Severe Behavior Problems in Autism: A Guide

Understanding Severe Behavior Problems

When discussing autism, a critical aspect to consider is the occurrence of severe behavior problems. These problems can significantly impact the lives of individuals with autism and those around them.

Definition and Impact

Severe behavior problems, in the context of autism, refer to problem behaviors such as self-injury, aggression, and property destruction. These behaviors can be intense and frequent, impairing a child's functioning significantly. Individuals with autism, along with other intellectual and developmental disabilities, are at an increased risk of engaging in these behaviors.

Children with Autism Spectrum Disorder (ASD) and intellectual disabilities (ID) often present problem behaviors at rates disproportionately higher than their typically developing peers. These can be severe, treatment-resistant, and chronic.

The impact of these behaviors is extensive. They can lead to a diminished quality of life, restrict access to community resources, and require costly resources to manage. Often, families have to resort to restrictive behavior management methods, increased use of physical restraint, mechanical restraint, seclusionary practices, and over-prescription of medication. Furthermore, studies have shown that behavior problems can indirectly impact maternal well-being by exacerbating behavior problems in adolescents and adults with autism [3].

Common Types of Problem Behaviors

There are several types of problem behaviors associated with autism. More than half of children and teens with autism may be physically aggressive toward caregivers or others, including behaviors like hitting, kicking, and biting. Younger children are more likely to hurt others, while older children and teens are more likely to hurt themselves, especially if they have trouble communicating.

Here are some common types of problem behaviors seen in individuals with autism:

Self-injury: This includes behaviors like head-banging, biting, and scratching oneself.
Aggression: This involves behaviors directed at others, like hitting, kicking, or biting.
Property Destruction: This covers actions like breaking objects, tearing things up, or other forms of vandalism.
Disruption: This includes behaviors that interrupt or interfere with activities, like yelling or throwing objects.
Elopement: This refers to the act of leaving a safe area or running away.

Understanding these behaviors is the first step towards addressing them. By recognizing the signs and understanding the underlying causes, parents, caregivers, and professionals can work together to develop effective strategies to manage and reduce these behaviors.

Causes of Severe Behavior Problems

In order to effectively address autism severe behavior problems, it is crucial to understand their potential causes. These causes can broadly be classified into three categories: genetic conditions, environmental triggers, and medical comorbidities.

Genetic Conditions

Some severe behavior disorders are directly linked to genetic conditions. It is crucial that these conditions are taken into account during the functional assessment process to ensure a comprehensive understanding of the individual's behavior [1]. Research is ongoing to better understand the specifics of these genetic links and how they contribute to behavior problems in individuals with autism.

Environmental Triggers

Environmental triggers can also contribute to severe behavior problems in those with autism. Challenging behaviors can have root causes in biological factors such as anxiety or environmental sensory processing issues. For instance, an individual with autism may react negatively to an environment that is too loud or brightly lit, leading to behavioral issues.

Medical Comorbidities

Medical comorbidities are often associated with autism and can significantly influence behavior. These may include conditions such as allergies, anxiety, constipation, gastroesophageal reflux disease (GERD), migraines, otitis media, rhinitis, sinusitis, and sleep disturbances. Many of these conditions co-occur with various challenging behaviors.

Condition	Prevalence	Associated Behaviors
Anxiety	40% - 80%	Aggression, self-injurious behavior (SIB), tantrums (NCBI)
Constipation	Varies	Behavioral changes, aggression (SPARK for Autism)
GERD	Varies	Behavioral changes, aggression (SPARK for Autism)
Migraines	Varies	Behavioral changes, aggression (SPARK for Autism)

Importantly, medical and dental conditions may be misinterpreted as behavior problems in individuals with autism. A severe change in behavior can often be an indicator of an underlying medical issue, such as constipation or an ear infection. This misinterpretation can lead to challenges in providing appropriate care and treatment [7].

