Cross cultural differences in challenging behaviors of children with autism spectrum disorders: An international examination between Israel, South Korea, the United Kingdom, and the United States of America

Challenging behaviors are deemed extremely common within the autism spectrum disorders (ASD) population. Numerous factors and their effects upon the presence and severity of challenging behaviors within this population have been investigated. However, there has been limited research to investigate the effects of cultural differences on challenging behaviors. The aim of the current study was to examine differences between cultures in the reported presence and severity of a multitude of challenging behaviors commonly displayed by children with ASD. The Autism Spectrum Disorders-Behavior Problems for Children was used to assess possible differences between the United States and three other countries (South Korea, Israel, and the United Kingdom). Relatively few differences were found between the United States and both South Korea and Israel, with the United States endorsing a higher presence and severity on items that differed. In contrast, the United States and the United Kingdom differed on nearly half of the behavior items assessed with the United Kingdom reporting greater endorsements. The potential implications of these results are discussed.     

Caregiver-mediated approaches to managing challenging behaviors in children with autism spectrum disorder

A significant proportion of children with autism spectrum disorder (ASD) are referred to mental health centers due to the presence of challenging behaviors. Because challenging behaviors in children and adolescents with ASD often result from underlying social and communication difficulties and comorbid anxiety, traditional caregiver-mediated behavior intervention techniques developed for children with disruptive behavior disorders may need to be adapted for this population. Behavioral interventions that target communication skills, social skills, anxiety, and sensory responsiveness in children with ASD may be needed. Notably, while best practice necessitates the involvement of caregivers in treating children and adolescents with ASD, few randomized control studies have examined the effectiveness of caregiver-implemented interventions in reducing challenging behaviors. This review summarizes the current literature with regard to caregiver-mediated behavioral interventions for children with ASD, and suggests areas for intervention development and research.     

A meta-analytic study on the effectiveness of comprehensive ABA-based early intervention programs for children with Autism Spectrum Disorders

Excitement and controversy have surrounded the effectiveness of Early Intensive Behavioral Intervention (EIBI) for young children with autism. The purpose of this meta-analysis was to investigate the effectiveness of EIBI based on applied behavior analysis in young children with Autism Spectrum Disorders (ASD). There were 11 studies with 344 children with ASD. Quality of studies was assessed using the Downs and Black Checklist. Experimental groups who received EIBI outperformed the control groups on IQ, non-verbal IQ, expressive and receptive language and adaptive behavior. Differences between the experimental and control groups were 4.96–15.21 points on standardized tests. These results strongly support the effectiveness of EIBI.     

Caregiver-Teacher Concordance of Challenging Behaviors in Children with Autism Spectrum Disorder Served in Community Mental Health Settings

Children with autism spectrum disorder (ASD) exhibit high rates of challenging behaviors that impair functioning and represent the primary presenting problem in mental health (MH) services. Obtaining symptom reports from multiple informants is critical for treatment planning. This study evaluated caregiver-teacher concordance of ratings of the intensity of challenging behaviors in children with ASD receiving MH services, and identified child clinical factors associated with concordance. This sample included 141 children (M?=?9.07 years), their caregivers, and teachers. Caregiver-teacher concordance of challenging behaviors was low and impacted by the degree and type of child psychiatric comorbidity. Findings support need for increased attention to the range of psychiatric problems children with ASD present to tailor treatment recommendations and service delivery.     

Outcome for children with autism receiving early and intensive behavioral intervention in mainstream preschool and kindergarten settings

The evidence for Early and Intensive Behavioral Intervention (EIBI) for children with autism is well founded in several efficacy studies. However, only a few studies have investigated the effectiveness of EIBI in community settings. This study examined whether children receiving one year of EIBI (N = 35) would make larger gains in adaptive behaviors than a group of children receiving treatment as usual (TAU; N = 24). At intake, the groups did not differ significantly on chronological age or level of adaptive behavior. After one year of treatment, children in the EIBI group scored significantly higher on all scales of adaptive behavior as compared to the children receiving TAU. Moreover, children in the EIBI group showed significant improvements in adaptive behaviors, maladaptive behaviors, and autism symptoms after one year of treatment, and this change continued into the second year of treatment, albeit to a lesser degree. Limitations of the study include lack of independent assessments of children receiving EIBI, and lack of random assignment of participants to treatment groups.     

