Challenging Behaviors In Children Research Articles

The Challenging Behavior of Children with Developmental Disorders

The Challenging Behavior of Children with Developmental Disorders

Feasibility of The Incredible Years Parent Program for Preschool Children on The Autism Spectrum in two U.S. sites

BackgroundParent strain and burden are high in families raising children with Autism Spectrum Disorder (ASD). Caregivers of young children with ASD are particularly vulnerable to stress. Yet, few interventions address the direct needs of this growing population of parents. This pilot trial describes the feasibility, acceptability, and short-term outcomes of The Incredible Years Parent Program for Preschool Children on the Autism Spectrum or with Language Delays (IY-ASD) in two U.S. locations. MethodWe recruited caregivers of children ages to 2–6 years old with ASD to participate in a non-randomized pilot trial of IY-ASD. We aimed to describe our program delivery process and assess 1) participant retention rates and reasons for program/research discontinuation; 2) caregiver acceptability of IY-ASD; and 3) pre- and post-intervention measures of parenting stress, caregiver coping, and child behavior. ResultsOf the 50 parents who enrolled, 42 completed IY-ASD (84%). We analyzed data for 36 participants after accounting for partners and a participant lost to follow-up. Program acceptability was high. Total and child-related parenting stress significantly decreased at posttest. We found no statistically significant changes in caregiver coping, parent-related stress, or challenging child behaviors. ConclusionsIY-ASD is a feasible and acceptable program for parents raising young children with ASD. A randomized controlled trial is needed to rigorously test the effectiveness of the intervention. Future research should consider a longer program period (i.e., 15–16 weeks); ASD-specific outcome measures; and, longer-term follow-up to examine program effects beyond post-intervention, as well as potential IY-ASD modifications to meet the diverse needs of participants.

Functional Communication Training: The Strength of Evidence Across Disabilities

Functional communication training (FCT) is a commonly used, often recommended intervention that involves teaching a functionally equivalent communicative response to replace challenging behavior. The purpose of this literature review was to evaluate the strength of the evidence for the use of FCT. A systematic review of the literature resulted in the identification of 215 single-case-design articles that evaluated the efficacy of FCT to reduce challenging behavior for individuals diagnosed with a disability. FCT resulted in a decrease in challenging behavior for 135 participants. The reviewers rated FCT as an evidence-based practice for individuals with autism, intellectual disability, other health impairments, and multiple disabilities based on What Works Clearinghouse standards. Overall, the extant literature indicates FCT consistently results in the reduction of challenging behavior in children with disabilities. Implications for practice and directions for future research are discussed.

Characteristics of Treatment Decisions to Address Challenging Behaviors in Children with Autism Spectrum Disorder.

To describe the characteristics of treatment decisions to address challenging behaviors in children with autism spectrum disorder (ASD). Parents of children aged 4 to 15 years with ASD seen in a developmental behavioral pediatric (DBP) clinic completed validated measures to characterize their child's behaviors and their own level of stress. Parents reported their treatment priority before the visit. During the visit, we assessed shared decision making (SDM) using the Observing Patient Involvement (OPTION) scale and alignment of the clinician's treatment plan with the parent's priority. Before and after the visit, parents rated their uncertainty about the treatment plan using the Decisional Conflict Scale (DCS). We calculated descriptive statistics for the measures. Fifty-four families participated. Children were a mean (SD) age of 8.8 (3.3) years, and 87% were male. Children had a variety of behavioral challenges, and parents reported high levels of stress. Commonly reported parent treatment priorities were hyperactivity, tantrums, anxiety, and poor social skills. Levels of SDM were low, with a mean (SD) OPTION score of 24.5 (9.7). Parent priorities were addressed in 65% of treatment plans. Approximately 69% of parents had elevated DCS scores before the visit. Although levels of decisional conflict were lower after the visit compared with before the visit (p < 0.03), 46% of parents continued to report high scores on the DCS. Parents leave DBP visits with feelings of uncertainty about treatment decisions and with treatment plans that do not always address their priorities. SDM interventions hold promise to improve the quality of ASD treatment decisions.

