Why do Problem Behaviors Occur in Children on the Autism Spectrum?

Research shows that brain development in children with autism is different from that of neuro-typical children. Differences in brain function cause the core symptoms of autism which are 1. Challenges in social communication and interactions and 2. restricted, repetitive behaviors. These symptoms often co-exist with one or more other brain-related social, physiological, psychosocial and communication difficulties. The spectrum of symptoms can include:

1. Developmental learning delays
2. Over or under sensitivity to lights, sounds, touch or tastes
3. Difficulty communicating
4. Repetitive movements and behaviors
5. Difficulty in social situations
6. Trouble with transitions
7. Attachment to unusual interests
8. Difficulty understanding emotions
9. Recurring sleep problems
10. Insufficient impulse control

Navigating a typical day with one or more of these conditions is challenging for a child with ASD. Without alternative coping mechanisms, the autistic child uses aggression and other forms of disruptive behavior to express vulnerability, frustration and stress.

What Problem Behaviors are Common for Children with ASD?

The most common forms of problem behaviors in children with ASD are:

• Aggression (lashing out at others causing physical harm, like biting)
• Self-harm
• Elopement (running or wandering away)
• Defiance (refusing to do what’s expected)
• Inappropriate self-stimulating behavior

These disruptive behaviors communicate the child’s need for help and support. Their behavior is out of control because they feel out of control and don’t have strategies to communicate in more acceptable ways. ABA teaches an autistic child to express their emotions using behaviors that are positive and socially acceptable. New positive behaviors receive reinforcement and problem behaviors are discouraged.

What is ABA Therapy?

ABA is an evidence-based treatment program.

An ABA treatment approach for autism spectrum disorder is based on the science of behavior which studies how behavior works, how it’s affected by the environment and how behavior is learned. ABA is “evidence-based” because several scientific studies demonstrated that intensive ABA therapy in the early formative years, is significantly more effective in shaping positive behavior change for children with autism than any other treatment approaches.

ABA therapy is implemented by a specially trained team.

A Board-Certified-Behavior Analyst (BCBA) designs and leads the ABA treatment plan

• A BCBA is a master’s trained professional with specific education and training in applied behavioral analysis.
• A BCBA is certified by the Behavior Analyst Certification Board (BACB) after completing at least 2000 hours of supervised practice and passing the BACB national exam.
• Responsibilities of the BCBA are to:

  • Assess the child

  • Formulate treatment goals
  • Measure progress
  • Supervise the Behavior Technicians
  • Advocate for the child across the treatment team
  • Assure a discharge plan is in place for continued care

A Behavior Technician implements the treatment plan. The education, experience and certifications for behavior technicians is varied and they practice ABA therapy under the supervision of a BCBA.

• Responsibilities of the technician are to:
  • Implement the plan working 1:1 with the child at home and in other locations such as a clinic or school
  • Track and measure progress and collaborate with the BCBA
  • Support the family and other caregivers to ensure consistent application of the treatment plan throughout daily life

ABA involves Intensive treatment.

Learning new behaviors takes practice. ABA therapy requires intensive treatment in the range of 20-40 hours/week, for 1-3 years, 3, depending upon the treatment goals. This allows for repeated practice of new skills. The intensity of practice, guided by a behavior technician, not only trains a new behavior but also helps to generalize the behavior to everyday life.

An ABA treatment plan is tailored to the needs of each child.

Each child with ASD presents with a unique set of impairments, skills and needs. The treatment plan is personalized so that the outcomes deliver functional benefits that enhance quality of life, not only for the child, but for the family as well. Factors such as gender, socioeconomic status, education, geographic location and family support also influence the treatment plan. For example, the treatment plan considers the availability of reliable family involvement, what other therapeutic services exist in the community, and what financial support is available.

Parent/caregivers have a critical role in ABA intervention.

Parents help prioritize the goals of therapy and actively participate in treatment. Parents have a 24 hour view of their child’s interactions and behavior and are in the best position to identify pertinent issues, report on progress in different settings and reinforce skills. ABA therapists hold regular training and coaching sessions with parents to assure they correctly implement behavior management strategies. Parent input to the discharge plan is essential to the long term success of treatment.

How does ABA Shape Positive Behavior Change for Children with ASD?

