Effective Behavioral Intervention for Adults on the Autism Spectrum: Best Practices in Functional Assessment and Treatment Development.

Abstract

As individuals with autism age out of the educational system, families and practitioners are faced with a number of challenges, including placement concerns and limited behavioral support. This change in available resources often affects the quality of behavioral intervention available to adults on the autism spectrum. These concerns are highlighted when considering the prevalence of maladaptive behavior in adult populations. While estimates of the prevalence of problem behavior vary considerably, levels of maladaptive behavior tend to be higher for individuals with autism relative to other disorders, and may include aggression, self-injurious behavior, property destruction, ritualistic behavior, disruption, inappropriate vocalization, and pica (among others). It has been estimated that the prevalence of aggressive behavior ranges from 6.4% to 32.0% of cases, self-injurious behavior ranges from 4.4% to 21.0% of cases, and destructive behavior from 2.3% to 19.0% of cases (Holden & Gitlesen, 2004; Lowe, Allen, Jones, Brophy, Moore, & James, 2007). While procedures for assessment and treatment for these kinds of problem behavior are well-established in the behavioral literature, the adult population presents unique challenges for families and care providers. The purpose of the current paper is to review the status of existing issues in functional assessment and treatment development in adult populations diagnosed with autism. In addition, we will review some potential strategies for improving services to this underserved population. Challenges to Functional Assessment and Treatment Development in Adults While assessment and treatment procedures for problem behavior have been well established in the research literature, the representation of adult populations is generally lacking relative to younger populations (Hanley, Iwata & McCord, 2003). There are a number of factors which contribute to this relative dearth in the literature. Legislation. Perhaps the most salient reason for the lack of services (and subsequently, research) in adult populations is that the legislation mandating the use of functional behavioral assessment and functional-based intervention procedures only extend to individuals to age 21. Upon reaching the age of 21, the adult populations are not provided with the same entitlements as their school-age counterparts with regard to "functional behavioral assessment" and "positive behavioral supports." Cost of Services. Providing services for adults with autism-spectrum disorders represents a substantial economic expense for families and government agencies (Cimera and Cohan, 2009; Ganz, 2006; Jarbrink, McCrone, Fombonne, Zanden, & Knapp, 2007). Adults with autism are among the most costly individuals with disabilities to serve, second only to those individuals with sensory impairments. It has been estimated that it costs approximately $3.2 million dollars to financially support an autistic person over their lifetime (Ganz, 2006). Considering that it is not uncommon for individuals with autism to live into their sixties (Shavelle and Strauss, 1998), it is clear that care during adulthood represents a sizeable cost. With limited funds available, assessment and treatment practices are more likely to use less thorough models of assessment and treatment which require less time, money and other resources. Lack of Qualified Staff. Another significant challenge to the use of the best available assessment and treatment practices with adult populations is a lack of qualified staff to conduct the assessments. It is often the responsibility of direct care staff to implement comprehensive care plans even though many staff members have little training and/or direct care experience (Sigafoos, Roberts, Couzens, & Caycho, 1992; Wood, Luiselli, & Harchik, 2007). Challenges, such as lack of training/support and fear of injury, may deter otherwise qualified staff from working with this population. …