Non-Pharmacological Treatment of Problem Behaviors in Children with Autism Spectrum Disorder

Abstract

Description and Impact of Behavior Problems Behavior problems are common in children with autism spectrum disorder (ASD) and range from relatively mild difficulties (e.g., tantrums, stereotypies, and noncompliance) to more severe behaviors, including selfinjury and aggression toward others. Problem behaviors are considered to be part of the clinical presentation of autism and have been linked to a range of difficulties including language and communication challenges, as well as sensory-based problems, and emotion dysregulation (APA, 2000; Gadow, DeVincent, Pomeroy, & Azizian, 2004; Koegel, Koegel, & Surratt, 1992; Lecavalier, 2006). More serious behaviors such as aggression and selfinjury not only pose immediate safety risks for the individual child and his or her caregivers but are also associated with broader functional impairments (RUPP Autism Network, 2007). They can interfere with learning opportunities, limit positive social interactions, and are associated with overall reduced independence (Horner, Carr, Strain, Todd, & Reed, 2002). Research suggests that behavioral difficulties often persist and worsen without appropriate treatment (Horner, et al., 2002; Tonge & Einfeld, 2003) and disruptive behavior in children with autism have been associated with high levels of parental stress, family isolation and decreased family cohesion (Lecavalier, Leone, & Wiltz, 2006; Schieve, Blumberg, Rice, Visser & Boyle, 2007). Given the prevalence, chronicity, and impact of behavior problems in children with ASD, the development of effective and feasible treatment options is critical for this population. Medication has been shown to be helpful in managing severe, disruptive behaviors in ASD; however, the effects of medication do not target core symptoms of the disorder, are often associated with adverse events, and challenging behaviors tend to re-emerge if the medication is discontinued (Aman, McDougle, Scahill, Handen, Arnold, Johnson, et al., 2009). There is a vast amount of research demonstrating the effectiveness of behavioral interventions in treating disruptive behavior in autism as well as targeting core social and communication deficits. Thus, intensive behavioral interventions have become a predominant treatment approach for autism and are the focus of this article (Bregman, Zager, & Gerdtz, 2005).