Conceptualizing and Measuring “Problem Behavior” in Early Intervention Autism Research: A Project AIM Secondary Systematic Review

Background: Some autistic children exhibit behavior that is described by caregivers and in research to be problematic. However, there is little consensus about the types of behaviors that should be reduced via intervention, which can range from inherently harmful behaviors such as aggression and self-injury, to non-normative but not harmful behaviors associated with autism such as repetitive movements. Likewise, there are a variety of conceptualizations and measurement practices associated with these behaviors.Methods: In this secondary systematic review of group-design, non-pharmacological intervention studies for autistic children up to age eight, we sought to explore researcher conceptualization and measurement practices of problem behavior. We defined problem behavior as any outcome where specific 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.Results: Forty-seven 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 inter-rater reliability, and that involved parent reports. For the ten most common assessment measures, two were validated along six different validation dimensions in autistic populations. All but one full scale or subscale measured either behaviors that were non-normative but not inherently harmful, or a mix of behaviors that were inherently harmful and that were non-normative but not inherently harmful.Conclusions: 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.