Problem Behaviours

Children with autism spectrum disorders display a variety of difficult behaviours that make their integration into school and the wider community a problem for them and their families. Many of these behaviours are related to an inability to communicate needs, or to sensory hypersensitivities. Many children have strong food preferences and aversions that make social occasions stressful for their families. Some children engage in self-harm when frustrated, for example striking their heads with their closed fists. Other children tantrum when faced with changes in their environment. Unfortunately, there are children who may strike out in situations that make the response seem unprovoked.

Conclusions:

• Prevention of problem behaviours should be a priority of any program.
• None of the individual interventions studied has been shown to be effective with all children.
• Comprehensive programs that address problem behaviours have several features in common and rightly emphasize:
• basic instruction, especially functional language and social interaction skills;
• school/instructional environments with teachers who are knowledgeable about children with autism and who have the skills to deal with their special needs
• classroom environments which emphasize routine
• family involvement in the teaching

• Interventions that manage the environment to reduce triggers for problem behaviour work well.
• Punishment works in the short-term, but produces unwanted effects, such as the child thereafter avoiding the punisher.
• In some drug studies:

• Haloperiodol was shown to be effective in reducing aggression, but there was a risk of significant side effects
• Clonidine treatment produced improvements in overaroused individuals, but there were side effects of drowsiness and reduced activity.
• Naltrexone produced mixed results, improving some domains, but worsening others.
• Risperidone looks promising for the treatment of aggression, and had fewer side effects compared to other neuroleptics
• Serotonin selective uptake inhibitors (SSRIs) reduced stereotypic behaviours, probably because of their effect on anxiety.
• Secretin had no effect on behaviour.
• Stimulants have significant side effects and may worsen autistic symptoms.

• Studies have shown that intensive exercise programs and relaxation training have benefits for reducing anxiety and stress, and thus problem behaviours.

Recommendations:

• There is a need for early identification and intervention with young children, in a program which supplies 20 to 40 hours of direct instruction per week, in situations with low teacher/child ratios.
• There is a need for research into ways of predicting which children will respond to which medication.
• With exception of children whose behaviour is precipitated by a seizure disorder, preventative behavioural interventions should be considered first before medication is used to control problem behaviours.
• Functional behavioural analysis should be used to discover what precedes and initiates aggression.
• Any decision to use medication should be made after considering all aspects of the child’s environment and personal history.