Caregivers, pediatricians, community mental-health providers, and school personnel should all engage in a collaborative effort to identify deviations from developmentally normative and clinically significant levels of challenging behavior in children with ASD. Initially, stakeholders in an individual’s care (e.g., PCP, school psychologist) screen for challenging behavior by employing a combination of indirect and direct assessment strategies to gather information about a child’s developmental presentation and presence of challenging behavior in relation to same-aged peers. These assessment strategies identify concerns related to the form, frequency, duration, and/or intensity of challenging behaviors, as well as consideration of the individual’s strengths and preferences. The information gathered from these assessments illuminate next steps for clinical decision making. Then, FBA may be needed to directly examine the environmental influences on challenging behavior, which in turn is prescriptive for treatment.

By continuing to monitor challenging behavior over time, perhaps during routine PCP visits, individuals can be linked to the assessment and treatment approaches that meet their, and their families, unique and ever-changing needs. For example, for more severe and frequent forms of challenging behavior, specialized settings that provide psychiatric assessment and functional analysis methodologies to inform treatment may be recommended (e.g., inpatient care). Over time, however, adaptive functioning may improve, and outpatient or community-based care may be better suited and preferred. Repeated measurement of challenging behavior over time and across services is needed to match treatment to each individual’s needs and strengths.

In closing, challenging behavior is prevalent in the ASD population and associated with a host of negative health outcomes. Early identification and assessment are needed to provide earlier intervention and improve quality of life.