Table Of ContentSERIAL EDITOR
ROBERT M. HODAPP
Vanderbilt Kennedy Center for Research on Human Development, Department of Special
Education, Peabody College, Vanderbilt University, Nashville, TN, USA
BOARD OF ASSOCIATE EDITORS
PHILIP DAVIDSON
University of Rochester School of Medicine and Dentistry
ELISABETH DYKENS
Vanderbilt University
MICHAEL GURALNICK
University of Washington
RICHARD HASTINGS
Bangor University
LINDA HICKSON
Columbia University
CONNIE KASARI
University of California, Los Angeles
WILLIAM McILVANE
E. K. Shriver Center
GLYNIS MURPHY
University of Kent
TED NETTELBECK
Adelaide University
MARSHA MAILICK SELTZER
University of Wisconsin-Madison
JAN WALLANDER
Sociometrics Corporation
VOLUME FORTY FOUR
I r
nternatIonal evIew of
RESEARCH IN
DEVELOPMENTAL
DISABILITIES
Challenging Behavior
Edited by
RICHARD HASTINGS
School of Psychology,
Bangor University, Bangor,
Gwynedd, Wales, UK
JOHANNES ROJAHN
Department of Psychology,
George Mason University,
Fairfax, VA, USA
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ISBN: 978-0-12-401662-0
ISSN: 2211-6095
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CONTRIBUTORS
Dawn Adams
The Cerebra Centre for Neurodevelopmental Disorders, School of Psychology, University
of Birmingham, Birmingham, UK
Debbie Allen
The Cerebra Centre for Neurodevelopmental Disorders, School of Psychology, University
of Birmingham, Birmingham, UK
Michael G. Aman
Nisonger Center UCEDD, Ohio State University, Columbus, OH, USA
Leah Bull
The Cerebra Centre for Neurodevelopmental Disorders, School of Psychology, University
of Birmingham, Birmingham, UK
Iser G. DeLeon
Department of Behavioral Psychology, The Kennedy Krieger Institute, Johns Hopkins
University School of Medicine, Baltimore, MD, USA
Darragh P. Devine
Department of Psychology, University of Florida, FL, USA
Robert Didden
Behavioral Science Institute, Radboud University Nijmegen, Nijmegen, The Netherlands
Cristan A. Farmer
Pediatrics & Developmental Neuroscience Branch, National Institute of Mental Health,
Bethesda, MD, USA
Meagan K. Gregory
School of Psychology, Florida Institute of T echnology, Melbourne, FL, USA
Mary Heald
The Cerebra Centre for Neurodevelopmental Disorders, School of Psychology, University
of Birmingham, Birmingham, UK
Andrew Jahoda
Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland, UK
Giulio E. Lancioni
Department of Neuroscience and Sense Organs, University of Bari, Bari, Italy
Russell Lang
Clinic for Autism Research Evaluation and Support, Texas State University-San Marcos,
San Marcos, TX, USA; The Meadows Center for Preventing Educational Risk, The
University of Texas at Austin, Austin, TX, USA
William R. Lindsay
Castlebeck, Department of Psychology, University of Abertay Dundee, Angus, Scotland, UK;
Bangor University, Wales, UK; Deakin University, Australia
ix
x Contributors
Kenneth M. A. MacMahon
Department of Clinical Psychology, Adult Learning Disability Service, NHS Lanarkshire,
Scotland, UK
Laura Lee McIntyre
Department of Special Education and Clinical Sciences, University of Oregon, Eugene,
OR, USA
Suzanne M. Milnes
Munroe-Meyer Institute, University of Nebraska Medical Center, Omaha, NE, USA
Jo Moss
The Cerebra Centre for Neurodevelopmental Disorders, School of Psychology, University
of Birmingham, Birmingham, UK; Institute of Cognitive Neuroscience, University
College London, London, UK
Mark F. O’Reilly
The Meadows Center for Preventing Educational Risk, The University of T exas at Austin,
Austin, TX, USA
Chris Oliver
The Cerebra Centre for Neurodevelopmental Disorders, School of Psychology, University
of Birmingham, Birmingham, UK
Carol Pert
Mental Health and Wellbeing, University of Glasgow, Glasgow, Scotland, UK
Claire C. St. Peter
Department of Psychology, West Virginia University, Morgantown, WV, USA
Cathleen C. Piazza
Munroe-Meyer Institute, University of Nebraska Medical Center, Omaha, NE, USA
Jeff Sigafoos
School of Educational Psychology, Victoria University of Wellington, Wellington, New
Zealand
Frank J. Symons
Department of Educational Psychology, University of Minnesota, Minneapolis, MN, USA
Larah van der Meer
School of Educational Psychology, Victoria University of Wellington, Wellington,
New Zealand
Lucy Wilde
The Cerebra Centre for Neurodevelopmental Disorders, School of Psychology, University
of Birmingham, Birmingham, UK
Paul Willner
Department of Psychology, College of Human and Health Sciences, Swansea University,
Swansea, UK
Kate Woodcock
The Cerebra Centre for Neurodevelopmental Disorders, School of Psychology, University
of Birmingham, Birmingham, UK; Culture and Social Cognitive Neuroscience
Laboratory, Department of Psychology, Peking University, Beijing, PR China
PREFACE
When we first conceived this volume, our aim was to bring together reviews
that represent the state of the art in relation to challenging behaviors in adults
and children with developmental disabilities. We sought international authors
at the forefront of their fields in the understanding and treatment of chal-
lenging behaviors. Authors were asked to include the latest research evidence
and thus to mainly incorporate published literature from 2002 to 2013. It is
very pleasing to see that all authors have delivered on this request, typically
only citing earlier studies where there is a lack of contemporary evidence or
where citations are needed to provide some context for the reviews.
