POSITIVE MANAGEMENT FOR CHALLENGING BEHAVIORS

IN CHILDREN WITH SPECIAL NEEDS

Stacy Carmichael, PhD ABPPLicensed PsychologistBoard Certified, Clinical Child & Adolescent Psychology

-Walter Barbee

If you’ve told a child a thousand times, and he still does not understand, then it is not that child who is the slow learner.

What is behavior management?

Behavior management is not an attitude adjustment

Systematic method of increasing or decreasing behaviors

Teaching appropriate behaviors and coping skills (discipline means “to teach”)

What are behaviors? You can see them, hear them and measure them if needed

Children with special needs at increased risk of inappropriate behaviors because:

They are not at the developmental level of same age peers or siblings

Adults or children may not know what to expect Motor planning difficulties, sensory concerns Cognitive delay, processing delay Difficult understanding abstract concepts such as

time, waiting Difficulty expressing wants, needs, feelings Anxiety Not understanding the perspectives and motives of

others As parents we may feel guilty and over-protect

Prioritizing behaviors to address

How harmful is this behavior to your child or other children/adults?

How does this behavior interfere with your child’s development and learning?

How does this behavior interfere with your child’s participation in family or peer activities?

How does this behavior interfere with positive social relationships/acceptance?

Common challenging behaviors

Wandering Biting/hiting/kicking/throwing (aggression) Yelling/screaming/tantrums Non-compliance with requests Attentional concerns Lack of initiative/difficulty organizing behavior Toileting Sleeping Eating Playing/social skills

We teach….

If a child does not know how to read, we teach.If a child does not know how to swim, we teach.If a child does not know how to multiply, we teach. If a child does not know how to drive, we teach.If a child does not know how to behavior….we……..teach? ……..punish?

-Tom Herner (NASDE President) Counterpoint, 1998, p. 2.)

Punishment vsreinforcement…what is going on?

Operant conditioning (BF Skinner) Reinforce- to strengthen the probability of

the behavior Punish- to decrease the probability of

behaviorPOSITIVE STIMULUS

NEGATIVE STIMULUS

PRESENTED Positive Reinforcement(winning lottery)

PositivePunishment(speeding ticket, yelling, spanking)

TAKEN AWAY Negative Punishment(Taking away cell phone when teen breaks curfew)

Negative Reinforcement(putting anti-itch ointment on bug bite)

Universal Preventative Practices

Review routines IF-THEN/earning Routines are clear, consistent (calendars, visual

schedules, visual timers for transitions) Review Physical Arrangements (tv, computer,

homework area, calm-down area, etc) Define and teach expectations and skills

Positive house rules (use respectful language, pick up after yourself, put toys away before you get new toys…..respect others, yourself and property)

Plan systematic responses To appropriate behaviors To inappropriate/challenging behaviors

What kind of “boss” are you?

Worst Supervisor Best Supervisor

What kind of “boss” are you?

Makes unreasonable demands for my level

Keeps changing his mind

Has unclear expectations

Never says Thanks or Good job

Keeps things fair Sticks to the plan and

keeps me informed Rewards all successes,

big and small Shows respect and

compassion Takes responsibility as

the boss

Worst Supervisor Best Supervisor

Special time

Improves the positivity of the parent-child relationship15 minutes daily, child directed interaction with a specific skill-building activityNo questions, no criticisms, no commandsP –praise, labeledR –reflect important comments from your childI -imitate what you child is doing that you likeD –describe what your child is doing (sports announcer)E –be enthusiastic!

Increasing appropriate behavior: Attention, Praise and Rewards

CATCH KIDS BEING GOOD! ROUTINES VISUAL CUES/SUPPORTS TO KNOW WHAT TO EXPECT AND DO Positive attention

Make positive attention specific Give positive attention right away Use powerful rewards that are not usually accessed Avoid criticism Tell your child WHAT TO DO, not what NOT to do

(Bottom on the seat please. Hands to your sides.) May use visual aides, photos or video models. TELL-SHOW-DO

Carry out promises, so make a request only if you have time to wait and follow through

Praise frequently Set them up for success with tasks you know they can do. Plan ahead to eliminate or decrease triggers (hunger, fatigue, crowds)

Ex: behaviors to praise

Sharing toys Talking quietly Asking for help Nice manners Being flexible Being patient Expressing feelings Not interrupting Waking up on time Getting dressed on time Being creative Calming down when upset Walking softly

Starting homework Making bed Putting away clothes Encouraging others Using humor Apologizing Being friendly Brushing teeth or hair Starting a new hobby Helping parent Picking up after self Telling the trying Complying with a time limit

Can you praise too much?

