BEHAVIORAL ISSUES IN AUTISM

BEHAVIORAL ISSUES IN AUTISM

CURRENT ISSUES IN AUTISM Series Editors: Eric Schopler and Gary B. Mesibov University of North Carolina School of Medicine Chapel Hill, North Carolina AUTISM IN ADOLESCENTS AND ADULTS BEHAVIORAL ISSUES IN AUTISM COMMUNICATION PROBLEMS IN AUTISM DIAGNOSIS AND ASSESSMENT IN AUTISM THE EFFECTS OF AUTISM ON THE FAMILY HIGH-FUNCTIONING INDIVIDUALS WITH AUTISM NEUROBIOLOGICAL ISSUES IN AUTISM PRESCHOOL ISSUES IN AUTISM Edited by Eric Schopler, Mary E. Van Bourgondien, and Marie M. Bristol SOCIAL BEHAVIOR IN AUTISM

BEHAVIORAL ISSUES IN AUTISM Edited by Eric Schopler and Gary B. Mesibov University of North Carolina School of Medicine Chapel Hill, North Carolina Springer Science+Business Media, LLC

Library of Congress Catalog1ng-1n-PublIcatIon Data Behavioral issues in autism / edited by Eric Schopler and Gary B. Mes i bov. p. cm. -- (Current issues in autism) Includes bibliographical references and index. 1. Autistic children Rehabilitation. 2. Behavior disorders in chi1dren--treatment. 3. Mentally handicapped chi 1 dren--behavior modification. I. Schopler, Eric. II. Mesibov, Gary B. III. Series. RJ506.A9B343 1994 618.92'8982--dc20 93-49102 CIP 10 9876543 ISBN 978-1-4757-9402-1 DOI 10.1007/978-1-4757-9400-7 ISBN 978-1-4757-9400-7 (ebook) Springer Science+Business Media New York 1994 Originally published by Plenum Press, New York in 1994 All rights reserved No part of this book may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, microfilming, recording, or otherwise, without written permission from the Publisher.

To the many families struggling with behavioral concerns, with the hope that this volume will provide insight, understanding, support, and assistance

Contributors JENNIFER BERRYMAN, State University of New York, Binghamton, New York 13902 JOSEPH CAUTELA, Behavior Therapy Institute, 10 Phillips Road, Sudbury, Massachusetts 01776 GLEN DUNLAP, Florida Mental Health Institute, University of South Florida, Tampa, Florida 33612-2399 WILLIAM D. FREA, Autism Research Center, University of California at Santa Barbara, Santa Barbara, California 93106-9490 PETER F. GERHARDT, The Eden Services, 1 Logan Drive, Princeton, New Jersey 08540 JUNE GRODEN, The Groden Center, Inc., 86 Mount Hope Avenue, Providence, Rhode Island 02906 SANDRA L. HARRIS, Graduate School of Applied and Professional Psychology, Rutgers, The State University of New Jersey, Busch Campus, Piscataway, New Jersey 08855-0819 KATHLEEN A. HEARSEY, Division TEACCH, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599-7180 DAVID L. HOLMES, The Eden Services, 1 Logan Drive, Princeton, New Jersey 08540 BRIAN A. IWATA, Department of Psychology, The University of Florida, Gainesville, Florida 32611 LEE KERN, Children's Seashore House, Biobehavioral Unit, 3405 Civic Center Boulevard, Philadelphia, Pennsylvania 19104. vii

viii CONTRIBUTORS ROBERT L. KOEGEL, Autism Research Center, University of California at Santa Barbara, Santa Barbara, California 93106-9490 JOHNNY L. MATSON, Department of Psychology, Louisiana State University, Baton Rouge, Louisiana 70803 PATRICIA M. MEINHOLD, Department of Pediatrics, The Ohio State University, and The Children's Hospital, Columbus, Ohio 43205 GARY B. MESIBOV, Division TEACCH, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599-7180 JAMES A. MULlCK, Department of Pediatrics, The Ohio State University, and The Children's Hospital, Columbus, Ohio 43205 MICHAEL D. POWERS, Department of Psychology, Newington Children's Hospital, Newington, Connecticut 06111 STACEY PRINCE, Center for Clinical Research, University of Washington, Seattle, Washington 98195 FRANK R. ROBBINS, Early Childhood Learning Center, 150 Fearing Street, Amherst, Massachusetts 01002 ERIC SCHOPLER, Division TEACCH, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599-7180 LAURA SCHREIBMAN, Department of Psychology, University of California at San Diego, La Jolla, California 92093 JAY A. SEVIN, Department of Psychology, Louisiana State University, Baton Rouge, Louisiana 70803 RICHARD G. SMITH, Department of Psychology, The University of Florida, Gainesville, Florida 32611 ALAN V. SURRATT, Center on Human Development, University of Oregon, Eugene, Oregon 97403-1235 TIMOTHY R. VOLLMER, Department of Psychology, Louisiana State University, Baton Rouge, Louisiana 70803 JENNIFER R. ZARCONE, Department of Behavioral Psychology, The Kennedy Institute, 707 North Broadway, Baltimore, Maryland 21205

