My daughter is now a big, lovely and easy-going girl — she will be sixteen next year — but she did not start out that way. Her problem behaviour was the greatest challenge I had to weather between the ages of eight and twelve. She showed a great deal of aggression, which is one of the major signs of autism in children.
She expressed problem behaviours including hitting and biting whenever she was angered. It was mortifying at times, and it made it difficult for me to leave her in the care of a nanny or in the company of other children. Long before I ever received her diagnosis, I was fielding complaint after complaint from her teacher about her aggression toward the other children.
Generally speaking, all children — autistic or not — express some form of problem behaviour. The difference is that a child without autism spectrum disorder will usually change course quickly once a parent or caregiver shows displeasure. According to my findings, problem behaviour is simply more common in children with autism.
As a single mother determined to protect my daughter from undue social stigma and pressure, I did most of this research on my own. It was during that research that I discovered functional analysis — a method that can find the cause of problem behaviour and identify the best way to treat it. Treating problem behaviour is usually far more straightforward than general strategies for behaviour management.
The Danger of Problem Behaviour
Caring for my daughter through her problem behaviour was the most exhausting period of my life — and it was not easy for her school or her teacher either. Unruly behaviours, including self-injury, tantrums and the destruction of property, placed her at real risk of social exclusion and isolation. It breaks my heart to admit it, but I am guilty of sometimes ignoring her, or of not wanting her to come with me to certain places.
According to a major study on autism, problem behaviour includes a child's inability to communicate their needs to parents or teachers, an inability to understand what is being asked of them, severe difficulty starting and maintaining social relationships and interactions, and engagement in repetitive, restrictive behaviours.
Problem behaviour is one of the health challenges of children living with autism — but underneath it are normal behaviours, turned up in frequency, intensity and duration.
Problem behaviour is one of the health challenges of children living with autism. And yet researchers point out that these so-called problem behaviours are usually normal behaviours observed in all children. The difference is that in children with autism, the frequency, intensity and duration are higher — and that is what distinguishes them from typically developing children.
The Causes of Problem Behaviour
Functional analysis pays close attention to how other people react to problem behaviour — because the way a parent or caregiver responds can cause the behaviour to become more entrenched, or escalate to an unmanageable level, even when that same response works perfectly well on children without the condition. Once the cause is determined, a personalised treatment plan can be developed.
When functional analysis is used to trace the cause of problem behaviour in autism, three factors are examined: what happens immediately before the behaviour (the trigger), the behaviour itself, and what happens afterwards (the response it receives).
Appropriate, Individualised Intervention
For children with autism, no single intervention has been found to eliminate problem behaviour completely. What experts in the field now advocate is prevention — stopping problem behaviour from taking root, beginning in early childhood.
In the past, a method called 'extinction' was used to treat problem behaviour — which simply means not giving the child what they want. More recent studies point to better ways of improving management without extinction:
- Functional communication — teaching the child a workable way to express the need behind the behaviour.
- Noncontingent reinforcement — providing attention and comfort on a steady schedule, not as a reaction.
- Differential reinforcement — rewarding the desirable behaviour rather than punishing the difficult one.
However much any parent or caregiver longs for problem behaviour to disappear, real care must go into choosing the treatment approach. The Clinical Practice Guideline for Autism/Pervasive Developmental Disorders, issued by the New York State Department of Health in 1999, warns that using an ineffective assessment or intervention is itself a form of indirect harm — because it displaces the effective help the child might otherwise have received (see The National Academies of Sciences, Engineering & Medicine).
