Interventions

While relatively minor challenging behaviors can often be treated in educational settings or with simple behavior plans, more severe and treatment-resistant problems often require specialized resources. This includes intensive behavioral interventions and/or the use of medications.

Oftentimes, pediatricians are the first professionals to encounter an individual’s challenging behavior. These primary care providers are positioned to initiate the process of assessing the individual’s immediate and longer-term care needs.

It is essential that individuals with more severe problems access the services of professionals who are qualified by training and experience, and licensed/certified to provide such services. These services may include:

• Assessment by a speech language pathologist to identify functional communication needs;
• Assessment by a behavioral service provider to identify the function or cause of challenging behavior; and
• Assessment by a psychiatrist to assess co-occurring psychiatric conditions.

Best Practice Behavioral Interventions

Focused treatment using applied behavior analysis (ABA) has a strong base of empirical support. This approach has been extensively researched and is widely recognized as representing best practices for challenging behaviors such as aggression and self-injury in individuals with ASD and Intellectual and Developmental Disabilities (IDD). The cornerstone of focused treatment for challenging behavior using ABA relies on functional behavioral assessment, which can identify the events that trigger and strengthen challenging behavior.

Assessment findings are then used as the basis for developing highly individualized treatments aimed at changing those situations that occasion the behavior and establishing new patterns of appropriate behavior using reinforcement. This approach to behavioral treatment is consistent with the principle of minimal restrictiveness because more intensive procedures are only used when lesser intensive ones have failed or are determined to be insufficient. These behavior analytic interventions have a strong base of empirical support and are widely recognized as representing best practices.

Risk Management

When encountering challenging behavior, it is important for clinicians to evaluate the risks presented by each type of problem behavior as part of the process for determining the best course of action. Mild challenging behavior, though it might not be harmful to the individual, can become moderate to severe and early intervention may prevent this progression. When problem behavior reaches crisis levels it can pose immediate risks to the individual and others and necessitate crisis management procedures. It is important to identify and weigh the risks of intervening in a crisis situation to employ crisis management, relative to the risks of not employing crisis management

There are also risks associated with assessment and treatment in terms of resources needed to develop effective intervention. Therefore, it is necessary to evaluate the risks of problem behavior in the context of both the risks and benefits of assessment and intervention. Additionally, even with mild challenging behavior, consideration should be given to developing a crisis management plan.