Performance of the Social Communication Questionnaire in children receiving preschool special education services

To assess the performance of the Social Communication Questionnaire (SCQ) in identifying children with autism spectrum disorders (ASD), this study screened 268 children identified as receiving preschool special education services. Parent-reported ASD diagnosis, education department recorded autism special education classification, ADI-R autism, and ADOS autism and ASD were considered as alternative criterion measures of ASD diagnosis. The validity of the SCQ in this population was examined, with a special focus on examining alternative cut-points for indicating ASD. The predictive ability of the SCQ in this population was comparable to that reported for other samples. In addition, findings suggested that a cut-point below the recommended threshold would likely be useful for research studies seeking to identify ASD cases from the population of children receiving special education services. The cut-point selected for use in clinical settings may, however, differ.     

The Relationship of Challenging Behaviors to Severity and Symptoms of Autism Spectrum Disorders

Challenging behaviors were assessed in 313 children, and it was demonstrated that children with autism spectrum disorders (ASD) exhibited greater levels of challenging behavior than both normally developing controls and children with psychopathology or atypical development. Next, we examined the relation between challenging behaviors and symptoms of autism in children with ASD. Severity of ASD was positively related to the number and intensity of challenging behaviors, and those with severe ASD exhibited significantly higher levels of problem behaviors than children with mild or moderate ASD. In addition, clusters of ASD symptoms were able to accurately predict endorsements of 8 of the 18 challenging behaviors assessed. Implications for the assessment and intervention of ASD and challenging behaviors are discussed.     

The relationship between sleep and behavior in autism spectrum disorder (ASD): a review

Although there is evidence that significant sleep problems are common in children with autism spectrum disorder (ASD) and that poor sleep exacerbates problematic daytime behavior, such relationships have received very little attention in both research and clinical practice. Treatment guidelines to help manage challenging behaviors in ASD fail to mention sleep at all, or they present a very limited account. Moreover, limited attention is given to children with low-functioning autism, those individuals who often experience the most severe sleep disruption and behavioral problems. This paper describes the nature of sleep difficulties in ASD and highlights the complexities of sleep disruption in individuals with low-functioning autism. It is proposed that profiling ASD children based on the nature of their sleep disruption might help to understand symptom and behavioral profiles (or vice versa) and therefore lead to better-targeted interventions. This paper concludes with a discussion of the limitations of current knowledge and proposes areas that are important for future research. Treating disordered sleep in ASD has great potential to improve daytime behavior and family functioning in this vulnerable population.     

A review of assessments for determining the content of early intensive behavioral intervention programs for autism spectrum disorders

A large proportion of national education and treatment centers for persons with autism spectrum disorders (ASD), including those providing applied behavior analysis (ABA)-based services, show a relatively high percentage of agreement among practitioners on the instruments they routinely use for a variety of purposes, including curriculum design and treatment evaluation. In this paper, several assessments are reviewed and evaluated in terms of their utility for designing comprehensive early intensive behavioral intervention (EIBI) curriculum programs for children with ASD. The assessments found to be most useful for this purpose are reported. A general critique regarding the available pool of assessment tools is provided and the need for a comprehensive assessment directly linked to curricula is discussed.     

Gender effects on challenging behaviors in children with autism spectrum disorders

Challenging behaviors are extremely prevalent within the autism spectrum disorder (ASD) population. To date, numerous factors affecting the rates of challenging behaviors within the ASD population have been examined including age, gender, ethnicity, and intellectual functioning. Controversy has arisen in regard to the effect of gender on challenging behaviors rates in individuals with ASD with some researchers finding differences while others do not. The aim of the current study was to examine the gender effects of children and adolescents with ASD on challenging behavior rates in an effort to assist in clarifying this relationship. Three hundred ninety-one children ages 2 through 17 years participated in the current study and were assigned to one of four groups: male with ASD, male without ASD, female with ASD, and female without ASD. Differences in rates of challenging behaviors between the groups were examined using the Autism Spectrum Disorder-Behavior Problems for Children. Overall, gender was not found to have an effect on the rates of challenging behaviors among children and adolescents with or without ASD. The implications of this finding are discussed along with possible future avenues of investigation.     