It's clear that the causes of severe behavior problems in individuals with autism are multifaceted and complex. This underlines the importance of a comprehensive and holistic approach to assessment and treatment, which takes into account not only the observed behaviors but also the various underlying factors that may be contributing to these behaviors.

Diagnosis and Assessment

A crucial step in addressing autism severe behavior problems is the diagnosis and assessment phase. This involves an in-depth evaluation of a child's behaviors, from determining what triggers these behaviors to identifying the root causes and conducting a functional analysis.

Functional Behavior Assessment

The functional behavior assessment is a key tool used in the diagnosis and assessment of severe behavior problems in children with autism. This process involves identifying the antecedents (or "triggers") and typical consequences of the behavior. Understanding the events that make the problem behavior more likely to occur is crucial to developing a treatment based on modifying those events [1].

For example, an antecedent could be a certain situation or event that precedes the behavior, while the consequence could be the response or outcome that follows the behavior. By identifying these factors, professionals can gain a better understanding of why the behavior occurs and how to intervene effectively.

Identifying Root Causes

Identifying the root causes of severe behavior problems in children with autism is a critical part of the assessment process. Some behavior disorders are directly linked to genetic conditions, and the functional assessment process should take these conditions into account.

Moreover, researchers have identified operant conditioning and medical comorbidities as major contributors to challenging behaviors in individuals with autism spectrum disorder (ASD) over the past 50 years.

The emergence and maintenance of problem behavior in children with ASD and ID are influenced by deficits related to ASD and ID, experiences that reinforce these behaviors, and interactions between deficits and learning experiences. Therefore, getting to the root of these behaviors is pivotal in formulating an effective treatment plan.

Functional Analysis

The functional analysis is an important part of the assessment phase. It allows professionals to identify the specific environmental antecedents and consequences controlling problem behavior [2].

This process typically involves manipulating the environment to see how the child responds and monitoring changes in behavior. The information gathered from a functional analysis can then be used to create a tailored intervention plan.

Applied behavior analysis (ABA) has been effective in treating a range of problem behaviors in children with ASD and ID. Comprehensive ABA interventions focus on establishing adaptive skills and problem-focused interventions target specific problems like self-injurious behavior, aggression, pica, disruptive behavior, and elopement.

In conclusion, the diagnosis and assessment phase is a critical step in addressing severe behavior problems in children with autism. Through the functional behavior assessment, identifying root causes, and functional analysis, professionals can gain a deep understanding of the problem behaviors and develop an effective plan to help children and their families.

Treatment Approaches

When addressing autism severe behavior problems, adopting the right treatment approach can make a significant difference. Various methods are available, each with distinct features. This section will explore three primary treatment approaches: behavioral therapy, multidisciplinary interventions, and inpatient treatment considerations.

Behavioral Therapy

Behavioral therapy, especially Applied Behavior Analysis (ABA), has proven effective in managing a range of problem behaviors in children with Autism Spectrum Disorder (ASD). This approach focuses on establishing adaptive skills and also targets specific issues like self-injurious behavior, aggression, pica, disruptive behavior, and elopement. ABA not only benefits the child but also helps the whole family cope better with the situation, providing a positive parenting environment and improving social relationships.

Multidisciplinary Interventions

For individuals with complex severe behavior problems that have not responded to outpatient treatment, an intensive multidisciplinary treatment may be required. This approach involves seeing both a behavioral psychologist and a psychiatrist. The combined expertise from these two fields provides a more comprehensive treatment plan, addressing not just the behavioral aspects but also any underlying mental health issues. This collaborative approach can help in managing severe behavioral disorders more effectively.

Inpatient Treatment Considerations

In cases of very severe behavior disorders, where there's a heightened risk of self-injury or harm to others, inpatient admission might be considered. Inpatient treatment provides a controlled environment where behavior can be closely monitored, and immediate intervention is available if required. This approach is usually considered when other outpatient or multidisciplinary treatments have not been effective. It's essential to remember that inpatient treatment is a considerable step and should be thoroughly discussed with healthcare professionals before proceeding.

