16 July 2012

Listen to parents, they know what they're talking about

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Validating emotions before punishing behavior

...quoted from the Autism Discussion Page, a very useful resource.


Validating emotions before punishing behavior

When a child is upset and acting out, we tend to focus on “stopping the behavior” as our first priority. When doing so we often punish the behavior, without first understanding “why” it is occurring. Often the child doesn’t have (1) good abilities to control their emotional impulses, and (2) have good skills in handling their reaction to their emotions. So, when we punish the behavior, we are punishing their emotions as well. This tends to invalidate the child, and does not teach them a better way of handling their emotions. I often recommend that whatever technique you use to reduce problem behavior, first “acknowledge and validate” the child’s feelings, then deal with the behavior. Try starting out the intervention this way:

1. Acknowledge that the child is upset "Wow..John, you really look upset to me!"

2. Next, validate that is ok to be upset, "I understand how that you are upset because you cannot have ______ right now. That might make me upset to." This does not mean you have to agree with him, or approve of his behavior, just acknowledge and validate how he feels.

3. Finally, help the child problem solve or understand when or how he might get what he wants. Focus on what you want the child to do, not on any negative behavior.

4. If the child is too upset to talk reasonably with you, simply say "You are too upset to talk right now. That's ok, you let me know when you are calm enough to talk." Then minimize any attention given to the upset behavior." Do not try and reason with a child who is acting out. So little emotion, speak matter of factly, and only reason and problem solve once the child calms enough to talk reasonably.
5. After the child calms down enough to talk, then return to steps 1-3.

This respects the child, even if we are punishing the behavior. Focus first on the feelings, not the behavior. “It is ok to be upset, but not ok to hit.” In order to reduce a negative behavior, you need to focus on training an better alternative way of responding to take it’s place. “How do you want the child to respond” when he is upset? Sit down with the child and work together to identify alternative ways of responding. Once you identify one or more, then practice and role play the desired response, until it becomes more automatic. Then, when the child is upset, validate his feelings, and then coach him to use the response you two have been practicing. You will find that you are then “teaching” the child, rather than simply punishing the child. The child see you as a “working partner” with them, and will try harder to develop more appropriate ways of acting.

Understanding Challenging Behaviour Part 2

 ... quoted from the Autism Discussion Page, a very useful resource.


Understanding Challenging Behavior Part 2: Core Deficit Assessment

Understand the core deficits of the disability to interpret the function of behavior!

For most of us, the often extreme reactions we see in children on the spectrum can look bewildering to us. We are taught to look at the observable triggers of the behavior, and the observable effects that the behavior has, in order to understand the “function” that behavior serves. However, what we see on the observable surface is not enough to understand the function the behavior serves. We often are quick to punish, or extinguish, a behavior, before understanding the adaptive function the behavior serves the child.

It is important to understand the core deficits of the disability to understand the true functions the behavior serves (what the behavior is communicating). You have to understand the (1 sensory challenges (sensory defensiveness, overload, arousal issues), (2) cognitive deficits (inflexible, black and white thinking; difficulty shifting gears; limited ability to evaluate consequences; poor empathy, etc.), (3) emotional deficits (poor frustration tolerance, limited emotional regulation, emotional overload, etc.), (4) social difficulties (difficulty reading social cues, reading effects their behavior has on others, etc.) (5) communication issues (difficulty expressing thoughts, feelings, and perspectives) and (6) medical/biological issues (digestive, allergies, weak immune system, etc.) in order to understand the “adaptive function” that drives the behavior. Once we understand the “core deficits” of the disability, the behavior is much easier to understand. In addition, once this function is identified, then we can provide the proactive supports needed to lessen the stressors driving the behavior, and teach more acceptable, alternative behavior to serve the same function.

If your child is having problems at home, or school, make sure those who are designing strategies for changing the behavior, understand your child’s unique vulnerabilities, and core deficits, that will help explain the behavior. Until you understand how the child experiences the world, you will often misinterpret what the behavior is communicating. The two links below will take you to two documents that will help you indentify and understand some of the core deficits (vulnerabilities) that must be understood. The first (Fragile World on the Spectrum) gives a summary of the different areas of vulnerabilities and strategies to support them, and the second document, “core deficit assessment” scale, you can use to help identify the your child’s specific vulnerabilities. If you understand these vulnerabilities, then you can accurately interpret why certain events result in such extreme reactions from the child. Understand first, before trying to change behavior. This is a simple check list that is meant to identify areas of vulnerability. It is not an all inclusive list, but a summary of common deficits that will lead you to look more closely into each areas of concern.


Fragile World on the Spectrum
https://docs.google.com/open?id=1mBVbanii-njBz3NsAEJqNK8haRiarACSX3vaiRcqp392vMeDDB4EWBwMCpYH

Core Deficits Assessment Scale
https://docs.google.com/open?id=0B1DaJtXzRn91YmRlYjU2ZmUtY2Q2Yi00ZWNmLWI5MzctOThmZTk3ZjMxZDdj

Understanding Challenging Behaviour

 ... quoted from the Autism Discussion Page, a very useful resource.


Understanding Challenging Behavior Part 1: Functional Behavior Assessment

(This is the same article as the one posted earlier in the “discipline” series, except it has a comprehensive “functional assessment form” for doing assessments. This is the professional evaluation tool I use when assessing challenging behavior)

This series will go more in depth in how to incorporate a functional behavior assessment (analysis of behavior) with a core deficit assessment (analysis of the autism vulnerabilities) to get a more thorough understanding of your child’s behavior challenges. The documents that are attached are meant for professional evaluations (forms that I use), but are helpful for everyone. This first article in the series will describe the process of doing a “functional behavior assessment”.

