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Problematic behavior, such as biting or hitting in response to unpleasant events, can emerge at different times in a child’s life, and is considered developmentally normal. The behavior often reduces to tolerable levels when caregivers express displeasure and redirect the child to respond more appropriately to the situation.

However, in some children, the behavior can increase in frequency or intensity until it feels unmanageable. For children with autism spectrum disorder, these problems can emerge more often than for other children.

If your child exhibits problematic behavior, there is help. Decades of research on the treatment of problem behavior has shown that a functional analysis is the best first step for determining the underlying cause of the behavior and identifying the most effective way to treat it. Furthermore, these treatments are often more elegant and straightforward than general behavior management strategies, such as sticker charts or levels systems which involve delayed rewards and require caregivers to keep track of even more stuff.

What Causes Problem Behavior?

Much of the focus of a functional analysis is on other people’s reactions to problem behavior. This approach makes sense because, in many cases, other people’s response may actually cause the behavior to become consistently unmanageable, even though those reactions might work for other children. Once the cause is determined, an effective and individualized treatment can be developed.

A functional analysis will determine which type of reaction (or combination of reactions) is causing problem behavior to persist:

• Attention or another type of reaction from caregivers (reprimands, scolding, consoling, giving toys or food to calm down, etc.) is the cause of problem behavior approximately 30 percent of the time (behavior analysts call this social-positive reinforcement).
• Getting out of doing unpleasant tasks (doing homework or chores, brushing teeth, getting a bath, etc.) is the cause approximately 30 percent of the time (social-negative reinforcement).
• Sensory reasons, which do not involve a reaction from anyone at all, are the cause approximately 20 percent of the time (automatic reinforcement); interestingly, behavioral treatments can be very effective in many of these cases as well.

The remaining 20 percent are a combination of reactions.

Please Just Make It Stop!

Most treatments involve no longer giving children what they want following problem behavior (behavior analysts call this extinction). However, recent research has highlighted ways to increase the effectiveness of treatment without extinction, which is important (and a relief) because extinction can sometimes be particularly difficult to implement.

There are strengths and limitations of each approach, but all can be effective in improving behavior when the strategy is matched to the cause of problem behavior:

• Functional communication training provides reinforcement following appropriate communication.
• Noncontingent reinforcement provides reinforcement on a schedule.
• Differential reinforcement of other behavior provides reinforcement when the problem behavior does not occur for a period of time.

Caregivers can learn to implement these strategies quickly and easily with the help of a behavior analyst.

Functional Communication Training

This treatment involves teaching children to ask appropriately for what they want instead of engaging in problem behavior (the “use your words” approach). Depending on children’s skill levels, they can be taught to ask nicely, hand a picture card, use a device, or use sign language. A good starting strategy is to ensure that it is easier for children to ask for what they want than to engage in problem behavior (e.g., saying “break” instead of hitting to get out of work, or using sign language to communicate “play” instead of hitting to get toys or attention from others). Once problem behavior decreases, children are then taught to use more extensive sentences (as skills permit) and to wait or accept “no” after requesting things, if necessary.

One young man who attended my clinic consistently engaged in explosive outbursts (hitting, screaming, throwing things) during homework time in the evenings when he encountered a difficult problem. His mom finally reached the point that she would do whatever was needed to avoid those outbursts. Ultimately, in fact, she stopped asking him to do hard work, even though she knew that it was to his academic disadvantage.

We worked with the young man to say “break” or “help” instead to receive a short (30 seconds) break, and despite his mom’s initial skepticism, she also was able to use the treatment with him at home. The approach helped him manage his reaction in tough situations, and the work situation was no longer the fight that it used to be.

We have effectively used the same approach to teach children to ask for their favorite things back when they are taken away or not present, as well as to ask for attention from caregivers.

Noncontingent Reinforcement

This treatment involves providing reinforcement on a schedule (the “wait until it is time” approach). Therefore, it tends to be one of the easier approaches to use in busy settings (e.g., full classroom, multiple children at home, caregiver must focus on other tasks, etc.). The starting strategy is to provide reinforcement before problem behavior would typically occur. If problem behavior occurs near the end of the wait time, simply wait five seconds before providing reinforcement.

We used this approach with a young woman who attended my clinic. She loved playing on her iPad and became extremely aggressive when it was removed. We started by only removing the iPad for a few seconds before she could have it back, and we slowly increased the time she had to wait. Over time, we were able to remove the iPad long enough to get other things done, and she had scheduled iPad times during the day at home. Once she learned that she would eventually get the iPad back, the outbursts were nearly eliminated.

We have used the same approach in homes and classrooms when a child engages in problem behavior to get out of work because the parent or teacher can schedule short, frequent breaks for the student and avoid many occurrences of problem behavior. For problem behavior that occurs for sensory reasons, we provide access to toys or other items that mimic the sensations produced by problem behavior so the child plays with the toys instead.

Differential Reinforcement of Other Behavior

This treatment involves providing reinforcement as long as the problem behavior does not occur for a specific period of time (the “you’ll get this if you don’t do that” approach). As in the previous treatment, the goal is to require no problem behavior for a short period of time at first but to increase it slowly as the problem behavior remains low. This strategy focuses on the absence of a particular behavior so a limitation is that the child may still earn reinforcement even if a different problematic behavior occurs during the wait time. A simple fix is to wait at least 5 seconds before giving the reinforcer if an undesirable behavior occurs.

I worked with a young man at an elementary school who engaged in loud, disruptive vocalizations (squealing, shouting, etc.) throughout the day for sensory reasons. I found his favorite snack, Slim Jim,) and gave him a very small piece if he talked appropriately or was not disruptive. At first he only had to refrain from those vocalizations for 30 seconds, but we slowly worked on going longer without the behavior. He did so well that he won Citizen of the Month and quietly attended an award ceremony at the local library – intermittently glancing at his timer and nonchalantly holding out his hand for a piece of Slim Jim just as the time ended.

We have effectively used this approach for children who need to tolerate being told they cannot have something they want, who need to do their work, and who need to let caregivers do other tasks before playing.

How Do I Choose?

All of these strategies can be very effective and easily tailored for individual children. When deciding which strategy to use, it can be helpful to practice each approach with the help of a behavior analyst who can provide tips and suggestions on how to do it correctly, as subtle changes can make a big difference.

Caregivers should not be afraid to openly discuss their preferences and possible challenges associated with a recommended treatment. The goal of any behavior analyst is to find an effective, manageable treatment that improves the situation for all involved.

Finally, I find it helpful to view these strategies as more like laying bricks for a building than shooting silver bullets. You have to lay the foundation and carefully plan the next steps. With some focused and deliberate work, you can build something beautiful.

Jennifer Fritz is an associate professor of behavior analysis at the University of Houston-Clear Lake (UHCL) and director of the Severe Behavior Disorders Research Clinic at UHCL’s Center for Autism and Developmental Disabilities. Dr. Fritz serves on the Editorial Board of the Journal of Applied Behavior Analysis, as the program chair for the Professional Track of the Texas Association for Behavior Analysis (TxABA) annual conference, and as secretary of the TXABA Public Policy Group. OAR funded her 2013 research project evaluating a model to increase access to treatment for challenging behavior.