Preface Division TEACCH, a statewide program in North Carolina, serves people with autism and their families through the School of Medicine at the University of North Carolina at Chapel Hill. TEACCH was one of the first, and remains one of the most comprehensive and effective, programs in the world working with this population. Over the years the puzzling and unusual behavior problems these children present have been among the most interesting and challenging of the enigmas parents and professionals confront. This book is designed to provide information on these behaviors that will be relevant and useful. As with the preceding books in our series, Current Issues in Autism, this volume is based in part on one of the annual TEACCH Conferences held in Chapel Hill in May. The books are not simply published proceedings of the conference papers. Instead, conference participants are asked to develop full-length chapters around their presentations. Other international experts, whose work is beyond the scope of each conference but related to its major theme, are asked to contribute chapters as well. These volumes provide the most up-to-date information on research and professional practice available on the most important issues in autism. This volume is designed to advance the understanding of behavior problems in autism. A general perspective on major issues and strategies in the field is presented. There are also major sections devoted to assessment techniques, intervention strategies, and major controversies in the field. We expect the volume to be of interest to students, professionals, and parents concerned with understanding and managing behavior problems of individuals with autism. ERIC SCHOPLER GARY B. MESIBOV ix

Acknowledgments A volume of this scope would be impossible without the cooperation, assistance, and support of many people. It is our great pleasure to acknowledge each of them. Our thanks go to Helen Garrison, who skillfully coordinated the TEACCH Conference on this theme. Her superb work on all aspects of these conferences has been an important aspect of the evolution of these books. Our secretarial staff, including Vickie Weaver, Jeanette Ferguson, Ann Bashford, and Amy Slaughter, handled the many typing and administrative chores with skill, competence, and good cheer. John Swetnam carefully reviewed each chapter, and his superb organizational skills kept this project moving ahead. His thoroughness and attention to detail are evident throughout the book. As with all of our projects, these books would not be possible without our extraordinary TEACCH colleagues, too numerous to name, who provide ongoing help, insights, cooperation, and splendid work. Their understanding of people with autism and their families is extraordinary and provides the knowledge and inspiration that we try to impart through these books. As is true for all our efforts in the TEACCH program, writing this book would not have been possible without the assistance of the families of our clients. Their energy, cooperation, and participation in our program have taught us so much about this important topic. Finally, the University of North Carolina at Chapel Hill School of Medicine, especially the Department of Psychiatry under the capable leadership of David Janowsky, has provided the environment that cultivates and nurtures scholarly pursuits of this kind. We also are most grateful to the North Carolina State Legislature, which makes this and our many other projects possible through their continued support. xi

Contents Part I: Overview Chapter 1 INTRODUCTION TO BEHAVIORAL ISSUES IN AUTISM Eric Schopler and Gary B. Mesibov Introduction................................................... 4 Overview..................................................... 4 Assessment Issues... 5 Treatment Issues............................................... 6 Special Issues... 8 References................................................... 10 Chapter 2 GENERAL PRINCIPLES OF BEHAVIOR MANAGEMENT Laura Schreibman The Behavioral Perspective... 13 Behavioral Assessment.......................................... 14 Specific Behavioral Procedures... 15 Current Issues and Trends in the Behavioral Treatment of Autism... 25 Concluding Comments.......................................... 34 References.................................................... 34 xiii

xiv CONTENTS Chapter 3 ADMINISTRATIVE ISSUES INVOLVING BEHAVIORAL APPROACHES IN AUTISM Michael D. Powers Administrative Considerations in Implementing Behavioral Programs to Treat Challenging Behavior... 40 Clinical and Social Considerations Guiding Intervention Efforts......... 46 Guidelines for Promoting Systemic Change... 51 Conclusion... 52 References... 53 Chapter 4 BEHAVIORAL PRIORITIES FOR AUTISM AND RELATED DEVELOPMENTAL DISORDERS Eric Schopler Introduction... 55 North Carolina's TEACCH Model................................. 56 Obstacles to Optimum Individualized Treatment... 58 Enduring Treatment Principles and Concepts... 68 Summary and Conclusions... 74 References... 75 Part II: Assessment Issues Chapter 5 SELF-MANAGEMENT OF PROBLEMATIC SOCIAL BEHAVIOR Robert L. Koegel, William D. Frea, and Alan V. Surratt Introduction... 81 Characteristics of Autism Requiring Extended Treatment Efforts... 82