All behavior serves a function (purpose) for the person. Behavior occurs for a reason(s). It serves a function for the child. The child may be acting out to escape or avoid something uncomfortable for him, may be doing it for the attention or reaction he gets from others, may be for stimulation when bored, or to gain something that he desires. The child may be screaming because he has no other way of communicating that he is hungry, frustrated, or in pain. He may be screaming because the demands placed on him are greater than his current skills in dealing with them. He may be screaming because he is overwhelmed by the sensory chaos of the load noises, bright lights, and strong smells in the grocery store. He may be screaming because his sister just took his favorite toy from him, or screaming because he just stepped on something sharp. Consequentially, the same behavior can occur for a variety of reasons (under a variety of conditions) and several behaviors (screaming, biting self, hitting others) can occur for the same reason (escape or avoid something undesirable).

Identifying the function(s) the behavior serves give us a good understanding of why it is occurring, the purpose that it serves for the child, what is maintaining the behavior, and some ideas of how to go about supporting the child and reducing the problem behavior. It can be troublesome to try and change a behavior before understanding the purpose that it serves the child, and the conditions under which it occurs. Reducing the problem behavior may be as simple as modifying some of the conditions causing the behavior (reduce demands, provide added support, etc.) or changing the way we react to the behavior (support rather than demand, minimize our emotional reactions, redirect, etc.). Often times we do not have to change the child at all, but modify the conditions (often our own behavior) surrounding the behavior. In other cases, we may need to teach alternative behaviors to replace the ones we wish to decrease.

When doing a functional assessment, we try to define the conditions occurring just prior to the behavior, that may be influencing (triggering) its occurrence. These conditions are usually called “antecedents” to the behavior. They set the stage for the negative behavior to occur. By tracking (documenting) when, where, what is occurring, as well as with whom, at the time the behavior is occurring, we are can identify common conditions (antecedents) that elicit the behavior. Maybe it may occur when certain demands are placed on the child, under certain sensory stimulation (bright sunlight), when left alone with nothing to do, etc. By noting these conditions each time the behavior occurs we can isolate out certain common patterns (conditions) that produce the undesirable behavior. Identifying what conditions the behavior occurs can tell us a lot about what function the behavior serves for the child (escape demands, attention, getting something, etc.) Often we can reduce the frequency of the behavior simply by eliminating or modifying the conditions (antecedents) that elicit the behavior. If we can change the conditions triggering the behavior (reduce the demands, provide more frequent attention, give frequent breaks, etc.) we reduce the need for the child to engage in the behavior. Even if we cannot eliminate or modify the conditions, we can provided added support (greater assistance) or accommodations to help the child adapt to the conditions (e.g. sunglasses to minimize bright lights). Changing the antecedent conditions triggering the behavior is often the best, and easiest, way to reduce the unwanted behavior. Change the conditions before trying to discipline the child.

We may also look at under what conditions does the behavior “not occur”. If the behavior does not occur when added support is given, then we may want to increase our support to minimize frustration. If the behavior occurs when the activity occurs in the morning, but not when the activity is in the afternoon, then we may change the time of the activity until the afternoon. If we can identify times and conditions when the behavior is less likely to occur, then we may want to increase those conditions. So, by identifying when, where, and under what conditions the behavior does occur, and when it reliably doesn’t occur, we can make major modification in these conditions.

In addition to identifying the conditions triggering the behavior (antecedents), we also want to identify the immediate effects (reactions) the behavior has immediately following its occurrence. Again we want to note what occurs (especially how people react, and what effects the behavior has for the child) immediately following the behavior (e.g. withdraw demands, reactions of others, getting something he wants, escaping situation, etc.). These are the gains, or payoffs. that the child receives from engaging in the behavior. These effects are often what are reinforcing the behavior, and increasing the likelihood that it will occur again under similar conditions. By identifying these effects we can often modify the effects so that the behavior does not provide the same payoffs for the child, thus decreasing the likelihood of occurring again under similar conditions. We may want to minimize our reaction to the behavior, if our attention seems to reinforce it, or we may want to make sure the child doesn’t get to what he wants by throwing a tantrum, or get out of doing things by acting out. Or, we may want to teach the child better, more adaptive ways, of obtaining the same effects (saying “stop” or “help”, rather than hitting, when wanting to escape a difficult demand).

As you can see, by changing the conditions that elicit the behavior (antecedents) and the effects (consequences) that occur immediately following the behavior, we can significantly modify the likelihood of the negative behavior occurring again. Most recently, the emphasis has been on identifying the conditions that trigger the behavior and building in added supports to either eliminate or modify the antecedent conditions, or providing accommodations and/or added assistance to minimize their negative effects. This way we are reducing the stressful conditions that trigger the child’s undesirable behavior.

In addition to changing the conditions, once we identify the function (purpose) that the behavior serves, we can also begin to teach other, more acceptable, behavior that can meet the same result (purpose, function). If the child chews on his shirt for stimulation to stay aroused, we might substitute chewing gum to take its place. If the child yells in class to get the teacher’s attention, he might be taught to raise his hand instead.

The following documents will provide you with a comprehensive functional behavior assessment form, that I use to evaluate a challenging behavior, a flow chart summarizing the components of a functional behavior assessment, and a power point presentation on doing a functional behavior assessment.

This link will take you to a comprehensive “Functional Behavior Assessment Form”
https://docs.google.com/open?id=0B1DaJtXzRn91OTdyZDVFTzNpT0k

Also, this link will take you to a nice flow chart for Functional Behavior Assessments:
https://docs.google.com/open?id=0B1DaJtXzRn91WnJDOGhDWkFOTDQ

Power point presentation on “Reducing Problem Behavior
https://docs.google.com/open?id=0B1DaJtXzRn91YURwV1NCdzFRbk9QSFktbmt4cXd5Zw

Different, not defective

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