Problem behaviors in children often present challenges to parents and other caregivers. For parents of children with autism and other developmental disabilities, these behaviors can pose a unique and complex set of challenges.

Children with autism and other developmental disabilities often exhibit severe behavior problems including screaming, hitting, kicking, throwing tantrums, destroying things, rocking back and forth, flapping their hands, and bolting away from parents or teachers. These children may also engage in self-injurious behaviors such as punching, hitting, or biting themselves.

What can parents do about these baffling behaviors? The child can't help, because language problems typically prevent him or her from describing what is wrong. Consequently, parents are left to guess, and they may assume that something mysterious must be wrong inside their child's body. This often leads them to try experimental treatments (such as skin brushing or swinging activities) designed to "fix" the child's sensory system, or diets and pills to "modify" the child's vitamin and mineral status. There is, however, little research to support these treatments.

Rather than trying to treat internal systems we cannot see, my colleagues and I have found that we are most successful when we treat what we can see - observable behavior that we can clearly describe and quantify.

Let's consider what might cause and contribute to the continuation of a problem behavior. In general, a child behaves in a certain way to get something he or she wants or to avoid or escape something he or she doesn't want. For example, the child might rock back and forth because it feels good, or throw a tantrum because it results in extra attention or in escaping an unpleasant task. Some children engage in self-injurious behavior to receive a hug or a massage. For other children, hurting themselves might result in the removal of undesired items, such as food, toys, or people. Although these children may initially stop acting out, they are likely to repeat their problem behavior frequently because it gets them what they want.

In my opinion, the best way to determine the cause of problem behavior is with a functional assessment or functional analysis. We use these methods to determine what "function" the behavior serves for the child. In other words, what does the behavior help the child obtain or avoid?

Carrying out a functional assessment is very complicated and should be done by a trained and experienced professional. At May Institute schools for children with autism and other developmental disabilities, we begin by checking on medical conditions to rule out things like ear infections, bowel impactions, allergies, and so on. Next, we write a clear definition and description of the behavior. Then, there are three methods we use to try to determine the function of a problem behavior:

o Conduct interviews with the child's parents and teachers, using standardized information-gathering tools. While the resulting information may not be completely objective, it is important because it comes from the people who are most familiar with the child and the behaviors.

o Observe the child during regularly occurring activities at school and at home, and record what happens before and after the problem behavior occurs. Over time, direct observations can help to identify certain consistent adult responses to behavior problems.

o Put the child in situations where we can control the response to the problem behavior. If behavior worsens each time attention is given, for example, we might learn that the behavior is maintained by adult attention. Studying behaviors in these controlled situations can be extremely helpful in determining what causes them.

The third method requires further comment. By altering the way we respond to the behavior, we can get a good idea of what might be maintaining it. Setting up these situations, however, can be problematic because we are making it likely that the behavior problem will occur. Therefore, it is very important to obtain parental consent, have a plan to ensure safety, include multiple observers, and make certain that the entire process is supervised by an experienced professional.

The primary purpose of the assessment is to help us develop effective treatment based upon the findings. I will discuss this in a future column.

May Institute operates schools for children and adolescents with autism and other developmental disabilities in Chatham, Randolph, West Springfield, and Woburn, Mass., and in Freeport, Maine. The Institute also provides residential and day services for adults. For more information, call 800-778-7601, or visit www.mayinstitute.org.

Dr. Harchik can be contacted in West Springfield at 413-734-0300, or at aharchik@mayinstitute.org.

The information presented on this site is intended solely as a general educational aid, and is neither medical nor healthcare advice for any individual problem, nor a substitute for medical or other professional advice and services from a qualified healthcare provider familiar with your unique circumstances. Always seek the advice of your physician or other qualified healthcare professional regarding any medical condition and before starting any new treatment.