I can’t even begin to tell you how much I love my son Sam. Probably about the same amount you love your child! I enjoy so many things about him. However, there are many aspects of life with Sam that can be challenging and frustrating for both of us. Many of our challenges are related to Sam having autism as well as severe intellectual challenges. He is now 32 years old, and doing pretty well! But I have many memories of behavior episodes or patterns throughout his childhood and into adulthood.
As a speech language pathologist I have had the opportunity to work with many children with autism spectrum disorders, Down syndrome, and other intellectual and developmental disorders (IDD). Individuals with these particular challenges have a greater tendency towards interfering behaviors. But any child experiencing a speech or language disorder may have behaviors related to struggling with communication. So from a therapist and parent perspective, I would like to share some observations and suggestions.
I find that we sometimes get caught up in a behavior and forget the individual. So in the middle of a behavior, we need to remember who our child or client is as a person; who or what motivates them, scares them, encourages them, affirms them and what overwhelms their senses. We need to internally set aside our reactions to the behavior long enough to see the person as their unique self, not just see a situation that must be resolved.
We have all heard that behavior is communication and what a true statement! A quote from the National Association of State Directors of Developmental Disabilities Services (NASDDD) Positive Behavior Supports Guidelines sums it up concisely “It must be understood that all human behavior is purposeful and goal oriented, although the purposes or goals of each behavior may not be readily perceived”.
After reminding ourselves that this is a child who has communication challenges and needs to know they are valued regardless of a particular behavior, we can then analyze the behavior and think of some strategies that will encourage successful behavior.
No Easy Fixes
People are complex. Each person has a unique neurological/biological makeup that will impact the ability to process incoming information, whether it is intentional communication or some other kind of sensory data; as well as produce outgoing information, which will communicate to others what they need or want to share. And then we each have our own experiences and personalities thrown in the mix. Nature and nurture… So keeping in mind that each person is different and “fearfully and wonderfully made”. There is no cookie cutter formula for behavior challenges that will work every time, though there are some very effective research based tools that will increase the rate of success.
Important Strategies to Promote Positive Behavior
Though it has been more formally linked with autism spectrum disorders, the science of behavior analysis actually applies to everyone. Recall our quote “all human behavior is purposeful and goal oriented…” That does not mean that we are always conscious of the purpose of our behavior or that all behavior is premeditated. I might dance around when my favorite song comes on and the purpose may just be to bring me joy in the moment or it may be to allow me an escape from troubling thoughts or from continuing to clean out the refrigerator. For a child struggling with their math homework, crying or begging to play outside longer, may be putting off a personally painful homework experience. Just to say, we have reasons for our behavior whether we realize it or not.
Behavior analysis is defined as the scientific study of principles of learning and behavior (Behavior Analyst Certification Board, BACB). If your child seems to have a pattern of behavior that results in social difficulties or impacts the ability to participate and progress in age appropriate situations, or causes him, her, or others (including you) an unusual amount of physical or mental harm, then you should seriously consider a functional behavior assessment (FBA).
FBA’s are typically completed by a behavior analyst and include:
- review of records
- interviews with parents or others who observe the behavior
- observation and gather data in the settings where the behaviors occur
- completion of rating scales such as the Question About Behavior Function (QABF) or the Motivation Assessment Scale (MAS)
- analysis of the behavior
The results will determine the function of the behavior: whether the child is seeking attention from others, avoiding/escaping something or a situation, trying to gain access to something he or she wants, or meeting an internal sensory need. Then the key is to see how the individual can meet these needs more appropriately or how the environment, information, or activity can be modified to remove the trigger (antecedent). For instance, if a bag of chips sitting on the teacher’s desk will result in a behavior to gain access, a few things could happen. The chips could be stored out of view and a visual or printed schedule could be put in place designating snack time.
Though this is a relatively simplistic explanation of behavior analysis, it should provide enough information to establish the importance and usefulness of analyzing behavior, particularly for children with autism spectrum disorders or other IDD diagnose There are many private ABA practices (Applied Behavior Analysis) and you can also request a functional behavior analysis through your school district if your child is receiving special education services. Whenever a school is raising concerns about a child’s behaviors, who is also receiving special education services under IDEA, a parent should always request a FBA.
Positive Behavior Supports
One of the reasons behavior analysis is so important is, again, to see the child as a unique and valuable person – not to be defined by their behaviors – and to help us, the adults in his or her life, understand how we can arrange the environment and use other strategies to help the child. These are labeled as positive behavior supports. Instead of just figuring out how to stop a behavior, we determine the purpose a behavior is serving for a child and then teach a new, positive way for the child to have the same outcome. We sometimes forget that the negative behavior is achieving a desired outcome for the child. How can we help them meet their need in a healthier way which will lead to better social interactions and personal contentment (for the child and those who interact with him or her on a daily basis)?