The selection of the right treatment approach for autism severe behavior problems is dependent on the specific needs and circumstances of the individual. It's crucial to involve healthcare professionals in this decision-making process to ensure that the chosen approach is both effective and suitable for the individual's personal situation.

Supporting Families

Addressing autism severe behavior problems requires not only understanding and addressing the needs of the individual with autism, but also providing support for their families. Parents and caregivers often face unique challenges that can lead to stress, the need for crisis management, and a demand for social support.

Caregiver Stress

Parents of individuals with autism spectrum disorders (ASD) often report high levels of stress and mental health problems. This stress is associated with the challenges of caring for individuals with complex needs and navigating multiple service sectors throughout their lives. In fact, mothers of children with ASD report experiencing greater emotional problems compared to mothers of children with intellectual disability without ASD and mothers of typically developing children.

Moreover, the stress levels of mothers of adolescents and adults with ASD are found to be higher than those of other parents. These mothers frequently experience fatigue, arguments, and stressful events.

Crisis Management

Crises in families of individuals with ASD can result from a buildup of stressors, such as the severity of a problem, a need for increased service, and problems with service providers. When a family is in crisis, they may require social support, more coping strategies, emergency services, and they may express concerns about the future of their child [8].

A crisis in these families is characterized by factors influencing four major areas: demands, internal capabilities, external resources, and subjective appraisal. It is seen as an acute disruption of psychological homeostasis where usual coping mechanisms fail.

Social Support Needs

The thematic model of crisis based on survey responses from mothers of children with ASD illustrates that crisis is a subjective experience. It is characterized by demands such as health problems, child behavior, and family issues; internal capabilities like failed coping and functional impairment; lack of external resources including support and finances; and subjective appraisals of extreme stress and hopelessness [8].

Hence, social support is crucial to help families cope with the demands and stressors they face. This can come in the form of professional assistance, support groups, financial aid, and emergency services. Offering a supportive and understanding environment can help families handle crises more effectively, reduce stress, and provide better care for their loved ones with ASD.

Future Research and Considerations

As ongoing investigations continue to explore the complexities of autism and its associated severe behavior problems, it's crucial to consider the long-term outlook, promising interventions, and holistic approaches that encompass overall health and wellbeing.

Long-Term Outlook

Adolescents and adults with autism spectrum disorder (ASD) are at an increased risk of developing chronic health problems during adolescence, such as seizures and gastrointestinal issues like diarrhea and constipation NCBI. This highlights the need for long-term care plans that consider the physical health needs of individuals with autism, alongside their behavioral challenges.

Additionally, research has shown that behavior problems can indirectly impact maternal well-being by exacerbating the health problems in adolescents and adults with autism. This underlines the importance of providing support for caregivers and families, as well as those with autism NCBI.

Promising Interventions

Structured and specialized programs have shown great promise in reducing symptoms and aiding individuals with autism in their daily activities NICHD. These interventions, often encompassing behavioral therapies and various other treatments tailored to the individual's needs, have the potential to significantly improve quality of life.

Moreover, research suggests that early diagnosis and interventions for autism, particularly during preschool or before, are more likely to have significant positive effects on symptoms and later skills NICHD. This underscores the importance of early detection and intervention in managing autism and its associated severe behavior problems.

Holistic Approaches

In light of research indicating that physical health problems in individuals with ASD can predict subsequent levels of behavior problems, a holistic approach to autism care is gaining recognition NCBI. This approach includes interventions focusing on health promotion alongside behavior problem treatment, highlighting the interconnectedness of physical health and behavioral challenges in autism.

As research advances, it's crucial to continue exploring the potential of holistic approaches, acknowledging the multi-faceted nature of autism and the various factors that contribute to the individual's overall wellbeing. This includes investigating the role of diet, exercise, sleep, and mental health in managing autism and its associated severe behavior problems.

While there are still many unknowns in the field of autism research, the continued exploration of these promising interventions and holistic approaches provides hope for improved care and better outcomes for individuals with autism.