Parent and Teacher Perceptions of Important Behaviors for Change

Background:

As the number of children diagnosed with ASDs increases, so too does the need for identifying effective treatments for the multiple concerns associated with these conditions. Due to the comorbidity of maladaptive behaviors including aggression and tantrums, the behaviors most important to target for change may or may not be part of the core symptoms of autism. Parents and teachers are in the best position to report outcome change over time, and information on the stability of behaviors across contexts is critical for effective program planning and monitoring  (Yoder, 2008), especially including home and school contexts.

Objectives:

The purpose of this study was to determine which behaviors are most important to target for change during treatment, according to parents and educators of preschoolers age 3-5 who are diagnosed with an ASD.

Methods:

We conducted 2 focus groups (n = 16) with educational and administrative staff of autism-specific preschools (one group for each school); and 3 focus groups with parents (n = 19) of children at those schools. Guiding questions addressed a) which behaviors are most important and relevant in parents’/teachers’ daily lives and b) ideas for specific questions to include in new measures. Participants were also given a copy of the Preschool Outcome Questionnaire (POQ; Wells and Plenk, 2002) and were asked to rate the relevancy of each question for evaluating the everyday behavior of the children. Data was analyzed by categorizing problematic behaviors discussed by participants from audio recordings as well as relevancy ratings from the POQ.

Results:

The five separate groups demonstrated remarkable consistency in their focus on several behavioral categories, including concerns about tantrums and aggression, and understanding instructions. Parents were much more likely to be concerned about communication skills while educational staff members were more concerned about attending behaviors. While many of the concerns participants mentioned were specific to autism (for example, communication and understanding social cues are closely aligned with the DSM-IV criteria of “impairments in social interaction and communication”), many of the participants’ concerns were more general. Concerns about potty training or tantrums, for example, are not specific to ASDs. The POQ shows potential to measure behaviors that this sample deemed to be important, but would need extensive revision to capture additional areas of concern and to remove items that are not deemed important to everyday life.

Conclusions:

Although many behaviors mentioned in these focus groups are non-specific to autism, they lead to significant everyday challenges for parents and professionals who are closest to the children. Analysis of existing survey measures reveals these measures often fail to adequately address several key behaviors highlighted in the focus groups.  Future treatment outcome measures should clearly address these and other topics important to parents and education staff.