One of the most difficult challenges that the family of a child diagnosed with an Autism Spectrum Disorder may face is aggressive behavior. Unfortunately, aggression is all too common in children with ASD, with recent research suggesting that rates may be as high as 68% of children behaving aggressively towards caregivers (Anderson, 2012). Aggression can take many forms, and can range in intensity from mild to extremely dangerous. The way aggression is expressed will depend on a number of factors, including the child’s age and size, his or her other skills and challenges, and the history of the behavior and how it has been responded to in the past. A tendency to engage in aggressive behavior can limit a child’s access to peers, typical environments, and age-appropriate experiences. It can also cause extreme stress and difficulty for the child’s family. Aggression is not easy to treat, but there is a large body of research that supports behavioral interventions as a means to decrease the occurrence of aggression. No matter how old a child is, or how severe his or her aggressive behavior may be, there is always the possibility of a successful program to decrease aggression.
What to know before you start
Aggression and other challenging behavior cannot be effectively treated without first conducting an assessment of the reasons that the behavior occurs. This procedure is called a functional behavior assessment (FBA for short).
Aggression is more likely to occur if a child cannot communicate effectively, or if his or her communication is not understood or attended to by those around him.
The primary focus of the FBA should be to determine what your child is trying to tell you through his or her aggression. This is referred to as the function of the behavior.
A BCBA should only conduct an FBA with your permission.
Once an FBA is conducted, the BCBA will create a behavior intervention plan (BIP) that is consistent with the determined function, and should train you and anyone else who will be interacting with the child on a regular basis on how to carry out the BIP.
The BIP should only be implemented with your permission and with the proper data collection and supervision.
Questions for the BCBA
How will you conduct the FBA? What data will you collect?
Most of the time, an FBA will consist of information provided by the caregiver, usually through an interview and/or survey, as well as data collected through direct observation by the BCBA.
A BCBA should not attempt to conduct an FBA without directly observing your child, and should not rely on caregiver information or other people’s observations alone.
Sometimes, a BCBA will recommend a functional analysis, which is a manipulation of the environment to try to “turn the behavior on and off.”
How long will the FBA take?
This will vary depending on the situation, but the BCBA should be able to estimate how long it will take to complete.
An FBA should not take an excessive amount of time to complete, especially if the behavior is in any way dangerous.
What will you do with the FBA information?
The data collected from the FBA will be used to develop a hypothesis of function, which in turn will help the BCBA to determine what skills your child needs to learn in order to reduce aggression.
The goal of the BIP should be to reduce aggression by teaching the child an appropriate replacement behavior.
How will you train us (the child’s family) to participate in any BIP?
Any plan to reduce aggression should involve the people in the child’s life who have regular contact with the child, and who may be affected by aggression.
There is no such thing as a BIP that is carried out only by the BCBA.
The BCBA should be available to explain the plan, answer any questions, work though the plan with you several times before you are on your own with it, and be available for follow-up support as needed.
What safety considerations are involved in the FBA or the BIP?
The procedures involved in the FBA and BIP should not make a dangerous situation any worse.
The BCBA should be able to discuss what possible safety or other risks exist with the FBA and BIP, and how these will be minimized.
Materials you may want to have
This will depend entirely on the BIP.
Many BIPs include strategies for increasing communication, so you may need to create communication books or boards, or you may wish to use technology-based communication.
You may also need to have visual cues, schedules, reinforcers, and other tools, depending on the BIP that is created.
No matter what kind of aggression and what kind of BIP is developed, there should always be a data-collection plan.
The type of data collected will depend on the behavior and the BIP.
Caregivers will probably be asked to collect some data, and should make every effort to collect accurate, realistic data.
If you are unable to collect data in the way that you are asked to, speak to the BCBA about adjusting the data collection system to make it more practical.
The BCBA should examine the data on a regular basis, and make adjustments to the BIP as needed, including starting to fade the BIP procedures when aggression has been reduced.
What to expect
Some BIPs may include a procedure known as extinction, in which the behavior is no longer reinforced.
When extinction occurs, the behavior will get worse before it gets better. This is called an extinction burst.
Talk to the BCBA about how this burst will be handled safely.
An extinction burst can be minimized by making sure to teach appropriate replacement behavior.
A BIP may take some time to have an effect on behavior, but probably no more than 2 weeks should be needed to assess effectiveness.
If the behavior is not improving within about 2 weeks, the BIP may need to be adjusted or changed.
Because aggressive behavior may not be immediately reduced, the BIP should include safety strategies for managing crisis behavior, but the main purpose of the BIP should be to teach replacement behavior.