Severe Problem Behavior
Understanding, identifying, and treating self-injury, aggression, elopement, and other high-risk behaviors in children and adolescents with autism and related developmental disabilities.
What Is Severe Problem Behavior?
Severe problem behavior refers to actions like self-injury, aggression, property destruction, and elopement that happen often enough or seriously enough to put a person's safety, family life, or daily routine at risk. It's sometimes referred to by many names including behavioral issues, behavioral challenges, or simply problem behaviors, but whatever term is used, what matters clinically is that the behavior is serious, persistent, and interfering with that individual's quality of life.
These behaviors aren't random. They tend to show up under specific conditions. For example, when a parent asks a child to turn off the TV and clean up for dinner, or when a teacher needs a student to transition from preferred activities to a group activity with the class. Challenging behavior can be common among children and adolescents with severe autism, an intellectual disability, or other developmental disabilities, who face a higher likelihood of developing significant problem behaviors than typically developing peers.
Common Types of Severe Problem Behavior
Every person is different, but most autism behavior problems, and problem behavior more broadly across intellectual and developmental disabilities, fall into a handful of recognizable categories. Understanding these autism behaviors and examples of problem behaviors in learners with autism is usually the first step for a clinical or educational team trying to identify what they're dealing with, and why. The same categories show up, sometimes just as severely, in children with intellectual disability, ADHD, or other developmental delays, even without an autism diagnosis.
Aggression
Aggression (hitting, biting, scratching, or throwing objects) is one of the most common and most stressful behaviors families and care teams face, and it appears just as often alongside other developmental and intellectual disabilities. Children with autism with aggressive behavior are more likely when a person has limited ways to communicate frustration, discomfort, or an unmet need. Aggression isn't a character flaw; it's usually the fastest tool available for getting their needs met.
Self-Injurious Behavior
Head-banging, hand-biting, and skin-picking are common examples of self-injury. The link between autism and self injury is well documented, but the behavior is also common among people with intellectual disability, Rett syndrome, and other conditions affecting communication.
Elopement
Elopement (bolting or wandering away from a safe adult or supervised space) is one of the most dangerous forms of problem behavior because of the immediate safety risk involved. It's a well-documented concern for children with autism, but it shows up across a range of intellectual and developmental disabilities.
Pica
Pica refers to eating or mouthing non-food items, such as dirt, paper, or small objects, a behavior that carries real medical risk and needs a targeted treatment plan rather than simple redirection. Pica is also common in children with intellectual disability and other developmental conditions, particularly when oral or sensory needs go unmet or the learner doesn't yet have a varied play skill-set.
Why Severe Problem Behavior Develops
Severe problem behavior is not inevitable for children or adolescents with autism or with an intellectual disability, but the probability of a repertoire of problem behavior developing is much higher for these children and adolescents.
We take the position that extraordinary forms of problem behavior are usually learned from ordinary interactions: problem behavior is occasioned by an interaction of contextual factors and strengthened by personally unique combinations of events experienced following episodes of severe problem behavior or their precursors.
This is why behavioral challenges and problematic behavior can look completely different from one person to the next, each pattern has been shaped by that individual's own history, regardless of diagnosis.
Who Is Affected
Severe problem behavior is most commonly associated with autism, but it isn't exclusive to it. Children and adolescents with an intellectual disability, developmental delays, or other neurodevelopmental conditions face a similarly elevated likelihood of developing a repertoire of problem behaviors. It can also emerge in individuals without any diagnosis at all, anywhere ordinary reinforcement patterns take hold. Autism is simply the population FTF sees most often.
Emerging vs. Severe Problem Behavior
Not all problem behavior is severe. Emerging problem behavior describes early-stage, lower-intensity behavior in young children, often recently diagnosed with autism, that hasn't yet become entrenched or dangerous. It's the focus of prevention-based programs designed to build skills before problem behavior has the chance to escalate. Severe problem behavior, by contrast, is what happens once that early window has closed: a persistent, functionally-reinforced pattern serious enough to put safety or quality of life at real risk, one that calls for formal assessment and treatment rather than prevention alone.
If a child or client's behavior is still new, infrequent, or low-intensity, our Emerging Problem Behavior page may be the better starting point.
How FTF Treats Severe Problem Behavior
FTF Consultants are expert in assessing and treating severe problem behavior. We build capacity and confidence in others to safely and quickly assess and effectively treat severe problem behavior, using a proven effective and generally applicable process that prioritizes safety and dignity while building meaningful skills.
Despite our assumption that extraordinary forms of problem behavior are usually learned from ordinary interactions, we take the universal precaution that all children who engage in severe behavior have likely experienced trauma in situations like those in which problem behavior is reported to be prevalent. The result is our commitment to open-door therapy models in which clients choose to participate, and may withdraw assent at any time, as well as prioritizing the clients' experiences during treatment sessions.
Our core methodology is Practical Functional Assessment and Skill-Based Treatment (PFA-SBT). We also train teams on Universal Protocols, a standardized starting point for assessing and reducing problem behavior across a caseload of any diagnosis, or as an accompaniment to a client's PFA-SBT sessions.
Our Three-Step Process
FTF builds capacity in others to implement an efficient model of assessment and treatment through a three-step process: training, synchronous assessment support, and asynchronous treatment support.
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Step 1: Training
The first step is training, usually completed through FTF's 10-hour on-demand course.
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Step 2: Synchronous Assessment Design and Implementation Support
FTF Consultants guide your team through designing both the assessment and treatment process for three children or clients served by your organization. Consultants then provide live, synchronous consultation while your staff implement the assessment. A structured reflection session follows to discuss what was learned and plan treatment from the results, with treatment often starting the same day.
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Step 3: Asynchronous Treatment Design and Implementation Support
From there, support continues through weekly consultation via video conferencing. By reviewing uploaded videos, data sheets, and graphs, an FTF Consultant helps your team progress treatment until critical social skills replace the conditions that used to occasion severe problem behavior. Support typically continues until treatment generalizes to relevant people and settings and produces a socially meaningful impact.
Frequently Asked Questions
Is aggression a symptom of autism?
Not directly. Aggression isn't a core diagnostic feature, but children with autism are more likely to develop aggressive behavior when communication is difficult. It's typically learned, not unavoidable, and shows up in other learners with disabilities too.
What causes self-injurious behavior in autism?
It usually develops because it reliably produces a preferred outcome, even though it's harmful. A functional assessment identifies what contexts influence it, regardless of diagnosis.
Can severe problem behavior be treated without medication?
Yes. Behavior-analytic approaches like PFA-SBT focus on identifying and replacing the function of the behavior directly, and are often used alongside or instead of medication.
Is elopement common in autism?
Yes. It's one of the more frequently reported safety concerns among children with autism, though it's also seen in other developmental and intellectual disabilities.
What's the difference between a meltdown and problem behavior?
A meltdown is a reaction to being overwhelmed; problem behavior is typically maintained by a specific consequence like escape or attention. They can look similar, but treatment differs for each.
How is severe problem behavior different from emerging problem behavior?
Emerging problem behavior is early, low-intensity, and the focus of prevention. Severe problem behavior is an established, higher-risk pattern that requires formal assessment and treatment.
Get Support / Work With FTF
Whether you're a school building classroom-wide prevention skills or a clinic looking to build internal capacity for treating severe problem behavior, in autism or any other population, FTF can help. Start with our 10-hour training course or get in touch to talk through your organization's needs.
Tell Us How We Can Help
To help us design an organizational training, provide on-site implementation support for your staff, and schedule follow-up video conferencing, tell us about you, your organization, and your goals.
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