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Effects of SOBER Breathing Space on Aggression in Children with Autism Spectrum Disorder and Collateral Effects on Parental Use of Physical Restraints

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Abstract

Several methods have been used to assist children with autism spectrum disorder (ASD) to self-manage their anger and aggression, including psychopharmacological, behavioral, and mindfulness-based interventions. However, no intervention works well with all children who engage in aggression and there is a need to investigate alternative management techniques. Four children with ASD were taught to use SOBER Breathing Space as an informal mindfulness-based practice to control their verbal and physical aggression in the family home. The SOBER Breathing Space required the child to Stop and see what is happening, Observe physical sensations and emotion regulation changes in the body, Breathe by deliberately bringing attention to the breath, Expand awareness of the situation, his or her response to the situation and longer term consequences, and Respond (versus react) mindfully. Effects of the SOBER Breathing Space on verbal and physical aggression were recorded in the family home, as well as generalization effects at school. In addition, parental use of physical restraints contingent on the children’s aggressive behavior was also recorded. In a multiple baseline design across subjects, the children showed they could control their verbal and physical aggression, and could respond mindfully to the emotionally arousing situation instead of automatically reacting in an aggressive manner. Results showed the training effects generalized from home to school, without training in the school setting. In addition, the effects were maintained during the 12-month follow-up period. Furthermore, parental use of physical restraints decreased rapidly and was eliminated within weeks of the children learning to use the SOBER Breathing Space for emotional regulation. This study suggests that some children with ASD may be able to successfully use the SOBER Breathing Space to self-manage their aggressive behavior, thereby eliminating the need for parents to use physical restraints.

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Acknowledgments

The data included in this paper were first presented at the Second International Conference on Mindfulness (ICM-2), Sapienza University, Rome, Italy May 11–15, 2016.

Funding

Preparation of this article was supported by a National Research Foundation of Korea (NRF) grant (NRF-2010-361 A00008) funded by the Korean Government (MEST). No funding for the study was needed because the services of the trainer and the research team were provided on a pro bono basis as a community service.

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Authors and Affiliations

  1. Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta University, Augusta, GA, 30912, USA

    Nirbhay N. Singh

  2. Department of Neuroscience and Sense Organs, University of Bari, Bari, Italy

    Giulio E. Lancioni

  3. WellStar School of Nursing, Kennesaw State University, Kennesaw, GA, USA

    Rachel E. Myers

  4. Department of Psychology, The College of Wooster, Wooster, OH, 44691, USA

    Bryan T. Karazsia

  5. McPherson Therapy and Consulting, Greenville, KY, USA

    Carrie L. McPherson

  6. Little Lotus Therapy and Consulting, Port St. Lucie, FL, USA

    Monica M. Jackman

  7. Institute of Mind Humanities, Wonkwang University, Iksan, South Korea

    Eunjin Kim

  8. San Diego State University, San Diego, CA, USA

    Taylor Thompson

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  1. Nirbhay N. Singh
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  2. Giulio E. Lancioni
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Contributions

NNS designed and executed the study, assisted with the data analyses, and wrote the paper. GEL collaborated with the design and writing of the study. BTK analyzed the data and wrote part of the results. REM, CLM, MMJ, EK, and TT collaborated in the writing and editing of the final manuscript.

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Correspondence to Nirbhay N. Singh.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Singh, N.N., Lancioni, G.E., Myers, R.E. et al. Effects of SOBER Breathing Space on Aggression in Children with Autism Spectrum Disorder and Collateral Effects on Parental Use of Physical Restraints. Adv Neurodev Disord 2, 362–374 (2018). https://doi.org/10.1007/s41252-018-0073-5

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