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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