Effects of SOBER Breathing Space on Aggression in Children with Autism Spectrum Disorder and Collateral Effects on Parental Use of Physical Restraints

Abstract

Several methods have been used to assist children with autism spectrum disorder (ASD) to self-manage their anger and aggression, including psychopharmacological, behavioral, and mindfulness-based interventions. However, no intervention works well with all children who engage in aggression and there is a need to investigate alternative management techniques. Four children with ASD were taught to use SOBER Breathing Space as an informal mindfulness-based practice to control their verbal and physical aggression in the family home. The SOBER Breathing Space required the child to Stop and see what is happening, Observe physical sensations and emotion regulation changes in the body, Breathe by deliberately bringing attention to the breath, Expand awareness of the situation, his or her response to the situation and longer term consequences, and Respond (versus react) mindfully. Effects of the SOBER Breathing Space on verbal and physical aggression were recorded in the family home, as well as generalization effects at school. In addition, parental use of physical restraints contingent on the children’s aggressive behavior was also recorded. In a multiple baseline design across subjects, the children showed they could control their verbal and physical aggression, and could respond mindfully to the emotionally arousing situation instead of automatically reacting in an aggressive manner. Results showed the training effects generalized from home to school, without training in the school setting. In addition, the effects were maintained during the 12-month follow-up period. Furthermore, parental use of physical restraints decreased rapidly and was eliminated within weeks of the children learning to use the SOBER Breathing Space for emotional regulation. This study suggests that some children with ASD may be able to successfully use the SOBER Breathing Space to self-manage their aggressive behavior, thereby eliminating the need for parents to use physical restraints.