A Family-Centered Feeding Intervention to Promote Food Acceptance and Decrease Challenging Behaviors in Children With ASD: Report of Follow-Up Data on a Train-the-Trainer Model Using EAT-UP.

This research note outlines the usefulness of Easing Anxiety Together with Understanding and Perseverance (EAT-UP), a train-the-trainer, family-centered feeding intervention, for promoting food acceptance of children with autism spectrum disorder (ASD). This report is a follow-up on a pilot study (n = 4) of the EAT-UP intervention previously completed by the same authors. Participants were 3 families of children with ASD receiving services from an outpatient department of a larger rehabilitation hospital in the northeastern United States. Three professionals working with the families were also recruited and trained by the first author, a speech-language pathologist experienced with the EAT-UP method. Initial assessment was followed by a baseline period for each participant. An individual mealtime plan was drafted for each family. Data on acceptance of less preferred food and the presence of challenging mealtime behaviors were recorded using direct observation and pre-, mid-, and postintervention measures and questionnaires. All children demonstrated increased food acceptance and dietary diversity and decreased challenging behaviors. Caregivers reported decreases in the frequency of problem behaviors and in the number of problem mealtime behaviors. Measures of procedural fidelity increased from 50% to 100% for registered behavior technicians and parents over the course of the EAT-UP intervention period. EAT-UP is an effective model for training professionals who work with families of children with ASD and challenging mealtime behavior. Implications for interprofessional practice and research are discussed.

A Systematic Review of Parent-Implemented Functional Communication Training for Children With ASD.

Supporting parents in reducing challenging behavior of children with autism spectrum disorder (ASD) requires the identification of effective, feasible, and sustainable interventions. Functional communication training (FCT) is one of the most well-established interventions in the behavioral literature and is used increasingly by parents. However, there is a need for additional evaluation of the literature related to parent-implemented FCT. In the present review, we identified 26 peer-reviewed studies on parent-implemented FCT. We conducted systematic descriptive and social validity analyses to summarize the extant literature. Across studies, parent-implemented FCT was effective in reducing child challenging behavior, and in some cases, intervention outcomes maintained and generalized to novel settings and implementers. However, few studies reported fidelity data on parent implementation of FCT, and data regarding sustained use of FCT by parents were limited. Results of the social validity analysis indicate that while FCT is often implemented by natural change agents in typical settings, parent training is often provided by professionals not typically accessible to parents. These findings suggest that future research is warranted in the areas of parent training and long-term sustainability of parent-implemented FCT.

Effect of Preservice Classroom Management Training on Attitudes and Skills for Teaching Children With Emotional and Behavioral Problems: A Randomized Control Trial

Childhood emotional and behavioral problems are prevalent in elementary classroom settings, making it imperative that high-quality, efficacious training be available to support teachers in managing disruptive and distressed child behaviors. Our study used a randomized control design to examine the impact of 36 hours of preservice education targeted at improving the attitudes of teachers toward children with emotional and behavioral difficulties, and developing their skills in using proactive and preventative strategies to address anticipated behavioral challenges. Eighty-two preservice teachers were randomly assigned to an elective course on management of emotional and behavioral problems (50 teachers) or to an alternate elective of their choice (32 teachers). Results highlight the positive influence of targeted preservice instruction; specifically, there were medium to large posttest effect size differences between preservice teachers who received this elective as compared with those who did not on measures of teachers’ use of psychological pressure (e.g., teacher disappointment and shaming; d = 0.76), their positive emotions ( d = 0.69), negative reactions ( d = 1.05), and their use of proactive strategies ( d = 1.43 and 1.59), inadequate strategies ( d = 0.73), and reactive strategies ( d = 1.01) in response to challenging child behaviors in simulated classrooms. No significant intervention-related differences were noted in preservice teacher self-efficacy, endorsement of rules and control, warmth and support, or negative beliefs. Overall, results provide promising evidence that preservice training can effectively affect the immediate attitudes and skills of teachers for supporting children with emotional and behavioral problems in a regular classroom context.