Great expectations trap? Possible… Don’t praise indiscriminately, talk about

specific facts Focus on the EFFORT not the results,

again encourage Teach your child that it’s okay to make

mistakes, not be perfect, that is part of learning

Rewards

Types of rewards Verbal or social rewards (praise, hugs, high fives,

games) Physical/non-social rewards (snacks, staying up or

preferred food, tokens or points to redeem for desired object)

Activity/sensory rewards (access to games, tv time, ipad time, music, blowing bubbles)

For Effective rewards: Use rewards immediately Initially reward the behavior every time it occurs Reward only the behaviors you want to increase

Billy, I liked the way you picked up your toys the first time I asked! That makes mommy really happy.

Time-In

Positive interactions and feedback children receive when engaging in appropriate behavior

Critical to quality of parent-child relationship CATCH THEM BEING GOOD! Doesn’t have to be a special occasion. Be specific, label your praise. Provide physical attention. Give immediate feedback. Avoid back-handed compliments. Use third-handed compliments. Plan parent-child activities that set them up for time-in.

Uh-oh, now what?

Ignore the behavior (extinction) if it is mild and only used to gain attention (planned ignoring)

Redirection to another activity or appropriate behavior is often helpful, provide choices

Removal from a situation or reinforcement (time-out)

Try not to feed into the behavior to give him/her what she wants, lecture/threaten, show anger or disappointment, be physical

Time out

Only helpful if “time-in” encourages appropriate behaviors and allows access to desired reinforcers (attention, toys.) Thus, it is actually “time-out” from positive reinforcement (no talking to, warnings, looking at, or access to reinforcers or escape from tasks.)

Lead child away to time-out area, tell them why and how long they will be in time-out.

Use visual timer, no more than 5 minutes, about one minute for every year of cognitive age.

Immediately after, remind them why they went to time-out, review how to handle the situation in the future, and immediately begin time-in and provide positive reinforcement for appropriate behaviors.

More at the Center for Effective Parenting, Parenting-ed.org

Ideas for decreasing challenging behavior

First try to increase appropriate behaviors so that it provides the functional equivalent for the child. Avoid giving attention to child during problem behavior.

During problem behavior, don’t escalate, simply remind child about what they can DO rather than NOT DO (“You could use your words to ask your sister to share.”)

After the problem behavior, provide immediate praise for appropriate behaviors.

Research on PBS

Effective for all ages of individuals with disabities ages 2-50 years

Effective for diverse groups of individuals with challenges: intellectual disability, oppositional behaviors, autism, emotional concerns etc

PBS so far is the only comprehensive and evidence based approach to address problem behaviors within a variety of natural settings.

Positive Behavior Support

General intervention for all behavior problems

Intervention is reactive (decreased outside activity, restraint, spanking)

Focus on behavior reduction

Quick fix Only the family involved

Intervention matched to purpose of behavior

Intervention is proactive

Focus on teaching new skills

Long term interventions

Involves family, teachers, therapists, admins, etc.

Old Way New Way

Positive Behavior Support Plans

Simply “TOOLS to help children be more successful in participating and succeeding in everyday life.” -A Parent

Remove the triggers to prevent problems Be proactive-set them up for success Eliminate the reinforcement of inappropriate

behavior Provide skill instruction to build appropriate

behaviors or communication and decrease need for child to engage in challenging behavior

Increase reinforcement of appropriate behaviors decrease reinforcement of challenging behaviors

ABC’s of Behavior

Antecedent (what happened BEFORE)

Behavior (what do you need to change)

Consequence (what happens after the behavior)

Common triggers of misbehavior

Pain, illness GERD/Reflux GI concerns/constipation Thyroid concerns Vision/hearing concerns Sleeping difficulties (apnea) Emotional distress-anxiety, depression Hungry, tired

Example of a rapid Functional Behavior Analysis

Find at: http://csefel.uiuc.edu (Center on the Social and Emotional Foundations for Early Learning)

ABC Chart –Why is this behavior working?

