Addressing the Challenging Behaviors Associated with Autism
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UTISM PECTRUM EWS TM A YOUR TRUSTEDS SOURCE OF SCIENCE-BASED AUTISM EDUCATION,N SPRING 2015 INFORMATION, ADVOCACY, AND COMMUNITY RESOURCES VOL. 7 NO. 4 Addressing the Challenging Behaviors Associated with Autism A Proven Method to Reduce Challenging Behaviors in Any Environment By George Suess has created a positive, restraints-free envi- Chief Executive Officer ronment for people with autism and many The Arc of Delaware County, NY other developmental disabilities—and helped other organizations reduce their use of restraints too, with the same step- he behavior challenges related by-step approach used internally. to autism can feel daunting for This approach is based on a series of family, caregivers, and commu- proven steps that move toward a culturally nity service organization profes- reinforced positive approach to reduce and Tsionals alike. But dwelling on challenging even eliminate challenging behaviors in a behaviors leads to a focus on questions way that is actionable for organizations, such as, “What will we do when this indi- schools, and home care environments. vidual displays this challenging behavior By applying these steps, other profession- again?” The answers often lead to a cul- als and family caregivers can do the same: ture focused on intervention and physical restraints. 1. Let Go of Preconceptions - There is a Caregivers often feel that this approach common belief that in order to prevent is not effective, and they’re right—phys- people from hurting themselves or others, ical intervention to address behavior one must physically intervene. This idea is challenges can result in escalation, hu- outdated, ineffective, and can hold teams miliation, and injury. But the field of com- back from making the all-in personal in- munity support services has relied on these But instead of focusing on handling neg- It’s possible to break the cycle of nega- vestment that is necessary to gain real re- traditional, reactive approaches for so long ative behaviors, what if the question care- tive reinforcement and physical restraint, sults from a positive approach. there is little belief and less conviction that givers asked was, “What will we do to pre- and shift to a dynamic that focuses in- The most effective way to dramatically positive, proactive philosophies and ap- vent this individual from behaving in this stead on encouraging positive behaviors. proaches can work. negative way again?” At The Arc of Delaware County, the team see Proven on page 28 Assessment and Treatment of Problem Behavior for Adults with ASD By Ethan Eisdorfer, MA Functional Assessment & Axelrod, 1999). While the literature 2007). It has been estimated that it costs Mikala Hanson, BA, and of Problem Behavior validating the effectiveness of these pro- approximately $3.2 million dollars to finan- Robert H. LaRue, PhD, BCBA-D cedures is clear, assessing the maladaptive cially support an autistic person over their Douglass Developmental Disabilities Functional assessment is an important behavior of adults with autism presents lifetime (Ganz, 2006). With limited funds Center at Rutgers University first step in the effective treatment of mal- unique challenges as compared to assess- available, assessment and treatment practic- adaptive behavior. Functional assessment ment with younger populations. Some of es are more likely to use less thorough mod- represents a collection of procedures used these challenges are highlighted below. els of assessment and treatment which re- s individuals with autism age to determine the environmental factors quire less time, money and other resources. out of the educational system, that cause and maintain maladaptive be- Legislation - Perhaps one of the most sig- families are faced with a num- havior. Functional assessments may in- nificant barriers for older individuals with Lack of qualified staff - Another significant ber of challenges. Maladaptive clude indirect assessment procedures (e.g., autism is the fact that legislation mandat- challenge is the lack of available trained Abehavior, in particular, can be a significant questionnaires and structured interviews), ing the use of functional assessments only staff with experience working with adults stressor for families of adults with Autism descriptive assessment (e.g., collecting ob- extends to individuals up to age 21. As a with ASD. Many staff members tasked Spectrum Disorder (ASD). While estimates servational data related to the antecedents result, adults diagnosed with autism are not with assessment and treatment plan devel- of the prevalence of problem behavior vary and consequences of maladaptive behav- entitled to the same behavioral supports as opment lack the necessary training to do so