Using functional assessment techniques, researchers have demonstrated that many of these behaviors are maintained by positive and/or negative reinforcement contingencies. That is, problem behaviors come under the control of social contingencies related to the presentation or removal of salient stimuli in the person’s environment. However, to complicate this analytical picture, people with autism also have a very high incidence of health conditions. Recent research findings indicate that the presence of health conditions can initiate or exacerbate problem behaviors. Indeed, it may be that many inconclusive functional assessments are not conclusive because the presence of a health condition (and its associated pain) has not been adequately assessed. An important finding of our research is that health conditions appear to increase behaviors that are negatively reinforced, but may not influence (or decrease) behaviors that are positively reinforced. This pattern suggests that the pain associated with a variety of health conditions may act as a motivating operation to establish noxious stimuli as negative reinforcers or increase their aversiveness, thus increasing rates of problem behaviors maintained by these contingencies. These findings suggest that health assessments and functional behavioral assessments should be conducted concurrently when the temporal pattern of problem behavior suggests a health condition may be a contributing factor. The resulting interventions may then need to target the health condition to alleviate or eliminate the pain associated with it and social reinforcement contingencies that may be maintaining the problem behavior. Therefore, assessment and intervention should be interdisciplinary and multifaceted in nature.

Review Craig H. Kennedy’s biographical statement.