Psychiatric Comorbidity & Differential Diagnosis of Autism Spectrum Disorders

Dr. Ozonoff’s presentation on Psychiatric Comorbidity & Differential Diagnosis of Autism Spectrum Disorders was very informative.  Dr. Ozonoff discusses the many reasons why it is difficult to diagnose someone with ASD with a co-morbid disorder due to the many symptoms and deficits that people with ASD can present with.  

Dr. Ozonoff mentioned the importance of Occam’s Razor when diagnosing an individual.  I think the same idea should be applied when conducting an FBA.  The idea behind Occam’s Razor is to find the simplest solution.  The purpose of an FBA is to determine the function of a behavior.  I feel that having a co-morbid disorder would not have any effect on the FBA that is conducted by a behavior specialist, unless it was a deficit such as a visual or hearing impairment.  Impairments such as these could have an effect on the outcome of an FBA if the professional conducting the FBA is not aware of the person’s condition.   Behavior analysts feel that direct observation is the best way to determine the function of a behavior, and indirect measurement should rarely be used, if at all.  If indirect measurement must be used then the person conducting the FBA must be aware of any deficits that would affect the use of indirect measurements such as checklists or questionnaires.   If the person is unable to complete this type of measurement, efforts must be made to measure the behavior in a different way.  The best option is always direct observation, it is the simplest, most objective, and most accurate way to conduct an FBA.

An FBA helps us to identify the type and source of reinforcement for challenging behaviors, and based on these findings we develop an intervention.  Once we determine the antecedents and consequences surrounding the behavior we can make efforts to change and replace that behavior.   We would do the same thing regardless of a person’s diagnosis.   If a behavior is found to be maintained by automatic reinforcement, then we try to find alternative reinforcers that are stronger than the automatic reinforcer.  If it is determined to be a function of attention or escape we would make efforts to change that as well.  The function of a behavior should not be determined by a diagnosis.