Early identification and treatment can prevent challenging behavior from escalating and becoming firmly established in autistic children. Decades of collaborative research in the United States has shown that parent-implemented behavioral interventions can help to reduce that challenging behavior. However, in China, where more than 2 million children have autism, evidence-based practices have not been systematically evaluated. While much is unknown about the prevalence of challenging behavior and how it is treated, research has shown that Chinese parents of autistic children who exhibit challenging behavior have much higher levels of stress. Providing training could give parents the help they need to reduce challenging behavior, especially since there is a lack of professional services and stigma attached to seeking help.
Because Chinese culture differs significantly from Western culture, determining the kinds of interventions that Chinese parents would agree to use is a critical first step. OAR-funded graduate researcher, Qi Wei, a doctoral student in special education and clinical sciences at the University of Oregon, proposed a study, “Treatment Acceptability of Behavioral Treatment Among Chinese Parents,” to do just that.
Funded by OAR in 2019, the study surveyed parents of autistic children to find out how they felt about six interventions:
- Noncontingent reinforcement, which is providing reinforcement on a fixed-time schedule, independent of target behavior
- Teaching appropriate behavior
- Positive reinforcement
- Extinction, which is discontinuing reinforcement that encourages unacceptable behavior in order to reduce the behavior
- Positive punishment, which is adding something, such as scolding or making the child do chores, to deter them from a behavior
- Negative punishment, which is taking away something the child likes, such as a favorite toy or snacks, to deter them from a behavior
Wei recruited 216 caregivers via an online rehabilitation platform on WeChat and asked them to answer a series of questionnaires that provided demographic information and describe their child-rearing beliefs. The caregivers also filled out a behavior problems inventory and a hypothetical vignette questionnaire (short stories about a hypothetical person used in research on sensitive topics). Wei analyzed their responses to determine acceptability ratings toward treatments, as well as the relationships among severity of challenging behavior, child-rearing values, and treatment acceptability.
Wei found that the parents preferred positive strategies, including noncontingent reinforcement, teaching appropriate behavior, and positive reinforcement, to extinction and negative punishment. Positive punishment was the least acceptable.
Parents who supported training, such as setting good examples, providing clear expectations, and teaching appropriate behaviors as early as possible, were more likely to prefer positive strategies. When both severity of challenging behavior and child-rearing values served as predictors, positive punishment was more acceptable for children with severe challenging behaviors and for Chinese caregivers who had greater approval of shaming (for example, expressing disappointment and reprimands). In contrast, the severity of challenging behavior did not have an effect on acceptability of other behavioral treatments, when child-rearing values were held constant.
Overall, Chinese caregivers appear to have attitudes toward behavioral interventions that are similar to American caregivers, indicating that evidence-based positive treatments such as functional communication training would be highly acceptable. They are not as accepting of extinction, which is used in applied behavioral analysis (ABA). Wei notes that explaining the rationale behind extinction, showing evidence of its effectiveness, and discussing the potential risks could help make it more acceptable to parents.
The study also highlights the role of child-rearing beliefs in parents’ willingness to accept interventions. With knowledge of the role those beliefs play, professionals can explain why they may not work as well and even be harmful to the child.
Sherri Alms is the freelance editor of The OARacle, a role she took on in 2007. She has been a freelance writer and editor for more than 20 years.