Treatment of severe problem behaviour in children with autism spectrum disorder and intellectual disabilities

Abstract

Children with autism spectrum disorder (ASD) and intellectual disabilities (ID) present with problem behaviour at rates disproportionately higher than their typically-developing peers. Problem behaviour, such as self-injury, aggression, pica, disruption, and elopement result in a diminished quality-of-life for the individual and family. Applied behaviour analysis has a well-established research base, detailing a number of assessment and treatment methods designed to address behaviour problems in children with ASD and ID. Although the variables that lead to the emergence of problem behaviour are not precisely known, those that are currently responsible for the maintenance of these problems can be identified via functional behaviour assessment, which is designed to identify events that occasion problem behaviour, consequences that maintain it, as well as other environmental factors that exert influence on the behaviour. Corresponding function-based treatment is implemented when environmental determinants are identified, with the aim of decreasing or eliminating problem behaviour, as well as teaching the individual to engage in more appropriate, alternative behaviour. In some cases, when problem behaviour is under the control of both environmental and biological variables, including psychiatric conditions, combining behavioural and pharmacological interventions is viewed as optimal, although there is limited empirical support for integrating these approaches.

Development of the Fearless, Tearless Transition model of care for adolescents with an intellectual disability and/or autism spectrum disorder with mental health comorbidities

“…7 A substantial proportion of children and adolescents with ASD, and/or intellectual disability, have associated severe behavioural problems and mental health disorders, often termed 'dual disability'. 8,9 Challenges to the transition of adolescents with dual disabilities relate to the intrinsic complexity of this cohort as well as deficits within health and disability care systems, thus leading to variation in transition planning, 10 higher levels of anxiety about transitioning, 4 and, for adolescents with more severe intellectual disability, greater parental reluctance to leave paediatric care compared with young people with chronic illness. 2 Furthermore, the extremely high burden of care 11 may lead to issues such as relinquishment of care in addition to acute distress and socioeconomic adversity.…”

“…A 2016 study suggested that the prevalence of ASD has continued to increase in Australia to 2.5% 7 . A substantial proportion of children and adolescents with ASD, and/or intellectual disability, have associated severe behavioural problems and mental health disorders, often termed ‘dual disability’ 8,9 …”

Evaluation of agomelatine for the treatment of sleep problems in adults with autism spectrum disorder and co-morbid intellectual disability

“…When both poor night-time sleep and ID coexist in autistic individuals, increased problematic daytime behaviours appear (Cohen et al, 2018). As happens in the general population (Crowley, 2011), sleep problems and problematic behaviour in individuals with autism lead to both families and residential services seeking treatment, including pharmacological treatment (Newcomb and Hagopian, 2018). Improving sleep patterns in individuals on the autism spectrum can have a beneficial impact both on the individuals and those who care for them (Devnani and Hegde, 2015).…”

Potential therapeutic uses of cannabinoids to treat behavioural problems in children and adolescents with developmental disorders

“…CHILDREN AND ADOLESCENTS with developmental disorders such as intellectual disability commonly exhibit challenging behaviours, including agitation, irritability, aggression and self-injury. 1 Aggression is observed in up to two-thirds of autistic children and adolescents, 2 and self-injurious behaviours -such as head banging, eye poking, arm biting and skin scratching -in more than one-quarter. 3 Approximately half of individuals with intellectual disability have psychopathology, 4 commonly manifesting as severe behavioural problems.…”

“…Behavioural problems in patients with developmental disorders can be difficult to treat. 1 Psychological interventions are often ineffective, leaving environmental modification and medication as the main strategies available. Management is commonly crisis-oriented, including calls to emergency services and presentations to hospital emergency departments.…”