Behavior Reduction

A. Adult Population

“Although early ASD research focused primarily on children, there is increasing recognition that ASD is a lifelong neurodevelopmental disorder. However, although health and education services for children with ASD are relatively well established, service provision for adults with ASD is in its infancy. There is a lack of health services research for adults with ASD, including identification of comorbid health difficulties, rigorous treatment trials (pharmacological and psychological), development of new pharmacotherapies, investigation of transition and aging across the lifespan, and consideration of sex differences and the views of people with ASD” (Murphy et al., 2016).

B. ASD Population

“Autism spectrum disorder (ASD) is a developmental disorder that affects communication and behavior. Although autism can be diagnosed at any age, it is said to be a “developmental disorder” because symptoms generally appear in the first two years of life. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), a guide created by the American Psychiatric Association used to diagnose mental disorders, people with ASD have: Difficulty with communication and interaction with other people, restricted interests and repetitive behaviors, symptoms that impact  the person’s ability to function properly in school, work, and other areas of life. Autism is known as a “spectrum” disorder because there is wide variation in the type and severity of symptoms people experience. ASD occurs in all ethnic, racial, and economic groups. Although ASD can be a lifelong disorder, treatments and services can improve a person’s symptoms and ability to function” (National Institute of Mental Health, 2018).

C. BD/ED Population

“The term emotional or behavioral disorder means a disability characterized by behavioral or emotional responses in school programs so different from appropriate age, cultural, or ethnic norm that the responses adversely affect educational performance, including academic, social, vocational, and personal skills” (Kavale, Forness, & Mostert, 2005).  “For ED, definitional problems are compounded by the different social contexts where they are used. An ED label is assigned through cultural rules that demonstrate considerable variability across contexts and make the process inherently subjective (Forness, 1996). The result is a high degree of ‘clinical judgment’ in ED designation (Smith et al., 1988). At best, ED definitions describe a general population, but encounter difficulty when applied to individual cases because a uniform interpretation is lacking” (Kavale, Forness, & Mostert, 2005).

D. Crisis Management

“Most clinical specialists agree that preventing a behavioral crisis instead of reacting to it is the recommended choice for intervention. Although prevention is not always easy, the area of antecedent assessment and intervention is a rich source of strategies and procedures (Luiselli, 2006, 2008a, 2008b ; McGill, 1999 ; Smith & Iwata, 1997). An antecedent perspective first identifies interpersonal and environmental conditions that reliably precede challenging behaviors and then, manipulates those conditions so that they no longer have a provoking effect. Clinically, these behavior-altering procedures focus primarily on changing features of discriminative stimuli and motivating operations (Friman & Hawkins, 2006)” (Reed, Reed, & Luiselli, 2013).  

E. Developing Behavior Intervention Plans

According to Killu (2008), the components of any good behavior intervention plan include conducting a functional behavior assessment, identifying antecedents and reinforcers, defining target behaviors and intervention strategies, and planning for generalization and maintenance of skills, which are a few aspects among many others of a good BIP. “Although this discussion has focused on the development of individual plans, practitioners should be aware that to provide effective interventions, not only must BIPs address issues specific to an individual student, but specific systems inherent to the school that also serve as contextual factors and that may contribute to the occurrence of undesirable behaviors (Todd, Horner, Sugai, & Sprague, 1999). Effective interventions are not developed in isolation, but rather are the product of individual and cumulative efforts and global and specific assessment strategies” (Killu, 2008).

F. Extinction

Extinction is the discontinuation of reinforcement for behaviors which had previously been reinforced. The goal of extinction procedures is to decrease the target behavior. Effects of extinction which must be programmed for include the occurrence of extinction bursts, as well as spontaneous recovery (Cooper, Heron, & Heward, 2007).

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G. Identification and Teaching of Replacement Behaviors

“A practitioner should never plan to reduce or eliminate a behavior from a person’s repertoire without first (a) determining an adaptive behavior that will take its place (also known as the fair pair rule) and (b) designing the intervention plan to ensure that the replacement behavior is learned” (Cooper, Heron, & Heward, 2019).

H. Punishment Procedures

Punishment procedures are stimulus changes that follow a response and decrease the likelihood that the targeted behavior will occur again in the future. Punishment can be positive (i.e., adding an aversive stimulus) or negative (i.e., removing a preferred stimulus). There are many considerations to be made both ethically and in terms of implementation which must be considered prior to being programmed (Cooper, Heron, & Heward, 2007).

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I. Treatment of Severe Problem Behavior

“A great deal of controversy has existed regarding the appropriate and effective treatment of severe behaviors such as self-injury and aggression exhibited by individuals with autism and developmental disabilities… the more severe forms of behavior have remained untreated in part because they typically do not respond to protocols that do not contain negative consequences (Foxx, 2003). This is especially true when the individual’s severe behavior is motivated by escape/avoidance. For these individuals, research has repeatedly shown that effective comprehensive treatment programs feature functional analysis, antecedent changes, reinforcement, and negative consequences or inhibitory techniques” (Foxx & Garito, 2007).

J. Treatment of Stereotypical Behaviors

“Contemporary discussions of the causes of stereotypy have focused on the etiology of these behaviors in terms of behavior–environment relations (Guess & Carr, 1991; Kennedy, in press). This perspective predicts that stereotypical responding may be maintained by a number of specific reinforcement processes. These findings suggest that a functional account of stereotypy needs to incorporate a greater array of events that may serve as positive or negative reinforcers for stereotypy” (Kennedy, Meyer, Knowles, & Shukla, 2000).

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K. Treatment with Comorbid Diagnosis (e.g., OCD, phobias, depression, etc.)

“It is becoming increasingly evident that many ASD children, adolescents, and adults can and often experience a number of comorbid medical conditions, the nature and prevalence of which remain as yet to be poorly defined. Many of these disorders have been largely ignored, at least in part, due to the challenges involved in conducting a meaningful medical history and physical examination in a frequently nonverbal patient whose behavior may interfere with a detailed assessment. However, there is a growing importance in identifying these disorders. First, ASD individuals deserve the same high-quality healthcare available to their neurotypical peers. They deserve to have treatable medical conditions identified and appropriately treated, resulting in decreased discomfort and improved overall health, thus allowing them to better participate in their therapeutic, educational, and vocational programs, and to achieve their best potential” (Bauman, 2010). “Accurate, reliable diagnosis of comorbid psychiatric disorders in children with autism is of major importance. Comorbid disorders may cause significant clinical impairment and additional burden of illness on children with autism and their families. When problematic behaviors are recognized as manifestations of a comorbid psychiatric disorder, rather than just isolated behaviors, more specific treatment is possible. Clinical experience suggests that specific treatment is more effective, i.e., associated with greater improvement in functioning, than nonspecific treatment” (Leyfer et al., 2006).

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For those of you interested in Behavior Reduction we encourage you to connect with other BDA employees to share with and learn from each other on how to apply the principles of Behavior Reduction in your current role or for special BDA related projects. 

If you have questions that your peers are unable to answer, please feel free to reach out to one of our in house experts for a quick tip!

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Brett DiNovi & Associates, LLC

**Some of the material on this site is copyrighted. Please request to use any of the material prior to usage.**

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