Treatment of challenging behavior exhibited by children with prenatal drug exposure

doi:10.1016/j.ridd.2007.05.007

Research in Developmental Disabilities

Volume 29, Issue 6, November–December 2008, Pages 582-594

https://doi.org/10.1016/j.ridd.2007.05.007 Get rights and content

Abstract

A large body of literature exists describing the harmful effects of prenatal drug exposure on infant and child development. However, there is a paucity of research examining strategies to ameliorate sequelae such as externalizing behavior problems. In the present study, functional analysis procedures were used to assess challenging behavior exhibited by two children who were prenatally exposed to drugs of abuse. Results for both children indicated that challenging behavior was maintained by access to positive reinforcement (adult attention and tangible items). For one child, challenging behavior was also maintained by negative reinforcement (escape from activities of daily living). Function-based interventions were effective in reducing challenging behavior for both children. Implications for utilizing methods of applied behavior analysis in research with children with prenatal drug exposure are discussed.

Section snippets

Participants and Setting

Participants were two toddlers receiving behavioral assessment and treatment services in a hospital-based intensive outpatient program for individuals with developmental disabilities and severe challenging behavior. Within our clinic, we have seen a subset of patients with prenatal drug exposure who presented with challenging behaviors at a very early age, typically prior to age 2 years. Both participants presented with histories of prenatal exposure to illicit drugs and severe challenging

Results

Results of functional analyses of challenging behavior, indicated as responses per minute (RPM) per session, are presented in Fig. 1. Randy's functional analysis (top panel) revealed high rates of challenging behavior in demand (mean = 2.2 RPM), attention (mean = 2.1 RPM), and tangible (mean = 6.0 RPM) conditions relative to the toy play (control) condition (mean = 0.1 RPM), suggesting that challenging behavior was maintained by access to adult attention, access to preferred items, and escape from ADL's.

Discussion

In this study, two youngsters prenatally exposed to heroin, cocaine and/or alcohol participated in functional analyses of severe challenging behavior. In both cases, challenging behavior was maintained by environmental variables-access to adult attention or preferred activities, or escape from demands. Additionally, behavioral interventions derived from functional analysis results effectively reduced rates of challenging behavior to near zero rate of occurrence for both participants. To our

Acknowledgements

The authors would like to thank Rebecca Heggemeyer and Tara Lieblein for their assistance with data collection.

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Additionally, some researchers have argued that traditional externalizing behavior treatments do not address attachment disruptions (e.g., Suchman et al., 2004) and focus too much on limit-setting and control, which could already be adequate among parents of PSE children (Peisch et al., 2018). On the other hand, there is evidence that the mechanisms underlying negative behavior in children with PSE are similar to the mechanisms underlying negative behavior in general (Kurtz, Chin, Rush, & Dixon, 2008; McConnel et al., 2002; Heller, Sobel, & Tanaka-Matsumi, 1996), and thus might respond well to existing interventions. Parent-Child Interaction Therapy (Niec, 2018) is an ecologically sensitive and flexible intervention that holds promise for treating the externalizing problems endemic to children with PSE.
Children with prenatal substance exposure (PSE) often have behavior problems, but few studies have demonstrated that behavior therapy can be effective for these children. The current study evaluated the efficacy of Parent-Child Interaction Therapy (PCIT) for improving behavior problems in a sample of 116 children with PSE using archival data from a Midwestern PCIT clinic. Analyses included mean comparisons of pre- and post-treatment measures of child and parent behavior, prediction of drop-out from treatment, and evaluation of the potential complicating effects of PSE on treatment response. Results indicate that treatment effects of PCIT for children with PSE appear similar to the outcomes observed elsewhere in the PCIT literature. There was no indication that maternal polysubstance use alters child response to treatment. Attrition was high, but similar to other community trials of PCIT. The current study lends support to the use of PCIT for children with PSE who have behavior problems.
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Commonly identified consequences that reinforce and maintain problem behavior in persons with IDD include provision of adult attention, access to tangible items, and escape from non-preferred tasks (Iwata et al., 1994a,b); however, a number of other functions for problem behavior have been identified (Lancioni, Singh, O’Reilly, Sigafoos, & Didden, 2012; Schlichenmeyer, Roscoe, Rooker, Wheeler, & Dube, 2013). Studies reporting on the functional analysis of problem behavior have included sub-populations of IDD such as individuals with ASD (Love, Carr, & LeBlanc, 2009; O’Reilly et al., 2010); prenatal drug exposure (Kurtz, Chin, Rush, & Dixon, 2008); and genetic disorders such as Angelman (Strachan et al., 2009), Cornelia de Lange (Bay, Mauk, Radcliffe, & Kaplan, 1993), Prader-Willi (Hall, Hustyi, Chui, & Hammond, 2014), Rett (Roane, Piazza, Sgro, Volkert, & Anderson, 2001), Soto (Harding et al., 2001), and Williams syndromes (O’Reilly, Lacey, & Lancioni, 2000). In its consensus document on clinical practices regarding behavior problems in FXS, the Fragile X Clinical and Research Consortium recommended using functional analysis to identify potential causes for problem behavior (Picker & Sudhalter, 2012).
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¹: Now at Millersville University, United States.

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Treatment of challenging behavior exhibited by children with prenatal drug exposure

Abstract

Section snippets

Participants and Setting

Results

Discussion

Acknowledgements

Obstetrics and Gynecology

Neurotoxicology and Teratology

Prenatal cocaine exposure: An examination of childhood externalizing and internalizing behavior problems at age 7 years

Epidemiologia e Psichiatria Social

Behavioral outcome of preschoolers exposed prenatally to cocaine: Role of maternal behavioral health

Journal of Pediatric Psychology

Manual for the child behavior checklist/4–18 and 1991 profile

Aggression at age 5 as a function of prenatal exposure to cocaine, gender, and environmental risk

Journal of Pediatric Psychology

Children's intellectual and emotional–behavioral adjustment at 4 years as a function of cocaine exposure, maternal characteristics, and environmental risk

Developmental Psychology

Effectiveness of a home intervention for perceived child behavioral problems and parenting stress in children with in utero drug exposure

Archives of Pediatric and Adolescent Medicine

Prenatal exposure to cocaine and other drugs: Outcome at four to six years

Annals of the New York Academy of Sciences

Introduction to the special issue: Impact of prenatal substance exposure on children's health, development, school performance, and risk behavior

Journal of Pediatric Psychology

Maternal substance use: Epidemiology, treatment outcome and developmental effects: An annotated bibliography, 1995

Substance Use and Misuse

Using parents as therapists to evaluate appropriate behavior of their children: application to a tertiary diagnostic clinic

Journal of Applied Behavior Analysis

Effects of three levels of early intervention services on children prenatally exposed to cocaine

Journal of Early Intervention

Teacher-assessed behavior of children prenatally exposed to cocaine

Pediatrics

Brief functional assessment techniques to evaluate aberrant behavior in an outpatient setting: A summary of 79 cases

Journal of Applied Behavior Analysis

A preliminary evaluation of empirically derived consequences for the treatment of pica

Journal of Applied Behavior Analysis

Growth, development and behavior in early childhood following prenatal cocaine exposure: A systematic review

Journal of the American Medical Association

Functional analysis of challenging behavior: A review

Journal of Applied Behavior Analysis

A functional analysis of verbal instructions of drug-exposed children and their mothers: The utility of sequential analysis

Journal of Clinical Psychology