he found Anthony, his nonverbal, fifteen-year-old son with ASD, banging his head against the windowpane. “Anthony!” he yelled, pulling him away. He sternly reminded him that head banging is dangerous and not allowed. Mr. Cappozolli then led Anthony over to a box of beads, off limits at other times, that the family used to distract him from continuing this perilous behavior.
Today, the Cappozollis were lucky—Anthony hadn’t broken the glass. Other times, they had not been so lucky. This behavior had cost them numerous trips to the emergency room and numerous windowpanes. More importantly, it had cost Anthony’s parents an untold amount of worry and grief, and had given them a sickening sense that they were helpless to protect their own son from himself. While grateful that he and his wife had the beads to interrupt the head banging, Mr. Cappozolli wished that he could understand where the head banging came from, and ultimately prevent it altogether.
The four children described above illustrate just a few of the behavior problems that children with an autism spectrum disorder may display. Your child may be challenging you with noncompliance, inattention, repetitive behaviors, or other problems. Some behaviors may be life-threatening, while others are just plain irritating. Some behaviors may lead to the destruction of property, while others may lead to the destruction of relationships with family or friends. For some parents, these behaviors are a constant, painful reminder of their child’s disability. For others, they may be a constant barrier to getting their child into the community and participating in the world.
While each type of behavior appears very different from the others, they do share a common thread. Each of the above behaviors does not seem to make any sense. The children engaging in these behaviors are losing things they value, ranging from television time to positive interactions with peers, but they are engaging in the behaviors anyway. Some behaviors, such as Anthony’s head banging, appear to be enormously painful, yet the behaviors persist.
For those who care about these children and desperately want them to be safe, happy individuals with a rich circle of friends and loved ones, these behaviors are enormously frustrating and are often the barriers between where these children are and where we want them to be. The purpose of this book is to help tear down these barriers. This book will help readers to identify how and why these troubling behaviors arise as well as to learn the basics of a strategy to eliminate them. Additionally, while this book cannot help with certain behaviors that require medication (such as tics), it can help you learn to distinguish behaviors that are part of underlying medical issues from those that will respond to behavioral intervention.
Over the years, research and experience have taught professionals who study behavior that making sense of a seemingly senseless behavior is an essential step to controlling it. This means that we must accept that these behaviors make perfect sense to the individuals engaging in them and then identify why. We must ask ourselves, “What purpose is this behavior serving?” and “How is this behavior benefiting my child?”
Well-established procedures have been developed to systematically identify the factors contributing to the occurrence of behavior problems in people with disabilities. Collectively, these procedures are referred to as “functional behavior assessment.” Results of functional behavior assessments are then ideally used to develop effective behavior intervention plans.
Study after study has shown that relying on a thorough functional behavior assessment is the most likely way to succeed in addressing an unwanted behavior (e.g., Repp, Felce & Barton, 1988). Behavior intervention plans based on functional behavior assessments work for individuals of all ages and all functioning levels (e.g., Crone, Hawken & Bergstrom, 2007; McLaren & Nelson, 2009; Wilder et al., 2009). This approach is relevant for individuals with the most severe developmental delays as well as for typically developing children and adults with no diagnosis at all. The research behind functional behavior assessment is so compelling that, legally, public schools in the United States must consider completing this type of assessment when addressing challenging behaviors (Individuals with Disabilities Education Act, 2004).
You do not have to be an expert in behavior analysis to understand and implement a functional behavior assessment. This book will teach readers how to complete comprehensive functional behavior assessments independently. In addition, this revised edition includes strategies that have been developed since the publication of our first edition that make it far easier to use these principles in home and school settings. The book has been written to help parents, grandparents, group home staff, and other caregivers, as well as teachers, school psychologists, and other professionals who may not have had access to specific training in this area. The methods described in this book can be used with toddlers, preschoolers, school-aged children, adolescents, and adults with any type of autism spectrum disorder, as well as other individuals with problem behaviors.
A general introduction to the principles of behavior will be provided in Chapters 1 and 2, including a discussion of how challenging behaviors arise and why individuals with autism spectrum disorders are more susceptible to developing them. Other foundation topics covered in these chapters will include an introduction to the principles of learning, a discussion of factors determining which behaviors will be performed in a given situation, and an overview of the types of consequences that may strengthen behaviors. Furthermore, Chapters 1 and 2 include an overview of functional behavior assessment and a discussion of how functional behavior assessment helps make sense of otherwise perplexing behaviors.
This background will equip readers for Chapters 3 through 8, which offer a practical, step-by-step guide to completing a functional assessment, including various forms of functional analysis—the “gold standard” in identifying the reasons why a behavior is occurring and informing effective intervention. These chapters also include “Keep it Simple Tips” to make the process more manageable, and handy tools to use when completing an assessment. This guide will help readers learn how to interpret assessment results, which are ultimately needed to develop an effective intervention. Chapter 9 summarizes the process, while Chapter 10 provides an overview of how to turn these assessment results into an effective plan. Finally, Chapter 11 addresses special topics such as adult issues, very infrequent but severe behaviors, and troubleshooting.
Armed with this combination of knowledge and skills, readers will be ready to make sense of those seemingly senseless behaviors and help their children or students tear down barriers to leading fuller and happier lives. If someone you care about is being held back by interfering behaviors, you can gain the skills to make a difference in his or her life. To begin empowering yourself to help, read on.
1 | Why Problem Behaviors Occur
Behavior problems can be maddening. Think about the examples described in the Introduction. Why would Anthony inflict so much pain on himself? Why would Grace destroy her chances of friendship with such violent behaviors? The answers to these questions are just not obvious. Professionals have struggled to understand behavior problems for a very long time. This chapter will give you a quick overview of how our thinking about the causes of, and interventions for, behavior problems has changed over time, and then tie that into the current thinking about why problem behaviors occur so often in individuals with autism spectrum disorders (ASDs).
How Do We Think about Behavior Problems? A Quick History
The Punishment-Based Approach
Historically, behavior interventions did not take into account the possible causes for a behavior. Instead, they focused on the question, “What is she doing?” Based on what a behavior looked like and what body parts were involved, a punishment was chosen. For example, if a boy swore, his mother might wash his mouth out with soap. If a girl hit someone, her teacher might hold her arms down at her side for thirty seconds. Through a trial-and-error process using this strategy, caregivers
