Autism Symptoms and the Functions of Problem Behavior

Background: Problem behavior (e.g., aggression toward others, self-injurious behavior) is a significant stressor for caregivers of children with autism (Estes et al., 2009).  Identifying the function of problem behavior using functional analysis (FA) frequently leads to effective treatments (Pelios et al., 1999).  Previous investigations of FA results for individuals with ASDs who engage in problem behaviors suggest tangible and escape functions are common (e.g., Love et al., 2009). To date, the symptom profile of children whose problem behavior is maintained by access to a tangible item versus the symptom profile of children whose problem behavior is maintained by escape from task demands has not been examined.

Objectives: We aim to better understand the relations between the symptoms of autism and the functions of problem behavior displayed by young children with ASDs. Ultimately, our objective is to develop symptom profiles that clinicians completing FAs with this population could employ to prioritize the order of their FA sessions and to more efficiently develop treatment plans. 

Methods: Twenty-six children (ages 2-6) diagnosed with ASD are participating in this study.  Autism symptoms were assessed with the ADOS and the ADI-R. Each child will complete extended FAs (Iwata et al., 1982/1994) of parent-identified problem behavior as part of a larger study of behavioral treatment via telehealth.  The FA is conducted over 2-way teleconferencing connections linking behavioral specialists from a university with an outpatient clinic within 50 miles of the child’s home.  Five minute sessions are conducted within individual single case multi-element designs during one hour periods, once a week, until at least 3 stable sessions are completed for each condition (free play, attention, tangible, and escape).  Behavioral functions are coded as: attention (behavior maintained by verbal or physical attention), tangible (behavior maintained by access to a tangible item), escape (behavior maintained by escape from task demand), and/or automatic (behavior maintained independent of social reinforcement).  Multiple functions can be coded for the identified problem behavior.

Results: To date, 26 participants have completed the ADOS and ADI-R.  Twenty-two have completed the FA.  Four are currently completing the FA or are scheduled to complete it.  The present investigation will focus on participants who display problem behaviors with tangible and/or escape functions (n = 21 at present).  Earliest findings suggest that children whose behavior serves a tangible function (n=5) or a combination of tangible and escape functions (n=13) tend to manifest more severe social deficits during the ADOS than children whose problem behavior serves an escape function (n=3).  ADI-R and ADOS scores will be further compared between these groups after all FAs are completed and diagnostic scores are standardized.      

Conclusions: Knowing the symptom profile of children whose problem behavior is maintained by different functions has clinical utility.  Earliest findings suggest children with more severe social deficits may be more likely to have problem behavior serving a tangible function or a combination of functions than problem behavior serving an escape function.