Menstrual discomfort as a biological setting event for severe problem behavior: assessment and intervention

Assessment and intervention approaches for problem behavior need to be extended to deal with biological setting events. To meet assessment needs, we developed a strategy involving four components: interview, archival record review, direct observation, and functional analysis. Data indicated that problem behaviors (aggression, self-injury, and tantrums) were linked to both a biological setting event (menstrual discomfort) and certain discriminative stimuli (task demands). To meet intervention needs, we developed a multicomponent strategy that addressed both the biological context (menstrual discomfort) and the psychosocial context (task demands). Intervention reduced problem behaviors to near-zero levels, maintained for 15 to 22 months across 3 participants. We discuss the extension of our approach to other biological setting events as well as multiple motivational variables.