How Do Certified and Uncertified Therapists Differ in Their Perceptions of a Mental Health Intervention for ASD?

ABSTRACTGiven the increasing efforts to implement evidence-based practices (EBPs) in routine mental health (MH) services, it is necessary to examine MH therapists’ perspectives of the training and delivery process to better understand the outcomes of EBP implementation efforts and influences on these outcomes. However, there is limited research examining how therapists who successfully completed training and receive certification in an EBP intervention differ in their perceptions of these implementation outcomes and influences from those therapists who do not successfully complete training and receive certification in an intervention. As such, the present study examined variability in therapists’ perspectives in the training and implementation of the An Individualized Mental Health Intervention for ASD (AIM HI) intervention, a package of well-established, evidence-based strategies developed to address challenging behaviors in children with autism spectrum disorder within community MH clinics, based on training certification status (i.e. certified vs. noncertified). Overall, both certified and noncertified therapists perceived the AIM HI intervention as useful and effective with their clients, described the increased use of structure and improved clinical skills, and reported intended sustained use of parts of the AIM HI protocol. Conversely, certified and noncertified therapists differed in their approaches to addressing the perceived challenges of EBP training and implementation, specifically time commitment and program structure, providing valuable insight into why some therapists did not achieve certification status. These data support the development of organizational leadership and provider engagement interventions designed to address attitudinal and organizational barriers to facilitate the successful training and implementation of evidence-based interventions.

Challenging behaviour clinical trial

University College London and Contact a Family launch the first UK trial investigating ways to reduce challenging behaviour in young children with moderate to severe learning disabilities and complex needs.

Comparison of behavioral intervention and sensory integration therapy on challenging behavior of children with autism

The current study used an AB crossover design to directly compare the effects of sensory integration therapy (SIT) and behavioral intervention (BI) on the challenging behavior of 10 participants with autism spectrum disorder. During the intervention phase, all participants received both treatments. Follow‐up probes were conducted 1 month following intervention for 4 participants implementing the more effective intervention. The results showed that BI successfully reduced challenging behavior to low‐ or near‐zero levels. In contrast, SIT resulted in higher and more variable rates of challenging behavior. One exception was noted for Participant 4 who engaged in a decreased level of challenging behavior during SIT. The findings are discussed in relation to implication for practice and future research.

The relationship between derived mutually entailed relations and the function of challenging behavior in children with autism: Comparing the PEAK-E-PA and the QABF

The study evaluated the relationship between participants’ abilities to derive mutually entailed relations across arbitrary stimuli and the function of their challenging behavior as indicated in the Questions About Behavior Function (QABF) indirect assessment. Entailed relational abilities were assessed using the Promoting the Emergence of Advanced Knowledge Equivalence Pre-Assessment (Dixon, 2015), and assessments were conducted across 47 individuals with autism or a related developmental disability. The results indicated that overall scores generated by the QABF were significantly lower for participants who could derive mutually entailed and/or combinatorially entailed relations (t (44) = 2.468, p < .05), and that in a greater proportion of cases, the QABF failed to isolate a single behavior function for individuals who could derive either mutually entailed or combinatorially entailed relations (χ 2 (1, N = 47) = 3.166, p < .05). The ability to derive entailed relations was not predictive of any specific challenging behavior topography (χ 2 (3, N = 47) = 6.251, p > .05) and was only related to scores on the Physical subscale of the QABF (t (24) = 3.37, p < .05). The results have implications for the assessment and treatment of individuals with autism, as well add to the development of a conceptual understanding of relational abilities and challenging behavior in this population.

Beyond ASD: Evidence for the Effectiveness of Social Narratives

Social narratives (e.g., Social Stories™) are common antecedent-based interventions promoted for the purposes of improving prosocial behaviors and reducing challenging behavior for children with and without disabilities. Although they are commonly prescribed and used, their effectiveness has almost exclusively been assessed for children with autism spectrum disorder (ASD). The purpose of this review was to synthesize the literature on social narrative interventions for children without ASD using a new synthesis framework: the Single Case Analysis and Review Framework (SCARF). Specifically, the review assessed the quality, rigor, and outcomes of single case design studies measuring the effectiveness of social narratives for decreasing challenging behavior or increasing prosocial behavior in children without ASD. Conclusions suggest cautious use of social narratives in isolation for children without ASD due to variable outcomes and absence of a sufficient number of rigorous studies. Future high-quality research is needed to address questions surrounding effective instructional components, participant characteristics, and implementation fidelity.

