Severe Behavior Problems

Severe problem behavior has the potential to greatly impact the quality of life, not only for the child who exhibits the behavior but also for those of whom provide direct care and support. Preventative strategies that are implemented during early intervention that help to teach skills (communication, toleration, cooperation) prior to the development of severe problem behavior can improve a child’s trajectory, reducing the future need for invasive management techniques such as restraint or seclusion. Reactive strategies will be necessary if the severe problem behavior has already become a pervasive issue and will often begin with a functional assessment to understand the environmental contingencies contributing to problem behavior. Behavioral treatments will then rearrange the contingencies to reduce severe problem behavior and promote other alternative appropriate behaviors. In addition, many of these children who exhibit severe problem behavior are likely to experience trauma sometime in their childhood. In this chapter, we discuss how behavioral treatments can be designed around a trauma-informed framework to address trauma and avoid retraumatization.