Lagging Skills May be Behind Challenging Behaviors in Children with Autism
CAR research suggests a promising framework for helping children with ASD overcome challenging behaviors
In school-aged children with autism, oppositional or aggressive behaviors- called “challenging behaviors” in the clinical literature- are among the most common difficulties reported by parents and teachers. Challenging behaviors can include hitting, teasing and other types of physical and verbal aggression as well as oppositionality, such as defiance, stubbornness, or argumentativeness. These behaviors can result in mounting levels of frustration and stress for family members, teachers, and classmates-as well as for the child him or herself.
A study recently published in the journal Autism by researchers from the Center for AutismResearch (CAR) at the Children’s Hospital of Philadelphia (CHOP) suggests challenging behaviors may arise when children lack certain skills required to cope with a problem or situation in an adaptive manner.
“It is a common misconception that challenging behaviors are only seen in young children or children with cognitive impairments. In reality, many school-age children with autism, including children with average or higher cognitive abilities, struggle with challenging behaviors as well," said Brenna Maddox, PhD, the study’s lead author. “We wanted to understand if there were specific skills that were lagging in development, and contributing to challenging behaviors in children with autism.”
For their study, the research team looked at challenging behaviors using the Collaborative and Proactive Solutions (CPS) framework, developed by Dr. Ross Greene and formerly known as Collaborative Problem Solving. CPS is an evidence-based cognitive-behavioral treatment to reduce challenging behaviors in school-age children with oppositional defiant disorder and ADHD, but it has never been tested for effectiveness in children with autism. CPS is based on the premise that children display challenging behaviors when their skills do not match the demand of the situation or environment. In particular, children who react with challenging behaviors often have difficulty with situations requiring cognitive flexibility and adaptability, frustration tolerance, and problem solving. When these situations arise, a child quickly overwhelms their capacity to cope adaptively and therefore reacts with a challenging behavior.
Using the CPS framework, CHOP researchers examined data from 182 parents of children with autism without intellectual disability. Parents completed several questionnaires evaluating their child’s challenging behaviors, executive function (time management, focusing attention, multitasking and behavior control), emotion regulation, language, and social skills. The study results showed that children with autism who had more impaired executive function and emotion regulation skills displayed higher levels of challenging behaviors. Specifically, children who experienced the greatest difficulty with emotion regulation, impulse control, and cognitive inflexibility were the most likely to show challenging behaviors.
This study is the first to use the CPS framework with children with autism, and while more rigorous studies are needed, researchers are hopeful the findings will shift the way people view and interact with children with autism displaying challenging behaviors.
“Instead of viewing a child’s challenging behavior as willful, we can focus on the incompatibility between environmental demands and the child’s lagging skills,” says Dr. Maddox, a postdoctoral fellow at the University of Pennsylvania and CAR. “For example, consider a child with executive function impairments who lacks the skills to independently complete his homework in a brief time period. When this child’s parent insists that he complete his homework before dinnertime, a mismatch between the child’s skills and environmental demands occurs, and might cause a “melt down” in which he screams at his parent and refuses to join his family for dinner.”
If borne out by further testing, these findings could help us understand the skills that a child needs to manage real world demands effectively. However, research is needed to understand how other people may set the stage for challenging behaviors by creating a situation where expectations are outpacing the child’s skills. While this research on how challenging behaviors occur is important, it is also important to recognize that CPS treatment may provide a new option for supporting individuals with autism and their families.
“We plan to test an adaptation of the CPS treatment with children on the autism spectrum in a future study to learn whether it is clinically effective,” says Dr. Benjamin Yerys, the study’s co-author and CAR scientist. “In the meantime, we encourage family members and professionals who support individuals on the autism spectrum to consider potential mismatches between their skill set and what is being asked of them in a given situation and to engage children in coming up with a plan for how to adjust the demand and build skills in order to bridge that gap.”
The authors say that by viewing challenging behaviors through the lens of lagging skills, parents, teachers and caregivers can take steps to teach their child the necessary skills to cope with stressful situations in healthier ways. “An important component of this approach is that it gives agency to the person on the autism spectrum,” explains Dr. Maddox. “By helping them to communicate their needs and participate in the solution, they are gaining crucial skills for greater independence as they grow older.”
For more information and resources about autism, visit the CAR AutismRoadmap™, which includes several clinician-reviewed articles on challenging behaviors. For more information about the Collaborative and Proactive Solutions approach, visit www.livesinthebalance.org.