Standardized Measures of Challenging Behaviors

Once a presenting concern has been identified, another class of standardized measures that focuses more specifically on challenging behavior may ensue. These scales often measure multiple forms of challenging, atypical, or disruptive behaviors, though, at times, users focus on just a single subscale related to challenging behaviors. Four of the most widely used options and the key characteristics and strengths and weaknesses of these measures are described below, with some additional options included in Table 4.

Aberrant Behavior Checklist Second Edition (ABC-2)

The ABC-2 (Aman & Singh, 2017) is one of the most widely utilized standardized questionnaires related to challenging behaviors in ASD. It includes five broad scales:

• irritability
• hyperactivity
• lethargy
• repetitive behaviors
• inappropriate speech

The ABC-2 has decades of support from research in autism and other intellectual and developmental disabilities for its psychometrics. The Irritability subscale, which is most commonly employed in research, includes a constellation of items tapping into tantrums, SIB, and one item on aggression. The ABC-2 Irritability subscale has been used to support FDA approval of medications to treat irritability and is widely used as an outcome measure related to challenging behaviors in ASD. The ABC-2 also includes a Hyperactivity subscale, which can be very relevant to challenging behaviors as well. The ABC-2 can be utilized across the lifespan.

Emotion Dysregulation Inventory (EDI)

The EDI (Mazefsky et al., 2018) is a standardized questionnaire of reactivity (intense negative emotional reactions) and dysphoria (low positive affect, unease). The Reactivity scale may be particularly relevant when challenging behavior is accompanied by emotional outbursts. The EDI includes young child (2-5-year-old) and 6+ caregiver report versions; a self-report version for ages 11 and older (including adults) and adult caregiver norms are being developed. The EDI has strong evidence to support its use in ASD, as well as general community and clinical samples, making it suitable for use in both settings specializing in ASD and those that serve broad populations including ASD. Advantages of the EDI include its validity for both nonverbal and verbal individuals, its brevity, change-sensitivity, and the availability of clinical cut-offs. The EDI is freely available for use (requests can be made at: www.reaact.pitt.edu by completing the EDI Inquiry Form).

Behavior Problems Inventory (BPI-01)

The BPI-01 (Rojan et al., 2001) is an informant questionnaire that measures the frequency and severity of different types of challenging behaviors. Originally developed for individuals with intellectual disability, the BPI-01 produces scores for aggressive/destructive behavior, SIB, and stereotyped behavior. It also has a short form which reduces the item number from 49 to 30 (Rojahn et al., 2012). The BPI-01 is only applicable to those who have demonstrated a behavior at least once in the past two months and is therefore more appropriate when challenging behavior is a referral concern.

Self-Injurious Behavior subscale of the Repetitive Behaviors Scale - Revised (RBS-R)

The SIB scale of the RBS-R (Bodfish et al., 2000; Lam & Aman, 2007) is perhaps the most common applied standardized measure of SIB. It is part of a broader scale focused on repetitive behaviors. It is a 43-item measure that assesses behavior in the past month. It is appropriate for use with children, adolescents, and adults. Unlike the other measures, the RBS-R is freely available.