More Strategies to Promote Communication and Positive Behavior
Though it is important to identify and analyze non-desired behavior patterns, we know that certain strategies will help with communication development and behavior for all children, whether they have a significant developmental disorder or a mild receptive-expressive language disorder.
Arrange the Environment
Insure that there are calming spaces available for a child who may become overwhelmed and need a sensory break. Some children need a quiet, less distracting area to learn and practice new skills. This helps them internalize language skills and other important concepts into their working memories so they can more easily access these skills in distracting situations or social setting at a later time.
Provide Structure and Organization
Utilizing schedules, calendars and routines will help a child know what is coming next. This is important because we often think a child understands everything we say and they can recall the order of events from a previous day. With children experiencing receptive language challenges, this is often not the case. Additionally, they may try to hold on to a routine in their head and then we change it! This can cause confusion and frustration. Visuals should be presented in whatever way is best for the child. Some children will need photos, others line drawings, and others will be able to read a short phrase. It is always a good idea to label pictures since some children learn to read meaningful words and phrases as they see them consistently paired with a photo. Think about it like visiting a foreign country where you don’t know the language. You will find that you are clutching whatever visual guide you brought along so that you can arrive at every destination and make it back to your hotel safely and on time. Children with autism or other intellectual or receptive challenge can feel the same internal tension of being lost and confused without their structure and support. It is easy to see how this could lead to behavior challenges to escape or gain something, or to just get attention.
Provide Adequately Trained Staff and Companions
Thinking back to the idea of positive behavioral supports, it is important to have support staff available who like the child and are familiar with his or her interests, challenges, and needs. A teacher, aide, therapist or parent who can affirm the child and communicate positive regard will do a better job of implementing the best strategies for the child and will typically have more success. This support staff should be close at hand during periods that have a history of high incidents of behavior or during new learning, since this can also lead to frustration. The staff should be aware of the functions of a child’s behaviors and what replacement behaviors or strategies have been put in place to help a child based on a functional behavior assessment. This information is typically found in a Behavior Plan (BP) in a school district. Make sure you have a Behavior Plan based on a PBA as part of your child’s Individual Education Plan (IEP) if the school is addressing interfering behaviors.
“When people can do what they like, they are happier and have greater self-esteem. They can learn self-control.” NASDDDS Positive Behavior Support Guide.
Research supports that children learn better when we follow their lead. Teaching concepts within the context of highly motivating play, activities, or games leads to better results. So the more personally appealing we can make experiences, the more likely we can maintain positive behaviors. For instance, if a child enjoys cooking, vocabulary, following directions (with visuals when needed), start and finish routines, turn taking and social interactions can all be addressed while making pudding. Certainly there will be times when the activity will not be highly motivating or may be overwhelming to the senses, but if a child knows that at some point soon ( because of a visual schedule), he or she will be rewarded with a motivating activity, it can help them move through the less appealing parts of a day. Creative staff often find ways to build some motivating activity into almost any part of the day.
Speech Therapy and Behaviors
Aspects of behavioral support can be incorporated into speech therapy to facilitate the best outcomes for the treatment plan. Obviously a child is going to learn appropriate communication skills more successfully in an environment that decreases the possibility of interfering behaviors. A speech pathologist may not be qualified to complete a functional behavior assessment, but he or she should be able to understand the results of an FBA and also have some working knowledge of the function of behaviors. So through parent information, outside reports and observation, it may be evident if a child is seeking attention, escaping, trying to gain something, or meeting a sensory need. Armed with this information, a therapist can design the therapy setting to be a calm, inviting place, with highly motivating activities and toys. Visual schedules can be utilized throughout the session. Positive affirmation is also very important so that the child senses that the therapist truly enjoys them and they are in a safe place. Parents and caregivers should join the treatment session for at least a short while to observe strategies and discuss supports they may need to increase communication across settings. It is also important to avoid discussing negative behaviors in front of the child, since this can sometimes trigger a behavior and also impact how the child feels about therapy. These discussions might be better via email or notes.
In summary, many children experience challenging behaviors, which not only impacts their quality of life but that of those closest to them. Instead of reacting, we need to analyze the function of the behavior and help the child meet their needs in appropriate ways that will also meet their personal needs. This will take time and effort but should lead to a more positive, richer, lifelong outcomes for everyone.
Sources and resources:
Personal experience of the author, Anne Bramlett, MS, CCC/SLP