Should we change targets and methods of early intervention in autism, in favor of a strengths-based education?

Early intensive behavioral intervention (EIBI) and its recent variant, naturalist developmental behavioral intervention (NDBI) aim to increase socialization and communication, and to decrease repetitive and challenging behaviors in preschool age autistic children. These behaviorist techniques are based on the precocity and intensity of the intervention, face-to-face interaction, errorless learning, and information fragmentation. Once considered to be “scientifically proven”, the efficacy of these approaches has been called into question in the last decade due to poor-quality data, small effects, low cost-efficiency, and the evolution of ethical and societal standards. Grounded on a reappraisal of the genetic and cognitive neuroscience of autism, we question three aspects of EIBI/NDBI: their focus on prerequisites for typical socio-communicative behaviors, their lack of consideration of autistic language development and learning modes, and their negative view of repetitive behaviors and restricted interests. We propose alternative predictions for empirical validation, based on the strengths of prototypical autistic children: (a) their non-verbal intelligence should be normally distributed and within the normal range; (b) improving access to non-communicative verbal and written auditory language material should favor their subsequent speech development and (c) decrease their problematic behavior; (d) lateral tutorship should increase the well-being of children and parents to a greater extent than personalized, face-to-face interventions by professionals; (e) admission to regular, but supervised daycare centers, combined with parental support and on-site crisis solving, represents a more cost-effective educational intervention than EIBI/NDBI.

Preservice early childhood teachers’ perceived effects on competence of dealing with social emotional challenging behavior of young children by taking early childhood social education class with multi-tiered approach

Preservice early childhood teachers’ perceived effects on competence of dealing with social emotional challenging behavior of young children by taking early childhood social education class with multi-tiered approach

Supporting professional development needs for early childhood teachers: an exploratory analysis of teacher perceptions of stress and challenging behavior

Abstract Early childhood teachers are a unique population of teachers and it is important to determine amendable factors that contribute to their stress. According to available research, challenging child behavior is associated with teacher stress and burnout in school-aged teachers. Given the lack of formal and coordinated in-service education and varied qualifications, early childhood teachers are particularly vulnerable to stress. Further, young children are more likely to have challenging behavior given their social-emotional developmental levels. The purpose of this study was to explore teacher characteristics and perceptions related to their stress, commitment, support, and challenging child behavior in their classrooms. Participants included 100 early childhood professionals. A teacher survey was utilized to determine their perceptions related to key variables. Regression analyses documented teacher commitment and challenging behavior in the classroom uniquely predicted variance in teacher ratings of stress and burnout. Commitment to their job was also a significant predictor to their perceptions of challenging behavior. However, only teacher stress/burnout predicted ratings of challenging behavior; thus, relationships among variables may be more complex. Teachers’ years of experience and education level were not related to other variables. For exploratory purposes, teacher professional development perceptions were also surveyed and results indicated that the vast majority of early childhood educators felt professional development was a good use of their time and that they wished more opportunities were available; however, most also indicated they felt training covered information they already knew.

Parents with Intellectual Disabilities Experiencing Challenging Child Routines: A Pilot Study Using Embedded Self-Determination Practices.

Practices to facilitate self-determination have not received appropriate attention in research concerning parents with intellectual disabilities (ID). Likewise, parenting interventions for adults with intellectual disabilities have seldom observed both parent and child behavioural outcomes. This study evaluated the effectiveness of a parenting intervention embedded with self-determination facilitation practices for two dyads of a parent with intellectual disabilities and their young child. The interventions focused on increasing parents' ability to correctly implement steps of a parenting routine while reducing occurrence of challenging child behaviour. The results of the study demonstrated two basic effects of correctly completed steps of the parenting routine and a reduction of challenging child behaviour. Parents also reported decreased feelings of stress during the routine following completion of the intervention. Implications for future research and replication of this pilot study are discussed.

