Caregiver perspectives on interventions for behavior challenges in autistic children

Background Children with an autism spectrum disorder (ASD) diagnosis have high rates of behaviors such as aggression, oppositional behaviors, and tantrums. Despite effectiveness of interventions for these behavior challenges in a considerable number of autistic children, there is little information on stakeholder perspectives about available interventions. The present study preliminarily characterized caregiver perspectives on intervention for behavior challenges in school-age autistic children. Method 321 caregivers of autistic children completed a survey about interventions used to address behavior challenges. Kruskal-Wallis rank-sum tests and subsequent pairwise comparisons using a Wilcoxon rank-sum test with False-Discovery Rate-adjusted p-values (q<0.05) were conducted for caregiver ratings of interventions. Thematic analysis was conducted for caregivers’ open-ended suggestions for improving interventions. Results Caregivers indicated limited approval of attempted interventions. For children with an IQ ≥ 70, the omnibus test was significant for caregiver ratings of intervention helpfulness (χ2(8) = 38.707, q<0.001, ε2 = 0.017) with medications and Collaborative & Proactive Solutions (CPS; Greene, 2010) therapy rated highest, and was significant for caregiver ratings of amount of improvement maintained over time (χ2(8) = 46.013, q<0.001, ε2 = 0.020) with medications, CPS, applied behavioral analysis (ABA), and “other interventions” rated highest. For children with an IQ < 70, pairwise tests revealed no significant differences. Caregivers suggested improvements at the systems, provider, caregiver/family, and child/intervention levels. Conclusions Caregivers’ limited approval of interventions used to address behavior challenges suggests the need for improved intervention options. While medications and ABA are standard-of-care interventions, CPS may be a caregiver-preferred and efficacious option that is underutilized among autistic children with an IQ ≥ 70.