Handling the difficult behaviors that autistic children can display is a challenge for parents, and can be extraordinarily stressful. But new research shows that teaching or “training” parents how to better manage these behaviors can make a big difference in the children’s everyday functioning, and possibly in their need for medication.
Parent training has long been shown to help manage difficult behaviors in non-autistic children, so the authors of the current study wondered if it might also help children with autistim spectrum disorder.
They were instructed to pay attention to what typically preceded or triggered tantrums and other unwanted behaviors and develop new ways of handling them so as not to reinforce them.
Lawrence Scahill and his team at Yale University’s School of Nursing and Child Study Center, recruited 124 families, with children between the ages of four and 13, who were diagnosed with autism spectrum disorder (ASD). The children regularly engaged in behaviors like tantrums, aggression, and self-injury. All of the kids were prescribed the antipsychotic drug risperidone (Risperdal), which has been approved by the FDA to treat behavioral problems in autistic kids.
Half of the parents were assigned to take classes in managing the behaviors. They were instructed to pay attention to what typically preceded or triggered tantrums and other unwanted behaviors and develop new ways of handling them so as not to reinforce them. For example, if a child often threw tantrums in response to getting dressed in the morning, the parent was shown how to anticipate the signs leading up to it, create a different morning routine, and use “selective ignoring” so as not to reinforce the unwanted behaviors. The parents were taught through one-on-one instruction, role playing, video vignettes to illustrate the methods, and phone and home visit follow-ups.
After the six-month study period, all kids showed decreases in difficult behaviors, but the children of the parents who’d taken the training showed a greater reduction. These children also showed improvements in basic functioning, including socializing, communicating, dressing themselves, and eating. However, most effects were non-significant, which means they could have been due to chance. Alternatively, more significant differences might be seen in a larger group of participants, which will need to be addressed in the future.
The study does bring some encouragement to families who are struggling with difficult behaviors. More research will be needed to determine the changes that might be seen in kids are not on medication but whose parents take a training course. Medication may or may not be appropriate for all children with autism, so learning how to manage the challenging behaviors can be helpful, and, the authors write, “enhance the quality of life in this vulnerable population.”
The study was published in the Journal of the American Academy of Child & Adolescent Psychiatry.