The relationship of comorbid anxiety symptom severity and challenging behaviors in infants and toddlers with autism spectrum disorder

The rates of comorbid anxiety as well as the presentation of challenging behaviors are elevated within the autism spectrum disorder (ASD) population. The current study utilizes the Baby and Infant Screen for Children with aUtIsm Traits (BISCUIT) to explore the relationship of anxiety/repetitive behavior symptom severity and challenging behaviors in infants and toddlers with ASD. Children with ASD who evinced more severe impairment associated with anxiety/repetitive behavior (n = 94) demonstrated higher rates of overall challenging behaviors than those with ASD who evinced no to minimal anxiety impairment (n = 291). Specifically, a comparison of individual challenging behavior items indicated that the infants and toddlers with moderate to severe anxiety impairment exhibited more significant challenging behaviors under the domains of aggression/destruction, stereotypies, and self-injurious behavior than children with no to minimal impairment. This study adds to the literature evidencing an exacerbation of challenging behaviors by comorbid psychopathology in individuals with ASD. Clinical implications of these results are discussed.     

Cost comparison of early intensive behavioral intervention and treatment as usual for children with autism spectrum disorder in the Netherlands

Early intensive behavioral intervention (EIBI) may result in improved cognitive, adaptive and social functioning and reductions in autism severity and behavioral problems in children with Autism Spectrum Disorder (ASD). For a subset of children, normal functioning may be the result. However, due to the intensity (20-40h per week for 3 years with a low child staff ratio) implementation costs are high and can be controversial. Estimated costs for education, (supported) work and (sheltered) living for individuals with ASD in the Netherlands are applied in a cost-offset model. A compelling argument for the provision of EIBI is long term savings which are approximately € 1,103,067 from age 3 to 65 years per individual with ASD. Extending these costs to the whole Dutch ASD population, cost savings of € 109.2-€ 182 billion have been estimated, excluding costs associated with inflation.     

Effectiveness of early behavioral intervention in public and mainstream settings: The case of preschool-age children with autism spectrum disorders

Despite the demonstrated positive outcomes of early intensive behavioral intervention (EIBI) among children with autism spectrum disorders (ASD), several challenges to its implementation on a large scale and in community settings remain. In order to maximize the accessibility and cost-effectiveness of its services, a regional public agency serving children with ASD implemented two consecutive programs: a 1 year pre-program for parents (intensive sessions followed by 1 hour per week of individual coaching) and an early behavioral intervention (EBI) program with less than optimal weekly intensity (16–20 hours) delivered in mainstream day care settings. The outcomes of these programs were assessed among 93 children. Their IQ, adaptive behavior, and socioaffective competencies were found to have improved after 12 months in the EBI program. Their autism symptoms had also decreased marginally. Although the pre-program did not have observable effects on children's outcomes, their parents reported positive impact on their well-being and family life. These results demonstrate the feasibility and sustainability of offering EBI to large, unselected populations. However, the pre-program may need to be offered more intensively in order to yield positive outcomes for children. Delivering EBI services in mainstream settings may foster the development of skills linked to social integration.     

Quality of Life in Parents of Young Adults with ASD: EpiTED Cohort

The impact of ASD on parental QOL was evaluated in the EpiTED cohort study at early adulthood. Two-third of parents of young adults with ASD (66.7%) reported that their QoL was at least moderately altered. The perceived impact of ASD on parental QoL was related to the young adults’ level of adaptive skills, as well as to symptom severity and the presence of challenging behaviors, which appeared to be the main risk factor. The study of change between adolescence and early adulthood showed that parents whose children had a decrease in challenging behaviors perceived a decreased impact on their QoL. These results argue for the importance to propose specific interventions to target associated challenging behaviors in ASD.     

Functional analysis of challenging behavior in children with autism spectrum disorders: A summary of 10 cases

Children with autism spectrum disorders (ASDs) often present with challenging behavior, such as aggression and self-injury. In studies of children with other types of developmental disabilities challenging behavior appears more often to be maintained by attention or escape from demands. Less is known about the operant function of challenging behavior in children with ASD. The aim of the present study was to provide an analysis of the function of challenging behaviors in 10 children with ASD or PDD-NOS. Each child was assessed across five conditions (i.e., attention, escape, tangible, alone, and play). Each condition was presented 8–10 times in a multielement design while the percentage of 10-s intervals with challenging behavior (e.g., aggression, self-injury) was recorded. The results showed that for 8 of the 10 children, challenging behavior was maintained by automatic reinforcement, but by multiple sources of reinforcement for the other 2 children. The overall findings differ from the results of studies on children with other types of developmental disabilities, suggesting the possibility of a characteristically more non-social function to the challenging behavior of children with ASD.     

