Challenging Behavior

For individuals with Profound Autism, challenging behavior can be a significant part of daily life. These behaviors often arise from communication difficulties, environmental circumstances, or internal sensations caused by physical health problems. At times, challenging behavior can become severe and even life-threatening.

It is important to remember that these behaviors are not “bad” or “intentional misbehavior,” but can be the person’s way of communicating distress, a reaction to pain, or the result of skill deficit. While challenging behavior can be overwhelming, there are evidence-based strategies and supports that can make a meaningful difference in keeping profoundly autistic people safe and healthy.

Types of Challenging Behavior

Challenging behavior may include self-injurious actions, physical aggression, pica (eating non-food items), or bolting (running away suddenly). For families and caregivers, it can be deeply traumatic to witness, bringing constant worry about the person’s safety and leaving them feeling unprepared without the tools or skills to help.

  1. Self-injurious behavior (head banging, biting, scratching, hitting self)

  2. Physical aggression toward others (hitting, kicking, biting, scratching, pulling hair)

  3. Pica (eating or mouthing non-food items)

  4. Bolting/elopement (running away suddenly, leaving safe areas)

  5. Property destruction (throwing, breaking, damaging objects)

  6. Severe tantrums or meltdowns (intense, prolonged emotional outbursts)

  7. Persistent screaming or loud vocalizations

  8. Repetitive or compulsive behaviors that interfere with safety or daily life

  9. Sleep disturbances (chronic difficulties falling or staying asleep, impacting family well-being)

  10. Encopresis/enuresis (soiling or urinating outside the toilet, when not due to medical causes)

Evidence-Based Treatments

Challenging behavior in profound autism can be complex, but research shows that there are evidence-based strategies that can help reduce risk, support communication, and improve quality of life for both the individual and their caregivers. These approaches are most effective when combined into a comprehensive, individualized plan tailored to the person’s needs.

    • A structured process to identify why a behavior occurs (e.g., escape, attention, sensory need, pain/discomfort).

    • Interventions are then tailored to address that function.

    • Considered the gold standard in treatment.

    • Functional Communication Training (FCT): Teaching individuals to use communication (words, pictures, devices) to express their needs and preferences.

    • Differential Reinforcement: Reinforcing appropriate alternatives while minimizing reinforcement for challenging behavior.

    • Skill Building: Teaching self-care, social, or coping skills to reduce frustration.

    • Choice-Making: Providing structured opportunities to make choices, which increases autonomy and reduces the need for challenging behavior to gain control.

    • Identifying and treating underlying health issues (e.g., pain, gastrointestinal problems, sleep disorders, seizures).

    • Regular health check-ups to rule out medical causes of behavior.

    • Medications (e.g., risperidone, aripiprazole) may be prescribed for severe aggression or self-injury.

    • Always combined with behavioral supports, not used alone.

    • Recognizing the emotional toll on families and caregivers.

    • Providing caregiver training in safe behavior support strategies.

    • Using crisis prevention and de-escalation strategies.

    • Adjusting surroundings to reduce triggers (noise, crowding, transitions, demands).

    • Providing predictability through visual schedules or structured routines.

    • Offering sensory supports (noise-canceling headphones, weighted blankets, calming spaces).

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