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Effective behavioral intervention for adults on the autism spectrum: best practices in functional assessment and treatment development.

Functional behavior assessment (FBA) is designed to obtain information as to the purpose a behavior serves an individual so practitioners can develop and test hypotheses regarding more appropriate replacement behaviors (Cooper, Heron, & Heward, 2007).  Manente, Maraventano, LaRue, Delmolino, and Sloan (2010), investigated the importance of FBA on adult populations and conducted an analysis of best practices and barriers.

According to Manente et al., there is inadequate research in the literature regarding adult populations compared to younger populations.  They cite legislation (entitlement for services for individuals under 22 years old only), cost of services and lack of funding, lack of qualified staff who focus on FBA for adults, and the severity and complexity of behaviors in adults as the main reasons why there is limited research and published best practices.  An interesting point made by Manente et al., is that adults have more severe problem behavior, compared to younger populations because of their physical stature and the fact that they have engaged in the problem behaviors longer and in multiple environments.  These reasons, Manente et al., suggest make adult populations less desirable candidates for practitioners who specialize in FBA.

Because of this lack of focus on adult populations, students who exit the school systems enter the adult services world with significant disadvantages.  According to Manente et al., failure to address problem behavior when students are entitled to services may lead to more restrictive placements and less community integration, higher risk of abuse, greater reliance on default technologies such as psychotropic medication and punishment procedures, and an overall psychological toll on human services staff and family members. All of this adding up to poor adult outcomes and decreased independence which affects the quality of life of the individual with autism as well as their families.

Manente et al., suggest that if this pattern is to be broken, there is a need for more qualified individuals who can and would be willing to conduct FBA on adult populations.  A bulk of their article focuses on an overview and the component of FBA and how modifications can be made to address the main reasons why adult populations are omitted from this best practice.  According to Iwata, Smith, and Michael (2000), problem behavior is mostly maintained by three types of reinforcement – social positive (seeking to get attention), social negative (seeking to escape attention or a task) and automatic (sensory).  FBA is designed to evoke the problem behavior in a controlled setting in an effort to determine which of these three types of reinforcement is maintaining a problem behavior.  Once this is determined, a practitioner can suggest and test the effectiveness of a more appropriate replacement behavior that serves the same function as the problem behavior.  Because adult populations often exhibit more severe problem behavior, compared to younger populations, there has been a reluctance to evoke their behaviors even if the end result could reduce or eliminate the maladaptive behaviors.  As a result, Manente et al., suggest alternative FBA modifications and/or models such as antecedent-behavior manipulation (structured descriptive assessment where antecedents are manipulated and behaviors are recorded), trial-based FBA (reinforcement of first instance of problem behavior only), latency-based FBA (measure of how long it took to reach the first instance of problem behavior), and FBA of precursor behavior (conducting FBA on the behavior which immediately precedes the more severe problem behavior).

Manente et al. point out that understanding the function of behavior is critical in developing effective treatment which could improve overall bleak outcomes for autistic adults who have maladaptive behaviors. They highlight two issues which need immediate attention:  First, they suggest that parent be pro-active in insisting behavior services occur with a focus on generalization and maintenance to multiple environments, to the greatest extent possible, while their children are young and still entitled to services.  This will better position these students when the time comes for them to transition out of the school systems and into the adult world, where they are only eligible for services – no entitlement.  Secondly, Manente et al., ask that practitioners and researchers continue to expand and develop effective FBA models specifically designed to address the complex needs of adults.  Because FBA is a proven best practice at reducing problem behavior and improved outcomes in younger populations, greater efforts need to be made to provide the same supports for their underrepresented adult counterparts.