considerably, it tends to be more common ior), and functional analysis (e.g., hypothe- their younger counterparts. Consequently, effectively (Sigafoos, Roberts, Couzens, & in individuals with ASD relative to other sis testing and the manipulation of environ- adults diagnosed with autism have few- Caycho, 1992; Wood, Luiselli, & Harchik, disorders. Common topographies of prob- mental variables). er opportunities to have sound functional 2007). This gap in the availability of well- lem behavior include aggression, self-inju- Over the last several decades, a robust assessments conducted, which can lead to trained professionals can lead to poorly de- rious behavior, property destruction, ritual- literature validating the effectiveness of poorer outcomes over time. signed assessment and treatment. istic behavior, disruption, and inappropriate functional assessment has emerged. The vocalization, as a few examples. While literature has shown that these assessment Cost of services - Providing services for Severity of the maladaptive behavior - An- procedures for assessment and treatment procedures are effective for identifying adults with autism spectrum disorders rep- other barrier to effective assessment and for these kinds of problem behavior are the function of maladaptive behavior and resents a substantial economic expense for treatment is the severity of the behavior well-established in the behavioral litera- that treatments based on these procedures families and government agencies (Cimera being treated in adults. Adults with autism ture, the adult population presents unique are more effective than treatments that are and Cohan, 2009; Ganz, 2006; Järbrink, challenges for families and care providers. selected arbitrarily (Pelios, Morren, Tesch McCrone, Fombonne, Zanden, & Knapp, see Adults on page 26 PERMIT NO. 137 NO. PERMIT Effort, PA 18330 PA Effort, MONROE, CT MONROE, 460 Cascade Drive Cascade 460 U.S. POSTAGE PAID POSTAGE U.S. Mental Health News Education, Inc. Education, News Health Mental ORGANIZATION NON PROFIT NON PAGE 2 www.mhnews-autism.org AUTISM SPECTRUM NEWS ~ SPRING 2015 Autism Spectrum News Mental Health News Education, Inc. Editorial Board Board of Directors Cindy Alterson, PhD, BCBA, Principal and Program Director Chairman Devereux Millwood Learning Center Jorge R. Petit, MD, President Quality Healthcare Solutions Group Joel Bregman, MD, Medical Director and Director of Psychiatry The Center for Autism Vice-Chairman Barry B. Perlman, MD, Legislative Chair Joseph D. Buxbaum, PhD New York State Psychiatric Association Director, Seaver Autism Center Icahn School of Medicine at Mount Sinai Secretary Susan M. Cortilet-Jones, MS, LMHC Peg Moran, LMSW, Vice President, Operations, Center for Regional Healthcare Innovation Licensed Therapist/Adult Coaching Specialist for Autism and Neurodiversity Westchester Medical Center Discovering Your World Treasurer Stephen E. Freeman, LCSW Debra Pantin, LCSW, Associate Executive Director The Freeman Group VIP Community Services Members of the Board Lynda Geller, PhD, Founder Spectrum Services, A Cooperative of Independent Peter D. Beitchman, DSW, LMSW, Principal Practices and Organizations, New York, NY Behavioral Health Consultation Constance Y. Brown-Bellamy, MPA, Vice President, Community and Government Relations Ami Klin, PhD, Director ICL Marcus Autism Center Carmen Collado, LCSW, Chief Networking and Relations Officer Harold S. Koplewicz, MD, President ICL Child Mind Institute Jonathan P. Edwards, LMSW, Training Specialist, Parachute NYC NYC Department of Health and Mental Hygiene Cecelia M. McCarton, MD, Founder and Executive Director The McCarton Foundation Alan Eskenazi, MA, CPHQ, CASAC, Senior Associate Executive Director The McCarton School (for Autism) Department of Psychiatry, Woodhull Hospital Mary Hanrahan, LCSW, Behavioral Health, Clinical Services Management Judith R. Omidvaran New York Presbyterian Autism Parent Advocate, New York Joseph Krasnansky, LCSW, Vice President and Chief Program Officer Theresa Pirraglia, Co-Founder and Board Member Lower Eastside Service Center FECA, The Foundation for Empowering Citizens with Autism Judith R. Omidvaran Autism Parent Advocate, New York John C. Pomeroy, MD, Founding Director Theresa Pirraglia, Co-Founder and Board Member Cody Center for Autism and Developmental Disabilities FECA, The Foundation for Empowering Citizens with Autism Stony Brook University Medical Center Janet Z. Segal, LCSW, Executive Vice President Emerita Patricia Rowan, LMSW, Consultant and Advocate Four Winds Hospital and President, Four Winds Foundation Kid’s Connection Alan Trager, LCSW, Chief Executive Officer Westchester Jewish Community Services Pat Schissel, LMSW, Executive Director Asperger Syndrome and High Functioning Autism Association Naomi Weinstein, MPH, Director, Center for Rehabilitation