CONTENTS xv Self-Regulation of Behavior... 87 Summary... 93 References.................................................... 94 Chapter 6 DEVELOPMENTAL DISORDERS AND BROAD EFFECTS OF THE ENVIRONMENT ON LEARNING AND TREATMENT EFFECTIVENESS James A. Mulick and Patricia M. Meinhold Introduction................................................... 99 General Process Assumptions... 101 Individual Factors.............................................. 106 Setting Factors... 110 Customs, Rules, and Regulations... 121 Conclusion: The Case for Environmental Impact Statements... 122 References.................................................... 124 Part III: Treatment Issues Chapter 7 ASSESSMENT AND TREATMENT OF SELF-INJURIOUS BEHAVIOR Brian A. Iwata, Jennifer R. Zarcone, Timothy R. Vollmer, and Richard G. Smith Definition, Risk, and Prevalence... 131 Etiology and Maintaining Variables... 132 Pretreatment Considerations... 135 Learning-Based Approaches to Treatment... 145 Other Treatment Approaches..................................... 151 Summary..................................................... 153 References.................................................... 154

XVI CONTENTS Chapter 8 TREATMENT OF FAMILY PROBLEMS IN AUTISM Sandra L. Harris Introduction... 161 The Impact of the Child's Autism on the Family... 162 The ABCX Model of Family Functioning... 164 Working with Families of Normative Needs... 168 Families with Special Needs... 169 Conclusions and Summary... 172 References... 173 Chapter 9 THE IMPACT OF STRESS AND ANXIETY ON INDIVIDUALS WITH AUTISM AND DEVELOPMENTAL DISABILITIES June Groden, Joseph Cautela, Stacey Prince, and Jennifer Berryman Definition of Stress and Anxiety... 178 Stress and Stressors in the General Population... 179 Stress and Stressors in the Population with Autism and Developmental Disabilities... 179 Maladaptive Behaviors and Their Relationship to Stress... 182 Fostering Adaptive Coping Strategies... 185 Case Examples................................................. 187 Advantages of Designing Interventions to Reduce Stress and Anxiety... 189 Implications for Further Research... 189 Summary... 190 References... 190 Chapter 10 STRUCTURED TEACHING Gary B. Mesibov, Eric Schopler, and Kathleen A. Hearsey Introduction... 195 Physical Organization... 196

CONTENTS xvii Schedules... 198 Individual Work Systems........................................ 200 Visual Structure... 201 Routines... 203 Teaching Methods... 204 Summary..., 206 References.................................................... 207 Part IV: Special Issues Chapter 11 ISSUES IN THE USE OF AVERSIVES: FACTORS ASSOCIATED WITH BEHAVIOR MODIFICATION FOR AUTISTIC AND OTHER DEVELOPMENTALLY DISABLED PEOPLE Johnny L. Matson and Jay A. Sevin Introduction................................................... 211 Confusion over Definition... 212 Conflict between Advocates and Professionals... 214 Concepts as Ideologies.......................................... 215 Data and Testimonials... 219 Age Appropriateness as Ideology... 219 Freedom of Treatment Choice.................................... 220 Professional Control versus Treatment by Bureaucratic Rule... 220 Future Directions... 221 Conclusions................................................... 223 References.................................................... 223 Chapter 12 SOME CHARACTERISTICS OF NONAVERSIVE INTERVENTION FOR SEVERE BEHAVIOR PROBLEMS Glen Dunlap, Frank R. Robbins, and Lee Kern Introduction................................................... 227 Functional Assessment and Hypothesis-Driven Intervention............ 231

xviii CONTENTS Antecedent and Curriculum-Based Interventions 234 Increasing Personal Control and Choice... 237 Summary... 241 References... 241 Chapter 13 THE EDEN DECISION MODEL: A DECISION MODEL WITH PRACTICAL APPLICATIONS FOR THE DEVELOPMENT OF BEHAVIOR DECELERATIVE STRATEGIES Peter F. Gerhardt and David L. Holmes Introduction... "... 247 Component I-Determination of Need... 248 Component II-Functional Analysis of Environmental Conditions....... 252 Component III-Functional Analysis of the Curricular Component... 256 Component IV-Differential Reinforcement... 258 Component V-Development of an Aversive Decelerative Procedure... 262 EDM Case Study............................................... 265 Discussion... 272 References... 274 AUTHOR INDEX... 277 SUBJECT INDEX... 285