The second request we made to all authors was to include discussion of
theoretical perspectives, both biological and psychosocial (and their interac-
tions), and perspectives on or implications for treatment. In terms of treat-
ment, sometimes the topic areas naturally lend themselves to authoritative
reviews of treatment evidence. In other cases, we encouraged authors to
discuss the implications of their theory and research reviews for treatment
and where possible to offer new insights that may prompt new lines of
work in the field. Although treatment is a part of all the reviews in the first
section of the volume (“Behavioral, psychological, and biological aspects of
challenging behaviors”), we focused in the second section specifically on
domains related to treatment that we believed were generating new evi-
dence or that go across multiple domains or forms of challenging behavior.
The volume begins with Sigafoos et al. providing perspectives on the
early emergence of challenging behaviors and early intervention. We then
move to four of the most common forms of challenging behavior in people
with developmental disabilities: self-injury (Symons & Devine), aggressive
behavior (Jahoda et al.), criminal/offending behavior (Lindsay), and eating/
feeding problems (Milnes & Piazza). The first section of the volume ends
with a chapter by Oliver et al. that focuses on genetic syndromes and an
integrative perspective on biological and behavioral/psychological models
of understanding.
In the second section of the Challenging Behavior volume, DeLeon et al.
provide an overview of developments in behavioral theory and implica-
tions for the treatment of challenging behaviors, McIntyre reviews evidence
for using behavioral parent training as a means of treatment especially in
young children, and Farmer and Aman review pharmacological interven-
tion approaches.
xi
xii Preface
We believe that these reviews provide a state-of-the-art perspective on
challenging behaviors in the field of developmental disability. In addition,
each author or team of authors have also addressed new ideas that they
and others have been working on and offer new perspectives on both our
understanding and treatment of challenging behaviors. It is clear from these
reviews that multiple viewpoints are being applied to challenging behaviors
and this is because we cannot ignore the evidence that a range of biologi-
cal, behavioral, psychological and social perspectives are needed to make
decisive progress in understanding of these behaviors. More importantly
though, these chapters make clear that simple models are likely to be found
wanting and that the proper transdisciplinary integration of several perspec-
tives into new theoretical understandings will benefit people with develop-
mental disabilities and their families and carers.
Richard P. Hastings
Johannes Rojahn
February 2013
CHAPTER ONE
Early Signs and Early Behavioral
Intervention of Challenging
Behavior
Russell Lang*,‡, Jeff Sigafoos†,1, Larah van der Meer†, Mark F.
O’Reilly‡, Giulio E. Lancioni§, Robert Didden¶
*Clinic for Autism Research Evaluation and Support, Texas State University-San Marcos, San Marcos, TX, USA
†School of Educational Psychology, Victoria University of Wellington, Wellington, New Zealand
‡The Meadows Center for Preventing Educational Risk, The University of Texas at Austin, Austin, TX, USA
§Department of Neuroscience and Sense Organs, University of Bari, Bari, Italy
¶Behavioral Science Institute, Radboud University Nijmegen, Nijmegen, The Netherlands
1Corresponding author: E-mail: [email protected]
Contents
1. Introduction 2
2. Theories on the Emergence of Challenging Behavior 4
2.1. Biological Influences on the Development of Challenging Behavior 5
2.2. Learning Factors and the Development of Challenging Behavior 6
2.3. Phenotype–Learning Interactions 7
3. Risk Factors and Precursors for Challenging Behavior 8
3.1. Risk Factors for the Development of Challenging Behavior 8
3.2. Precursors of Challenging Behavior 9
4. Review of Early Intervention Studies for Treatment of Challenging Behavior 16
4.1. Previous Meta-Analytic Reviews 16
4.2. Examples of Successful Early Behavioral Intervention 20
4.3. Important Components and Attributes of Effective Intervention 25
4.4. Child Characteristics Associated with Positive Intervention Outcomes 27
5. Remaining Issues and Future Research 28
6. Conclusions 29
References 30
Abstract
This chapter summarizes research on the emergence of challenging behavior and
early behavioral intervention for the treatment of challenging behavior in young
children with Intellectual Disability (ID). Biological and learning theories related to the
emergence of challenging behavior and risk factors for challenging behavior, which
include a variety of constitutional (e.g. intelligence quotient, syndrome, adaptive
behavior deficits) and environmental variables (e.g. reinforcement contingencies), are
reviewed. Literature related to precursor behaviors that reliably predict challenging
behavior is also reviewed. Data support the use of behavioral intervention to reduce
International Review of Research in Developmental Disabilities, Volume 44 © 2013 Elsevier Inc.
