behavior Analyst Certification Board (BACB), maintains a certificant registry to search for and contact BCBAs in your local area. You can access the registry
here.
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Challenging behavior is a concern that effects both adults on the autism spectrum and their families. While safety should always be the priority, it is also important that caregivers seek assistance when needed.
In addition to their helpline (800-4-Autism),
Autism NJ provides an
overview of the prevalence of severe challenging behavior among individuals on the autism spectrum and related current public policy initiatives.
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You may feel a bit overwhelmed about where to start. Below are some resources for informing any assessment you may conduct and/or intervention strategies you may use. Understanding
why the behavior is occurring will directly inform
how you go about treating it. If challenging behavior is putting you or others in danger,
you should seek emergency assistance.
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The ability to organize information about a challenging behavior is key to hypothesizing its function. These resources may help you get started to better understand the
why of the challenging behavior.
The Functional Assessment Screening Tool (FAST) is an indirect assessment that may be a useful first step in assessing the challenging behavior. It is important to note, you should not rely solely on an indirect assessment to develop a behavior plan! You also need to actually observe what happens just before and just following to the behavior to best understand the social and environmental variables that may control it.
A-B-C data collection is a form of descriptive assessment that helps determine the
why of the behavior based on direct observation. While functional analyses are the gold standard for assessing challenging behavior, this method is far better suited for informing a treatment plan.
To learn more about the basics of functional analysis,
these lecture notes by Dr. Brian Iwata offer an in-depth understanding of functional analysis procedures. These notes are intended for more advanced practitioners.
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Looking for a quick reference chart? Seek no further!
This detailed guide will help match an intervention strategy to a behavior's function. Also, this guide offers contraindicated strategies (i.e., what you shouldn't do) when intervening with challenging behavior.
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Here are some additional strategies to consider for treatment plans you may develop. If you have the ability to discuss the plan with your support team (e.g., behavior analyst, support coordinator), it may be helpful to seek their input as well.
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In conjunction with a replacement skill, such as an FCT response, it is important to include consequence-based strategies (i.e., reinforcement).
A token economy is a good way to signal progress towards rewards that can be earned for engaging in more appropriate behaviors. Keeping this age appropriate could be as simple as providing check marks on a piece of paper or sticky note for appropriate behavior.
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For some forms of challenging behavior, teaching or learning coping skills may help stop the behavior or lessen its intensity.
Click here to access a worksheet with ways to help cope with distressing times.
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"Challenges are what
make life interesting.
Overcoming them is what makes life meaningful
."
- Unknown
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We are proud to announce that Dr. Christopher Manente is a member of the Leadership Advisory Board for the
A Place in the World project. This groundbreaking report will provide the foundational
nomenclature for housing and service delivery models. The study will serve as the definitive resource for the housing industry, scholars, direct service providers,
policymakers, researchers, and other stakeholders.
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WE HOPE YOU ENJOYED THIS ISSUE OF THE RCAAS E-NEWSLETTER
AND FOUND IT USEFUL. PLEASE DON’T HESITATE TO SEND
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