Challenges and Perceptions of Services Providers Working with Young Children with Autism Spectrum Disorder and Concurrent Problem Behaviors

Background: The presence of problem behaviors (PB) is a major challenge for intervention addressing needs of young children with a diagnosis of autism spectrum disorder (ASD) or intellectual disability (ID). A previous study has shown that PB interferes with the improvement of social behavior following a program of early intensive behavioral intervention (EIBI; Rivard & al., submitted).

Objectives: 1) describe training, assessment and intervention tools currently used by staff involved in a public program of EIBI offered to children with an ASD and PB; 2) assess the needs for training, assessment and intervention tools, as perceived by staff of public rehabilitation centers.

Methods: Semi-structured interviews were conducted with 75 persons (first line staff, professional clinicians and managers) involved in a EIBI program across 8 public rehabilitation centers in the province of Quebec, Canada. The interview includes 25 questions about training, assessment and intervention tools.

Results: 90% of respondents said that they had worked during the past year with children who have PB. To the same extent, respondents mentioned that they need training on PB as well as training on early childhood. To assess PB, respondents use tests suitable for typically developing children or for adults with ID or ASD. The need for assessment tools addressing the specificities of children with ID or ASD has been mentioned almost unanimously. Children with PB receive the same services as other children with ID or ASD. The majority of respondents (88%), however, indicate that they have to adapt the program. Respondents identified many of the challenges they face when working with children with PB, their families and day care settings. Among others, the growing problem of access to resources has been highlighted.

Conclusions: The recent implementation of EIBI in rehabilitation centers in Quebec has brought many benefits for children with ASD. However, the programs put in place so far tend to privilege the development of preschool skills. Based on recent research findings about the efficacy of EIBI for children with PB, it is now important to return to key components of EIBI programs. The present study shows that staff perceived significant needs for training, assessment and intervention tools for PB.Subsequent phases of the research program are therefore: 1) to validate a screening tool to detect and assess PB of children aged between 18 months and 6 years before their entrance in EIBI programs of our centers, 2) to conduct a study of prevalence and key factors associated with PB among children attending our rehabilitation centers, and 3) to provide a framework for intervention and supervision to improve services efficacy.