Adolescents\u2019 Behaviors as Moderators for the Link between Parental Self-Efficacy and Parenting Practices

Based on theory that parents with higher levels of self-efficacy (PSE) should find it easier to parent effectively in the face of challenging child behaviors than should parents with lower levels of PSE, this study examines the link between PSE and parenting using children’s behaviors as potential moderators. Participants were 130 parents who had an older adolescent (Mage = 17.58) in addition to the target adolescent (Mage = 11.79), and both adolescents’ externalizing behaviors were used as moderators for the link between PSE and parenting of the target adolescent. Path analysis in Mplus showed that higher PSE was linked to more promotive parenting but only among parents who had an older adolescent with lower levels of externalizing behaviors. Among parents of adolescents with higher levels of externalizing behaviors, whose promotive parenting was significantly lower than other parents overall, PSE did not predict promotive parenting. The link between PSE and parenting did not differ depending on the target adolescents’ behavior. Findings suggest that the link between parents’ beliefs and parenting depends on the broader family context. More specifically, how PSE is linked to parenting practices depends at least partly on the experiences that parents bring from parenting an older adolescent to their interactions with a later-born adolescent. From a clinical perspective, parents might need guidance in how to think about their earlier parenting experiences when parenting a younger adolescent.

A Survey of Parents' Perceptions and Use of Time-out Compared to Empirical Evidence

ObjectiveTo assess parents' perceptions and use of time-out (TO) in contrast to empirical indications and examine the relationship between reported implementation procedures and perceived effectiveness. MethodsWe surveyed parents of preschool and school-age children (n = 401, aged 15 months to 10 years) at well-child visits with regard to their awareness, perception, and usage of TO. Parents were specifically surveyed regarding TO components that have been empirically evaluated or pertain directly to its underlying behavioral principles. Descriptive analyses, group comparisons, and correlational analyses were used to characterize responses and evaluate the relationship between TO administration variation and perceived effectiveness. ResultsMost parents (76.8%) reported using TO in response to misbehavior, but a large majority of these parents (84.9%) reported implementing TO in a manner counter to empirical evidence. Parents who endorsed TO as effective varied significantly from those who did not on key implementation components (eg, use of a single warning). Further, several reported implementation practices were correlated with perceived effectiveness and challenging child behavior. For example, requiring a child to be calm before ending TO was positively correlated with perceived effectiveness. ConclusionsThese results cement TO as a widely disseminated practice but cast doubt on the fidelity with which it is typically implemented. Better methods of educating parents on evidence-based discipline are needed.

Sensory Processing and Challenging Behavior in the General Population

Abstract Date Presented 4/8/2016 The literature emphasizes sensory processing contributions to challenging behavior in children with conditions. Our findings illustrate that children in the general population show similar relationships. By recognizing these relationships, we can better support all children’s participation. Primary Author and Speaker: Evan Dean Additional Authors and Speakers: Scott Tomchek, Winnie Dunn, Lauren Little

The Relationship Between Challenging Behaviour, Cognitions and Stress in Mothers of Individuals with Intellectual Disabilities.

Cognitions are starting to receive more prominence as important when examining a number of factors including the topography of challenging behaviour. This study examined the relationships between maternal stress, challenging behaviour (aggressive and self-injurious behaviours) and parental cognitions and specifically whether maternal cognitions mediated the effect of challenging behaviour on parenting stress. 46 mothers of children and young adults with ID completed questionnaires regarding their child's challenging behaviour, maternal cognitions and stress. Significant correlations were found between challenging behaviour and maternal stress. The overall mediation models for aggression and self-injurious behaviour were significant. The Challenging Behaviour Perception Questionnaire: Consequences client subscale was the only independent significant mediator for both behaviours. Cognitions do play an important part in mediating the relationship between challenging behaviour and stress. Further research is needed to examine the similarities and differences between the mediation models for aggression and self-injurious behaviour.