Click icon to add picture

Antecedent Behavior Consequence

What is the function of the behavior?

WHY is your child engaging in the problem behavior in the first place?

Typically, a child’s behaviors occurs to: ESCAPE/AVOID demanding task,

person, situation

OBTAIN ACCESS to desired reinforcer (object, activity, feeling)

GAIN ATTENTION (even negative) from other people

Other communication (pain? sensory overload?)

Formal PBS Process

1:Establish your team, identify goals 2: Gather information (FBA) 3: Develop hypothesis (best guess as to

function of problem behavior) 4: Design behavior support plans 5: Implement, monitor, evaluate

outcomes and refine your plan

Support Plan for Challenging Behaviors

Behavior Hypothesis –what is the function or purpose of the behavior?

Prevention Strategies- Ways to make events and interactions that precede the problem behavior easier for your child to manage

Replacement Skills-skills to teach throughout the day to replace the problem behavior

Responses- what will adults do when the problem behavior occurs

Function of tantrums?

Antecedents (Triggers)

Behaviors Consequences/Responses

Walking to car from house

Walking to car from public place

Demand is placed on going to next activity

-tired/late afternoon

Tantrums-cries, yells, screams, throws self onto ground, sometimes throws objects

FUNCTION:Avoid/prolong transition

Sometimes allowed to continue what he was doing a bit longer

Verbal coaxing

Physically helped after a bit of his tantrum

Ex: Prevention, New Skills and New Responses

Prevention New Skills New Responses

-Give him predictability with mini schedule-Count down/visual timer to give him time to process and prepare for transition-”Going Places” social story

-Say, “I don’t want to.”-Follow schedule.-Go places with adult and stay (successful transition)-Ask “Where are we going?” with prompting.

To Problem Behaviors-Praise brother and parent-Prompt to use his words and give him words-Give Choices (Would you like to walk by yourself or hold hands? Would you like to take the red car or the blue car?)To New Skill-Give him highly desired items to help reinforce successful transitions(juice, car)-Praise for successful transitions

Obstacles to success

Parental optimism/pessimism about the ability to influence their child’s behavior at age 3 was the most significant factor in predicting which children with a developmental disability continued to have behavior problems at age 6 (Durand, 2001)

Examples of Pessimistic and Optimistic Self-Talk

My child is disabled. Shopping with my child

is a nightmare. That won’t work with

my child. I tried that and it didn’t

work! Oh no, here we go

again. She has enough to deal

with. I’m not going to push.

I’m not a good parent.

My child needs help learning new skills.

My child is not yet ready for shopping trips.

I’ll try it. I’m willing to try it again. OK, I’m ready for this. She will learn how to

control herself. I work very hard at being

the best parent I can be.

Pessimistic Self-TalkOptimistic Self-Talk

More information:

Fox and Duda, What Works Briefs: What are Children Trying to Tell Us?: Assessing the Function of Their Behavior. Center on the Social and Emotional Foundations for Early Learning.

Clark, Lynn. (1996.) SOS! Help for Parents: A Practical Guide for Handling Common Everyday Behavior Problems.

Barkley and Benton. (1998.)Your Defiant Child. 8 Steps to Better Behavior. Van Bourgondien. (1993.) Bx Mgmt in the Early Years. Preschool Issues in

Autism. Website: Center for Effective Collaboration and Practice.

http://cecp.air.org/ Durand (2007.) Positive Family Intervention: Hope and Help for Parents

with Challenging Children. Psychology in Mental Retardation and Developmental Disabilities, 32(3), 9-13.

Rabiner, (2007.) Behavioral Treatment for ADHD: An Overview. Found at www.helpforadd.com on 1/15/13/

http://www.apbs.org/ Association for Positive Behavioral Supports