This Autism Speaks Weatherstone fellow is evaluating the best ways to safely stop violent behavior in someone who has autism
The following blog post is the first in a new series featuring Autism Speaks research fellows and their ground-breaking work.
For more on the central role our fellowships play in Autism Speaks’ mission, please see: “Autism Speaks Science@Work: Meet our research fellows,” by Interim Chief Science Officer Mathew Pletcher.
By Sarah Slocum, a board certified behavior analyst, is pursuing doctorate work at the University of Florida, in Gainesville. Slocum’s 2014 Autism Weatherstone Predoctoral Fellowship supported her research evaluating emergency interventions for safely stopping dangerous self-injurious or violent behaviors of individuals affected by autism. Slocum also has an adult brother severely affected by autism.
I’m pleased for this opportunity to tell you about how my Autism Speaks Weatherstone Predoctoral Fellowship allowed me to conduct much-needed research on how best to help individuals with autism who engage in dangerous self-injurious or aggressive behavior. Often times, this type of behavior stems from an inability to appropriately communicate. The harmful behavior becomes the individual’s means of communication.
I work in the field of Applied Behavior Analysis (ABA), which focuses on teaching appropriate behavior. As a behavior analyst, it’s my job to develop behavioral programs that reduce behavior that stands in the way of learning new skills and leading a happier life. Over the years, my research has focused on helping control some of the most severe and dangerous types of behavior such as violent head banging, punching and kicking. Because of the intensity and danger involved, we need ways to quickly and safely stop this behavior before an individual or others gets hurt.
In the current study, we’re evaluating the immediate effects of several interventions. Do they stop dangerous behavior efficiently and effectively? We left, for a future study, the evaluation of how well these methods work over the long term.
From prior research, we know that developing an intervention to help someone with this type of challenging behavior begins with learning why he or she engages in the harmful behavior. So in a controlled fashion, we’ll set up an environment that presents some different scenarios. Think of this assessment like an allergy test. In an allergy test, the physician exposes the patient to potential allergens to see which result in allergic flare-ups. Similarly, we want to see what conditions result in flare-ups in behavior in the individual’s day-to-day life.
For example, we might test to see if an individual engages in problem behavior to get a rise out of adults or get some food or a toy he wants. Once we know what triggers the behavior, we can intervene to help change it.
Interventions for dangerous “escape” behaviors
Participants in our current study tend to have flare-ups when asked to do things that they don’t want to do. So I’m comparing the effectiveness of three interventions for stopping dangerous behaviors aimed at avoidance. We call this “escape behavior.”
In other words, sometimes individuals affected by autism engage in self-injury or aggression to get out of an upsetting situation. When someone has difficulty communicating, as is common with autism, this type of behavior can become a consistent response to everyday frustrations such as having to get dressed in the morning or stop playing a game to come to dinner.
Intervention 1: Earning a break
The first intervention involves earning a break from the task by following directions or complying. Take, for example, someone who hits his therapist when asked to complete a math problem. We want to encourage him to complete the task without the aggression. So we allow him to earn a break when he completes a problem.
Here, the individual learns that he won’t get a break for engaging in the harmful behavior. Instead, he earns that break by cooperating.
Sometimes, this involves hand-over-hand guidance to complete a task. Over time, the individual learns that appropriate behavior is the way to get what he wants.
We know from research that this can be an effective ABA approach to reduce dangerous behavior. But the process of using hand-over-hand physical guidance isn’t always practical. Some children and adults with autism are larger or faster than their therapists. Forcing them to complete work isn’t always feasible or safe.
Intervention 2: Earning a food reward
The second intervention involves a reward in the form of a small snack – such as a piece of popcorn – to promote an appropriate response over a self-injurious or aggressive one. Research has likewise supported the effectiveness of this type of approach when reducing dangerous behavior, even without the use of hand-over-hand guidance. For example, we might offer a piece of popcorn each time the person completes a task such as the math problem.
Intervention 3: Temporarily backing off to regroup
The third approach we’re evaluating involves putting a temporary stop to the situation that triggers the violent behavior, then slowly and systematically repeating the request at set intervals. For example, if asking a child to complete a math problem triggers a violent response, we might stop prompting for a set amount of time. Then we calmly and systematically repeat the request at regular intervals.
Although removing the demand initially might not seem ideal, it allows for time to regroup, and allows us to re-introduce the necessary instructions back into the learning process.
Our research suggests that the first intervention – a break for complying with our requests and the use of hand-over-hand guidance – is not particularly effective in the short term. By contrast, the second two interventions – using a small food reward or initially backing off the request – are both highly effective at immediately reducing self-injury and aggression.
Conclusion: We think that caregivers might do well to consider these two options when “escape behavior” is so severe it must be avoided for the safety of all of those involved.
Again, I’d like to thank the Stavros Niarchos Foundation for funding my dissertation work with the Autism Speaks Weatherstone Fellowship, as well as the Autism Speaks community at large for supporting our work.