Treatment of Autism Spectrum Disorders

Abstract

concepts, a directive approach, and family involvement (Anderson & Morris, 2006). Although further research is required to gain a better understanding of diagnosis and treatment of AS, researchers agree that treatment for AS should begin early in development. Because of the high academic functioning of many children with AS, diagnosis can occur later than it does in children with autism (Eisenmajer et al., 1996). Early detection and intervention in areas of social understanding and social skills is essential in the treatment of AS. Again, one should recognize the importance of a detailed assessment of the strengths and deficits of each child to develop the most appropriate individualized education plan. Family members should be involved at all stages of treatment to facilitate generalization of learned skills, and to increase family understanding and management of challenging behavior (Tsatsanis, Foley, & Donehower, 2004). Comprehensive treatment in the areas of social, behavioral, cognitive, and emotional development may vastly improve the quality of life for the child with AS. Functional Assessment and Treatment Children on the autism spectrum exhibit a wide range of challenging behavior, including aggressive, self-injurious, and disruptive behavior. Some behavior may be severe and intrusive enough to warrant a behavior intervention plan informed by a functional behavioral assessment (FBA). An FBA is defined as “a process which searches for an explanation of the purpose behind a problem behavior” (OSEP Questions and Answers, 1999) and is mandated by the Individuals with Disabilities Education Act (IDEA) Amendments of 1997 in cases in which a child’s behavior has resulted in negative educational outcomes. Specifically, FBAs are mandated when the behavior has resulted in the child’s suspension or placement in an alternative setting either for 10 consecutive days or because a due process hearing officer has determined the behavior is dangerous to the student or others, or when a student is placed in an alternative setting for 45 days when he or she has been involved in a weapons or drug offense. Although children with autism may infrequently meet these extreme requirements, IDEA also stipulates that if an individual’s behavior interferes with his or her learning or the learning of others, or poses a danger to the individual or others, then the student’s individual educational plan (IEP) team should implement a behavior intervention plan informed by a functional behavior assessment to address the behavior. These stipulations apply to many children with autism. Unfortunately, IDEA does not specify what elements constitute either an FBA or an effective intervention. We summarize here the components of a functional behavioral assessment and also discuss the importance of using the results of an FBA to inform and develop a function-based intervention for challenging behavior. Functional Assessment Iovannone, Dunlap, Huber, and Kinkaid (2003) conducted a review of comprehensive treatments for children with autism and found that one of the TREATMENT OF AUTISM SPECTRUM DISORDERS 307 components common to all effective treatments was a functional approach to challenging behavior. Although a child’s behavior may often appear unpredictable and random, most professionals in the field agree that all adaptive and maladaptive behavior is functionally and lawfully related to events in the environment and serves a purpose for the individual (Northup et al., 1991). An FBA is used to identify this function of a behavior so that an appropriate, function-based treatment can be implemented. In the context of functional assessment, behavior is maintained by either positive reinforcement or negative reinforcement, that is, by environmental stimuli that are either added to (i.e., positive reinforcement) or removed from (i.e., negative reinforcement) the environment following the occurrence of a behavior that subsequently increases the likelihood of that behavior occurring again in the future. Examples of positive reinforcement may include the presentation of attention, desired items, or pleasurable sensory input, and examples of negative reinforcement include the removal of demands or other aversive environmental stimuli or physical sensations. A behavior may function to gain access to any of these forms of reinforcement and, additionally, the behavior may function to gain access to several forms of reinforcement simultaneously (Northup et al., 1991). The purpose of a functional assessment is to determine which of these myriad functions currently maintains a maladaptive behavior so that an effective intervention can be developed. Prior to either the functional assessment or development of a behavior intervention plan, one must develop an operational definition for the challenging behavior. An operational definition defines the behavior as a measurable observable event, thus reducing biased reporting of the behavior and increasing the reliability of measurement of the behavior (Cooper, Heron, & Heward, 2007). Accurate assessment and treatment of the behavior will rely heavily on accurate data collection and measurement of the behavior. Without data and measurement, one cannot determine conclusively that a behavior has been reduced.