There are three basic steps in developing an ABA intervention plan:

1. Identify the need that’s being met through problem behavior
2. Replace problem behavior with positive behavior
3. Reinforce replacement behavior and ignore the problem behavior

Step One: Identify need from the child’s perspective “What’s In It for Me”

The first step in ABA is to identify what need the child is communicating, from their perspective, i.e. “What’s in it for me?” Are they trying to:

1. Gain attention?
2. Get a desired item or something specific such as a toy, candy, another turn in a game?
3. Escape from a situation they find unpleasant?

A BCBA uses structured observations of a child to:

• Describe the problem behavior
• Observe what happened before the behavior and
• What happened after the behavior, i.e. how did the caregiver respond

This is referred to as an A-B-C assessment which helps the therapist understand why a problem behavior may be happening and how a different consequence or response could affect the likelihood of the behavior occurring again. The ABC Assessment Worksheet below contains an example of data collected by a BCBA during an assessment of an autistic child. The task is to understand what need the child is communicating using problem behavior.

This assessment reveals a pattern of behavior:

• The child uses outbursts to gain something they wanted – an iPad, more snack, candy, and another turn in the game.
• After the outburst, they get what they wanted. The caregiver’s response, likely driven by a desire to stop the outbursts, rewards the negative behavior.

This is a good example of how the caregiver’s response unintentionally reinforces disruptive behavior, creating a vicious cycle that is counterproductive to positive behavior change.

Step two: Replace problem behavior with positive behavior

An ABA intervention takes a two-pronged approach to changing behavior:

1. Replace problem behavior with positive behavior
2. Change caregiver response to the child’s behavior

Replacement behavior should be easier and more efficient for the child than disruptive behavior. For example, pointing to a picture or using words to communicate takes less effort and energy than a tantrum. In learning positive behaviors, the child learns both what to do as well as what not to do so the strategy is supportive and instructive vs. punitive. The behavior technician teaches the replacement behavior and explains new “rules” e.g. “You will not get candy if you cry. You will get candy if you say, “Candy please.”

Step three: Use Positive Reinforcement for Replacement Behavior

Caregiver response to behavior is critical to behavior change. Positive reinforcement in response to desired behavior, increases the likelihood of that behavior being repeated. Likewise, ignoring or discouraging undesired behavior extinguishes that behavior. The diagram below illustrates the two phases in establishing positive behavior change for a child with autism.

Problem Behavior Extinguished

Replacement Behavior Reinforced

Positive reinforcements are customized to the child’s preferences and interests. High fives, hugs, edible treats, T.V time, more game time etc. are examples of commonly use rewards. Reinforcers will change over time as they lose appeal but rewarding appropriate behavior needs to be a consistent part of the interaction.

Behavior change takes time, but with consistency and patience using ABA principles as directed by a BCBA, the effort will be rewarded with sustained positive behavior and life-long benefits.

Conclusion

Applied Behavioral Analysis is accepted as a best practice for positive behavior change for children on the autism spectrum. It’s a holistic approach that provides structure, direction, and support for the child and their family. The intensity of the treatment results in functional, measureable change that is evident in every day life. To paraphrase Mary Beth Walsh, Ph.D, a parent-advocate for autism, every child with autism deserves effective, science-based behavioral intervention, that allows them to develop their full potential and live their best life.

To learn more about ABA and to schedule a consultation with a Board-Certified Behavior Analyst (BCBA), visit our website at www.propelautism.com.

Sources:

1. Applied Behavioral Analysis Program Guide, There’s a Wide Variety of Symptoms and Signs of Autism, https://www.appliedbehavioranalysisprograms.com/lists/5-symptoms-of-autism/ (accessed 7.1.2022).

2. Center for Disease Control and Prevention, Signs and Symptoms of Autism Spectrum Disorder, https://www.cdc.gov/ncbddd/autism/signs.html (accessed 7.6.2022).

3. Autism Speaks, “What is ABA?,” https://www.autismspeaks.org/applied-behavior-analysis, (accessed July 5, 2022)

4. James Macron, M.Ed., BCBA, LBA, ”How to Safely Manage and Change Challenging Behavior,” Sponsored by Propel Autism, https://www.youtube.com/watch?v=vwo9ufOIHxw (accessed July 5, 2022)

5. Walsh, Mary Beth. “The Top 10 Reasons Why Children with Autism Deserve ABA.” The Behavioral Analysis in Practice Journal, Volume 4, Summer 2011, pp.72–79.