Psychiatric Times September 2005 Vol. XXII Issue 10
Autistic disorder (autism) is a childhood-onset disorder characterized by marked impairments in social interaction, communication and behavior. Aggression is a frequent reason for psychiatric referral in this population. As such, the clinician needs to be knowledgeable regarding aggression assessment and treatment. This article will provide an overview of treatment modalities, with emphasis on the future direction of interventions targeting aggression in children with autism.
Behavioral and pharmacologic interventions cannot begin until the patient has been thoroughly assessed in terms of diagnosis, cognitive abilities and other factors related to the complaint of aggression. In identifying these factors, it is important to begin with a detailed inquiry as to the duration, frequency and severity of the aggression, as well as precipitating or exacerbating factors. Evaluation for comorbid psychiatric disorders (e.g., major depression) and symptoms (e.g., impulsivity), as well as medical conditions (e.g., epilepsy), is also important in guiding interventions.
An initial behavioral assessment, called a functional analysis, is performed prior to behavioral therapy. Functional analyses are controlled observational sessions that are conducted to objectively determine the primary motivating factor for the child's misbehavior. Primary motivational factors or functions of behavior are typically to seek attention, access a preferred item or escape a task. Another function may be that the child engages in a behavior that is inherently pleasurable. As such, determination of any appropriate and beneficial treatment approach would be selected on the basis of the empirically determined motivational factor, rather than on arbitrary selection (Hagopian et al., 2001).
Behavioral interventions, particularly those based upon applied behavior analysis (ABA), have long had empirical support for addressing problematic behavior (for a review, see Schreibman, 2000). These methods have been utilized for a wide range of disorders and myriad behavioral difficulties (Heflin and Simpson, 1998) and have not been exclusively utilized for the treatment of autism. However, intervention with roots in ABA has been regarded as one of the primary forms of treatment, given its stability in the literature and practice over decades, as well as the fact that it lends itself to objective evaluation.