Bottema-Beutel Kristen, Guo Ruoxi, Hinson-Wiliams Jessica, Shen Yueyang, LaPoint Shannon, Woynaroski Tiffany, Sandbank Micheal
Lynch School of Education and Human Development, Boston College, Boston, MA, USA.
School of Teacher Education, Florida State University, Tallahassee, FL, USA.
J Child Psychol Psychiatry. 2025 Jun 1. doi: 10.1111/jcpp.14177.
Some autistic children exhibit behavior that caregivers, clinicians, and researchers consider problematic. However, there is little consensus about the types of behaviors that should be treated as a problem and reduced via intervention. In autism intervention research, problem behaviors range from inherently harmful behaviors such as aggression and self-injury to nonnormative but not harmful behaviors associated with autism such as repetitive movements. Likewise, there are a variety of conceptualizations and measurement practices used to assess these behaviors.
In this secondary systematic review of group-design, nonpharmacological intervention studies for autistic children up to age eight, we explore researchers' conceptualizations of problem behavior and measurement systems to assess problem behavior. We defined problem behavior as any outcome where behaviors were targeted for reduction or elimination. A coding scheme was applied to 102 studies that met inclusion criteria for the secondary review. All studies were double coded by two independent coders.
Sixty-two percent of studies described reducing behavior as a primary or secondary purpose of the study and/or intervention, 33% gave a rationale for targeting behaviors for reduction, and 28% offered a conceptualization of the behavior(s) they targeted. Only 8% offered a conceptual definition. The most common measures were 'off-the-shelf' measures that had undergone at least some previous validation beyond interrater reliability and that involved parent reports. For the 10 most common assessment measures, two were validated along six different validation dimensions in autistic populations. All but one full scale or subscale measured behaviors that were nonnormative but not inherently harmful, or a mix of behaviors that were inherently harmful and that were nonnormative but not inherently harmful.
Intervention researchers should provide clear definitions and rationales for targeting behaviors for reduction via intervention and should develop refined measurement tools for assessing these behaviors in collaboration with the autistic community.
一些自闭症儿童表现出照顾者、临床医生和研究人员认为有问题的行为。然而，对于哪些行为类型应被视为问题并通过干预加以减少，几乎没有达成共识。在自闭症干预研究中，问题行为的范围从本质上有害的行为，如攻击和自我伤害，到与自闭症相关的非规范但无害的行为，如重复动作。同样，用于评估这些行为的概念化和测量方法也多种多样。
在这项对8岁及以下自闭症儿童的群组设计、非药物干预研究的二次系统评价中，我们探讨了研究人员对问题行为的概念化以及评估问题行为的测量系统。我们将问题行为定义为任何旨在减少或消除的行为结果。一种编码方案应用于102项符合二次评价纳入标准的研究。所有研究均由两名独立编码员进行双重编码。
62%的研究将减少行为描述为研究和/或干预的主要或次要目的，33%给出了针对行为进行减少的理由，28%对他们所针对的行为进行了概念化。只有8%提供了概念定义。最常见的测量方法是“现成的”测量方法，这些方法至少在评分者间信度之外还经过了一些先前的验证，并且涉及家长报告。对于10种最常见的评估方法，其中两种在自闭症群体中沿着六个不同的验证维度进行了验证。除一项全量表或分量表外，所有量表测量的行为都是非规范但并非本质上有害的行为，或者是本质上有害与非规范但并非本质上有害行为的混合。
干预研究人员应为通过干预减少行为提供明确的定义和理由，并应与自闭症群体合作开发完善的测量工具来评估这些行为。