ISSN 2211-6095, http://dx.doi.org/10.1016/B978-0-12-401662-0.00001-4 All rights reserved. 1
2 Russell Lang et al.
challenging behavior in young children with ID. A two-phase model involving functional
analysis followed by function-based treatments appears to produce the largest effect
sizes. Additional research is required to establish the utility of preventing challenging
behavior by reducing risk factors and/or through the treatment of precursor behavior.
Future research should also aim to more fully explore child characteristics that might
predict intervention outcomes.
1. INTRODUCTION
Challenging behavior (e.g. self-injury, aggression, and property
destruction) is prevalent among individuals with intellectual disability
(ID) (Poppes, van der Putten, & Vlaskamp, 2010). For example, a study of
900 individuals with ID reported an 11% prevalence figure for challenging
behavior (Holden & Gitlesen, 2006). There is also evidence to suggest
that challenging behavior among individuals with ID emerges during the
early years of life. Emerson et al. (2001) gathered data on the emergence of
challenging behavior among some 4000 individuals with ID. The research-
ers surveyed the presence or absence of several major types of challenging
behavior (e.g. aggression, self-injury, and destructive behavior). Their data
suggested that challenging behavior typically emerged around 2–3 years of
age, although in some cases such behavior was present within the first 6
months of life.
In a more recent study, Kurtz, Chin, Huete, and Cataldo (2012) moni-
tored 32 children who were <5 years of age. The children were moni-
tored because each had begun to engage in self-injurious behavior (SIB)
within the previous 6 months. The monitoring procedures involved (1)
interviewing parents, (2) standardized measures of development, language,
and challenging behavior, and (3) home-based observations. Among
this sample, SIB was reported to have started prior to 1 year of age. In
addition to SIB, most of the children also engaged in other challenging
behavior (e.g. tantrums and aggression). The earlier emergence of chal-
lenging behavior in this study, compared to Emerson et al. (2001), could
stem from Kurtz et al.’s selection of a smaller sample of children who
had already begun SIB. This sample could thus be seen as perhaps more
clearly at risk than the larger population in the Emerson et al. study. Still,
these studies suggest that early intervention and prevention of challeng-
ing behavior among children with ID may be required prior to 1 year of
age in some cases.
Indeed, without effective early intervention, challenging behavior is
likely to persist and greatly impede socialization, complicate rehabilitation
Early Signs and Early Behavioral Intervention 3
and education efforts, and cause injury to the individual and/or their
caregivers (Green, O’Reilly, Itchon, & Sigafoos, 2005). While fluctuations
in the intensity and frequency are common, challenging behavior has
been found to be highly persistent across the lifespan (Taylor, Oliver,
& Murphy, 2011; Totsika & Hastings, 2009). In extreme cases, the
challenging behavior can be fatal (Luiselli, 2012). Even in less extreme
cases, challenging behavior is a major source of stress for parents (e.g.
Hastings, 2002; Peters-Scheffer, Didden, & Korzilius, in press). Challenging
behavior is also commonly identified as a major cause of “burnout” among
professionals (Yoon, 2002). Given the early emergence, persistence, and
adverse consequences, it is not surprising that a great deal of research
has focused on understanding the nature, assessment, and treatment of
challenging behavior in young children with ID.
However, understanding the evidence base related to the nature,
assessment, and treatment of challenging behavior in young children with
ID is complicated by several factors. First, broad theoretical perspectives
regarding the etiology of challenging behavior (i.e. biological and learning)
have been delineated. These theories are not necessarily mutually exclusive
in that learning experiences may strengthen behavior that might have had a
genetic basis. Still the two perspectives do tend to suggest different e mphases
in terms of early intervention.
Second, the frequency, severity, and form of challenging behavior, as
well as the specific approach to early intervention, are often influenced by
the presence or the absence of a number of risk factors. Several risk factors
have been associated with challenging behavior among individuals with ID.
These include comorbid conditions such as autistic disorder and severity of
ID (e.g. Richards, Oliver, Nelson, & Moss, 2012). Specifically, challenging
behavior is generally more prevalent among individuals with severe versus
mild/moderate ID. Deficits in adaptive behavior functioning, especially
communication and social skills deficits, have also been implicated as risk
factors for challenging behavior among individuals with ID (Sigafoos,
Arthur, & O’Reilly, 2003). However, these general claims need to be
tempered by the fact that links between some of these factors—degree
of adaptive behavior deficits for instance and probability of challenging
behavior—are not always evident. Kurtz et al. (2012), for example, found
little relation between communication ability and SIB in their sample of
32 preschool children. Additional potential risk factors that have been
identified in some studies include living in an impoverished environment
and the presence of significant health/mental health problems, such as
