Understanding Problem behavior in children with Autism

By: Dr. Rupali Joshi

Autism is characterized by severe and pervasive impairment in several important areas of development: reciprocal, social interaction and communication as well as behavior and imagination. In order to be diagnosed with autism, the behavioral symptom in all of the abovementioned areas must be present by age of 3 years. The majority of children also have learning disability although few have epilepsy and visual hearing impairment problems.

According to D.S.M-5 the autism diagnostic criteria are –

1. Deficits in social emotional reciprocity, ranging, reduced sharing of interests, failure to respond to social interaction.
2. Deficits in nonverbal communicative behaviors used for social interaction, for example ranging from poorly integrated verbal and nonverbal communications to abnormalities in eye contact and body language and lack of facial expressions.
3. Deficits in developing, maintaining and understanding relationships. Difficulties in adjusting behavior to suit various social contexts, difficulties in sharing, imaginative play or in making friends, amounting to absence of interest in peers.
4. Stereotyped or repetitive motor movements, use of objects or speech (Lining up toys etc.)
5. Inflexible adherence to routines or ritualized patterns in verbal and nonverbal behavior (Extreme distress at small changes, rigid thinking pattern, greeting rituals etc.)
6. Highly restricted and fixated interests that are abnormal in intensity or focus (Strong attachment to or preoccupation with unusual objects)
7. Hyperactivity to and/or unusual interest in sensory inputs of the environment (adverse response to specific sounds or textures, excessive smelling or touching of objects, visual fascination with lights or movement.)
8. Symptoms must be present in the early developmental period.
9. Symptoms cause clinically significant impairment in social, occupational or other important areas of current functioning.
10. These disturbances are not better explained by intellectual disability or global developmental delay.

Autism is associated with a combination of genetic and environmental factors. Risk factors during pregnancy include certain infections, such as rubella, toxins including valproic acid, alcohol, cocaine, pesticides, lead, and air pollution, fetal growth restriction, and autoimmune diseases. Controversies surround other proposed environmental causes; for example, the vaccine hypothesis, which has been disproven. Autism affects information processing in the brain and how nerve cells and their synapses connect and organize; how this occurs is not well understood. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5), combines autism and less severe forms of the condition, including Asperger syndrome and pervasive developmental disorder not otherwise specified (PDD-NOS) into the diagnosis of autism spectrum disorder (ASD).

Problem behaviors of children with autism are among the most challenging and stressful issues      faced by schools and parents in their efforts to provide appropriate educational programs and parenting.  Problem behaviors such as property destruction, physical aggression, self-injury and tantrums are major barriers to effective social and educational development. Such behaviors put young children at risk for exclusion and isolation from social, educational, family and community activities. In addition, Problem behaviors also place enormous burden on families, particularly as children grow from preschool to school age. Concerns about social behavior problems has led to new standards and procedures for discipline, student suspension etc.

The definition of problem behaviors depends on whether the behaviors are considered from the perspective of a child with an autistic spectrum disorder or from the perspective of a parent or teacher. From a child’s perspective, problem behaviors includes the difficulty to understand demands of a classroom or a parent and to communicate his or her needs and wants, several difficulties in initiating and maintaining social interactions and relationships, confusion about the effects and consequences of many of his or her behaviors and engagement in restrictive and repetitive behaviors and interests that may limit the child’s ability to learn and to fit it with peers. From the teacher’s or parent’s point of view, problem behaviors include lack of compliance with or disruption of classroom routines, tantrums, destruction of properties and aggression against self or others. There are accumulating research works suggesting a strong positive correlation between autism and problem behaviors.

Researcher have indicated that those with more severe autism symptoms are likely to experience significantly more problem behavior that are also of greater severity than those with moderate and mild autism symptoms. Some research findings suggest that autism symptoms severity is a key predictor of later emotional and behavior problems in children and adolescents with high functioning autism.

Problem behaviors may result from deficits in children’s ability to express their needs, desires and problems or to understand and to respond to naturally occurring social cues and norms.  In addition to biological factors that increase the risk of problem behaviors, environmental factors can also lead to the emergence and sustenance of problem behavior. Children with autism generally behave in a way that is considered not normal due to a reason. For instance, they may have destructive behavior like throwing objects across the room or make loud noise to get their parents’ attention. This purely results from wanting to draw attention. Just like every other child, children with autism may also cry when they want to avoid or quit a task they do not want. There may be hundred of situations and behaviors that child does not like at school or home. Parents should determine and enlist these situations and behaviors that cause the children to yell and unease in order to avoid them. More than half of young adults with autism remain unemployed and unenrolled in higher education in the two years after high school. This is a lower rate than that of young adults in other disability categories, including learning disabilities, intellectual disability or speech-language impairment.

After listing behaviors that trouble the child, parents and expert should determine the most important elements and action accordingly. Many children do not display problem behaviors that warrant treatment by a professional. However, given the increased risk of the problem behaviors in autism. it is important to be proactive. The responsibility on parents and teachers is even greater because they must take on a more active role in engineering the optimal environment and in teaching adaptive skills that seem to develop naturally in children without disability.

Many proactive methods can be utilized, like creating an environment that is highly enriched with preferred toys and activities, sticking with a structural routine and presenting clear cues to make transitions more predictable. Activity books, photographs are particularly helpful. Many early intervention programs teach these skills for educational readiness but these efforts can also have significance for decreasing the risk of problem behavior. Other appropriate behaviors such as compliance, cooperation and coping should be referred to as much as possible. Parents should watch for any signals that indicate increased levels of stress and provide frequent breaks from work frustration or fatigues sets in.

No cure exists for autism spectrum disorder and there is no one-size-fits-all treatment. The goal of treatment should be to support development and learning. Research demonstrates that job activities that encourage independence reduce autism symptoms and increase daily living skills Early intervention during the preschool years can help child learn social communication, functional and behavioral skills. The current treatment options for the core symptoms of autism are limited to psychosocial therapies, such as applied behavior analysis. Educational interventions often used include applied behavior analysis (ABA), developmental models, structured teaching, speech and language therapy, social skills therapy, and occupational therapy. Among these approaches, interventions either treat autistic features comprehensively, or focalize treatment on a specific area of deficit] The quality of research for early intensive behavioral intervention (EIBI)—a treatment procedure incorporating over thirty hours per week of the structured type of ABA that is carried out with very young children—is currently low, and more vigorous research designs with larger sample sizes are needed. Two theoretical frameworks outlined for early childhood intervention include structured and naturalistic ABA interventions, and developmental social pragmatic models (DSP). One interventional strategy utilizes a parent training model, which teaches parents how to implement various ABA and DSP techniques, allowing for parents to disseminate interventions themselves. Various DSP programs have been developed to explicitly deliver intervention systems through at-home parent implementation. Despite the recent development of parent training models, these interventions have demonstrated effectiveness in numerous studies, being evaluated as a probable efficacious mode of treatmenIt is important that the treatments focus on a person’s specific needs, rather than the diagnostic label. If behavioral and educational interventions aren’t sufficient, medication may help an individual with autism to better manage his symptoms. Three main classes of medication are used with autism patients: stimulants, antidepressant and anxiety medications, and atypical antipsychotics. There is tentative evidence that music therapy may improve social interactions, verbal communication, and non-verbal communication skills. There has been early research looking at hyperbaric treatments in children with autism.Studies on pet therapy have shown positive effects.

Dr. Rupali Joshi

Department of Psychology, P.N.G.P.G. College,
Ramnagar, Nainital Uttrakhand