Translating Research to Practice for Children With Autism Spectrum Disorder: Part 2

Behavior Management in Home and Health Care Settings

Margaret W. Bultas, PhD, RN, CNE, CPNP-PC; Norah L. Johnson, PhD, RN, CPNP-PC; Karen Burkett, PhD, RN, PPCNP-BC; Judy Reinhold, MSN, RN, CPNP, PMHS


J Pediatr Health Care. 2016;30(1):27-37. 

In This Article

Abstract and Introduction


Introduction: Managing home and health care for children with autism spectrum disorder can be challenging because of the range of symptoms and behaviors exhibited.

Method: This article presents an overview of the emerging science related to the methods to foster family self-management of common concerns regarding activities of daily living and behaviors, as well as for the health care provider in primary and acute health care settings.

Results: Recommendations are provided to enhance the overall delivery of services, including understanding and managing a child's challenging behaviors, and supporting family management of common activities of daily living and behaviors.

Discussion: Health care providers' knowledge of evidence-based recommendations for providing care, supporting family self-management of common concerns, and referral heighten the likelihood of better outcomes for children with autism spectrum disorder.


Behavior issues are a significant problem for children with autism spectrum disorder (ASD). Social and communication impairments, anxiety, and fear can lead to challenging behaviors in the health care setting and can be further complicated by mental health comorbidities (Mayes et al., 2012). Children with ASD have more contact with the health care environment than typically developing children, including children with chronic health conditions (Wu, Kung, Li, & Tsai, 2015). Health care expenditures have been found to be up to nine times greater for a child with ASD because of increased comorbidities, increased use of medications, challenging child behaviors, and the behavioral complexity of providing care to this population (Gurney, McPheeters, & Davis, 2006; Liptak, Stuart, & Auinger, 2006; Mandell, Cao, Ittenbach, & Pinto-Martin, 2006; Tregnago & Cheak-Zamora, 2012; Wu et al., 2015). Parents and health care providers (HCPs), including nurses and nurse practitioners (NPs), have both expressed concerns related to ineffective management of challenging behaviors in the health care setting for children with ASD (Minnes & Steiner, 2009; Rhoades, Scarpa, & Salley, 2007; Weil & Inglehart, 2010).

This review article provides an overview of the current evidence available to support HCPs. In addition, anticipatory guidance for behavior management for families of children with ASD in the home, as well as in primary and acute health care settings, is presented.