Subclinical autism spectrum symptoms in pediatric obsessive–compulsive disorder

The literature on subclinical autism spectrum (ASD) symptoms in pediatric obsessive–compulsive disorder (OCD) is scarce, and it remains unclear whether ASD symptoms are related to OCD severity. The aims of the present study were to assess the prevalence of ASD symptoms and age and sex differences in children and adolescents with OCD, and to explore the relation between ASD symptoms and OCD severity. This is the largest study of ASD symptoms in an OCD population to date, and the first directly aimed at elucidating sex and age differences in this matter. The study used baseline data from the Nordic Long-term OCD Treatment Study in which parents of 257 children and adolescents with OCD aged 7–17 completed the Autism Spectrum Screening Questionnaire. OCD severity was assessed with the Children’s Yale–Brown Obsessive Compulsive Scale. Pediatric OCD patients were found to exhibit elevated rates of ASD symptoms compared to a norm group of school-age children. ASD symptoms were concentrated in a subgroup with a prevalence of 10–17 %. This subgroup was characterized by a male preponderance with a sex ratio of approximately 2.6:1, while children versus adolescents with OCD exhibited similar rates. Autism-specific social and communication difficulties were not related to OCD severity, while restricted repetitive behavior was positively related to OCD severity. The results indicate that clinicians need to be aware of ASD symptoms in children and adolescents with OCD since one out of ten exhibits such symptoms at a clinical sub-threshold.     

Epilepsy in autism spectrum disorder

The purpose of this review is to provide an overview of the research on epilepsy in autism spectrum disorder (ASD). Topics explored are the prevalence of epilepsy in ASD, the importance of studying epilepsy, as well as the questionnaire measures used to assess epilepsy side-effects. Research on the relationships between epilepsy and parental stress and psychological distress, developmental regression, language and communication, adaptive behavior, social skills, autism severity, challenging behavior, comorbid psychopathology, gastrointestinal symptoms, sleep problems, sensory issues and quality of life are also discussed. Finally, recommendations for treatment are given as well as areas where future research is needed.     

Parenting stress within mother-father dyads raising a young child with autism spectrum disorder

BackgroundThe present study assessed different facets of parenting stress in families with a child with ASD (perceptions of parenting-related roles, parent-child interactions, and the child’s behaviors) at three timepoints: right after receiving an ASD diagnosis, immediately following specialized intervention services, and one year after receiving services, upon primary school entry.MethodParticipants were 258 mother-father dyads and their child. Parents provided demographic information and completed measures on their parenting stress and their child’s autism symptom severity.ResultsPartial correlations revealed that, at the time of diagnosis, after controlling for children’s age and autism symptom severity, mothers’ and fathers’ stress was positively and significantly associated with each other, suggesting a bidirectional relation between partners’ psychological adjustment. Cross-lagged panel analyses demonstrated different longitudinal and transactional links, depending on the dimension of stress examined.ConclusionsFindings are discussed in terms of supports that could assist mothers and fathers of children with ASD.     

Effects of activity schedules on challenging behavior exhibited in children with autism spectrum disorders: A systematic review

We reviewed studies implementing activity schedules to decrease challenging behavior of children with autism spectrum disorders (ASD). Systematic searches of electronic databases, journals, and reference lists identified 18 studies meeting the inclusion criteria. These studies were evaluated in terms of the effectiveness of activity schedules to decrease challenging behavior on the basis of forms and purposes of activity schedules, various settings in which the activity schedule was applied, severity of ASD diagnosis, and communication abilities of the participants. Activity schedules were implemented to decrease challenging behavior in 43 participants aged three to 18 years. Activity schedules included photographs, line drawings, and videos intending to promote self-regulation, independence, transitions, or play skills. Regardless of the form and intended purpose of the activity schedule, they proved effective in reducing challenging behavior in each of the reviewed studies. There was some variation in effectiveness of the activity schedules across settings, severity of ASD diagnosis, and communication abilities. Included studies are summarized and evaluated in terms of effectiveness across the aforementioned variables. Implications and suggestions for future research on the use of activity schedules to decrease challenging behavior are discussed.