Parent Training to Address Problem Behaviors of Youth with Autism Spectrum Disorder

In my work with parents of children with ASD and co-occurring challenging behaviors, I often hear the following: “I feel like I am walking on eggshells, worrying that the next thing I do is going to set my child off”; “My child’s behavior feels very unpredictable; when he is set off, it feels like it is coming out of the blue,” and “All those strategies that worked with my other child(ren) don’t seem to work with her.” And parents are correct!

At first glance, their child’s behaviors appear unpredictable and explosive, which often results in parents understandably avoiding confrontations or placing demands that might set the child off. The good news is we have a lot of research supporting the use of strategies based on the principles of applied behavior analysis (ABA) to help unravel the mystery surrounding a child’s behavior and to develop treatment plans that can successfully reduce these challenging behaviors. When starting treatment with families, I ground the journey with Three Key Concepts:

1. Behaviors are learned. This is not to suggest that a parent has set out purposefully to teach their child to hit others, for example, but rather the hitting is the result of the child learning that hitting “works” for them to get a want or need met. For a classic example, consider a child who is yelling in the checkout aisle of the grocery store because he wants some candy on display. His mother may initially say no, but when the child continues to scream, the parent may finally give him the candy. This choice makes sense in the moment because it stops the behavior, the child is now happy and the mother no longer has to manage a tantrum in public. But this might cause problems in the future because the child has ‘learned’ that screaming gets candy. The good news is that if a child has learned to hit others, whine, or tantrum, he can also be taught new, more appropriate ways to behave.
2.  Behaviors are forms of communication. Children with ASD often have difficulty with communication — they may find it hard to tell you what is bothering them or may not have a good way to ask for something they want. Even children who are quite verbal can have difficulty “using their words” when they become frustrated or angry. Children with ASD whose communication skills are limited may learn that their behaviors communicate their wishes very effectively. So, when your child is engaging in a problem behavior, an important question to ask yourself is, “What is my child trying to communicate through this behavior?” A tantrum could be saying, “This is too hard.” Screaming could mean, “Leave me alone.” Hitting could be communicating, “That’s mine. Give it back.
3. Behaviors serve a function. A child may act out in order to escape or avoid a situation or demand. For example, a child having learned he will be sent to the principal’s office might hit another student in the classroom in order to “escape” the assignment just given by the teacher. A child also may engage in a problematic behavior to get attention. For example, a child might bang his head as he has learned that this will quickly get his father’s attention when he is talking on the telephone. A child may learn his behavior gets him what he wants. For example, a child may scream loudly when his mother turns the TV off because he has learned that she will turn it back on to stop his screaming during his baby sister’s naptime. Finally, some children engage in behaviors because they are pleasing to the child or are “automatically” rewarding. For example, a child may flap his hands because he finds this pleasant to do when excited. We often consider these behaviors as being motivated by factors such as sensory input, reduction of internal anxiety, or perhaps just being pleasing to the child.

When it comes to treating challenging behaviors, the starting point will always be trying to understand the purpose or “function” of the child’s behavior. To illustrate this point, consider a child who is disruptive while doing class work – making paper airplanes, talking loudly to classmates, making noises – and the teacher sends the child to the principal. This child may be disruptive because he is trying to escape from doing class work. While the teacher’s consequence is logical, it will not be effective in reducing the behavior in the future because the child succeeded with escaping from class work. Take the same exact behaviors and teacher response, but this time the function of the child’s behaviors is to get attention from his classmates. In this case, the teacher’s consequence of removing him from the classroom should help to decrease the disruptive behavior because she is targeting the correct function of the behavior – seeking attention. This is why it is so important not to just focus on the behavior when thinking of how to treat problem behavior. It is more useful to target the function of the behavior!

Creating a treatment plan is the hard work ahead, figuring out which specific strategies will address the function of the challenging behavior. As you move forward on that journey, keep in mind that any new strategy may take some time to work as your child is learning a new behavior! Consistency, predictability, and follow-through are the keys to success. Your child will learn to accept new rules when he sees you responding the same way every time.

To learn more about addressing challenging behavior from Dr. Bearss, watch her Autism 204 talk from last month.