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Effective Strategies for Decreasing Challenging Behavior in Individuals with Autism Spectrum Disorders

Effective Strategies for Decreasing Challenging Behavior in Individuals with Autism Spectrum Disorders
Tara Warwick, MS, OTR/L
January 16, 2018
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Introduction and Overview

I'm excited to be here with you to discuss challenging behavior. This is one of my favorite topics to talk about because I've seen how effective these strategies can work to significantly decrease challenging behaviors. I'm an occupational therapist and I'm an owner of a company. As such, I work with a lot of children with challenging behaviors, and I provide support for our therapists who have children with challenging behaviors. I also travel to schools across the state who have students with challenging behavior. I help teachers with these strategies in the classroom. These techniques and strategies are not difficult or time-consuming. They are based on altering how we think about challenging behaviors.

Challenging Behavior

To highlight the importance of intervention with regard to challenging behaviors, I'm going to provide some statistics. Within the context of the school, children who exhibit challenging behaviors are considered at increased risk of academic failure, delinquency, dropping out, gang membership and adult incarceration (Dunlap, 2006). Additionally, in 1995, Campbell estimated that approximately 10 to 15% of all typically developing preschool children have chronic mild to moderate levels of behavior problems. That statistic is not even looking at individuals with autism; it's looking at typical preschoolers. With all the budget cuts in schools right now, we have about 25 to 30 children in each classroom. We're seeing more and more children with behavior issues and not just those with autism. Children are not getting outside as much and they're using more electronic gadgets, such as iPads. Academics are much more challenging now than they used to be. Our expectations are so high that we are seeing all these challenging behaviors pop up. We've got to change how we think about challenging behavior. It is critical to address these behaviors as early as possible.

I would like to share a quote with you that I find especially pertinent:

If a child doesn't know how to read, we teach. If a child doesn't know how to swim, we teach. If a child doesn't know how to multiply, we teach. If a child doesn't how to drive, we teach. If a child doesn't know how to behave, we...teach? punish? Why can't we finish the last sentence as automatically as we do the others? (Tom Herner, 1998)

Before we can address challenging behavior, we have to start by changing our perception of challenging behavior. Instead of punishing a child, we need to teach them how to behave. That's what today's training is aimed at: to begin thinking about behavior a different way.

What Does the Research Say?

I wanted to present this additional research and data to emphasize the need for working with children who exhibit challenging behavior.

Presence and Impact

In 2006, Dunlap et al. stated that "when children with significant problems are neither identified in a timely way nor given appropriate education and treatment, their problems tend to be long-lasting, requiring more intensive services and resources over time. Moreover, when the challenging behavior of young children is not addressed in an appropriate and timely way, the future likelihood increases for poor academic outcomes, peer rejection, adult mental health concerns, and adverse effects on their families, their service providers, and their communities." In other words, we need to address challenging behavior as early as possible. They go on to state that "although some systems and tools for early identification of children with challenging behaviors are available, the actual identification of these children and provision of appropriate services are very low." In my experience, we'll identify that children have challenging behaviors, but we don't look at why they are having these behaviors. From now on, any time you see challenging behavior in the clients you're working with, start by thinking about the why. Once we have the "why" then we can put the proper supports in place.

Prevention

Dunlap et al. also reported that "children and their families who access mental and physical care are less likely to have behavioral and social problems." Furthermore, they assert that "nurturing and positive parenting is associated with children who have healthy relationships and reduced challenging behavior." Finally, they indicate that "high-quality early education environments and caregiver interactions are associated with fewer behavior problems and the development of social competence."
 
When I'm working with teachers, if they are having a lot of challenging behaviors, I tell them to start by looking at their classroom and the environment. If you're working with a family, maybe in an outpatient setting, look at the child's home environment. What are their routines? How much positive interaction is going on? What kind of reinforcements are occurring? We must look at those environments first in order to eliminate some of the challenging behaviors. 

Intervention

Once again, according to Dunlap et al., "Interventions based on a functional assessment of the relation between the challenging behaviors and the child’s environment are effective for reducing challenging behaviors of young children." In other words, we can't just look at the child: we also have to look at what is going on in the environment. The environment could be a trigger for their behavior. In a similar vein, Dunlap states that "interventions involving alterations to features of the child’s activities and the child’s social and physical environment have been demonstrated to reduce challenging behaviors." 

"Teaching procedures have been demonstrated to be effective in developing children’s skills and reducing challenging behaviors." You'll hear me say this a lot throughout the presentation today. We need to focus on the skill we want to teach them, instead of only focusing on the challenging behavior. Furthermore, components "implemented over time and across multiple relevant environments can produce durable, generalized increases in prosocial behavior and reductions in challenging behaviors."

This last one is a big one: "Family involvement in the planning and implementation of interventions facilitates durable reductions in challenging behaviors of young children." We have to get families on board, we have to get teachers on board. We have to create a village for these children that are having significant challenging behaviors.

Another one of my favorite quotes is by Pam Leo from Connection Parenting:

You can't teach children to behave better by making them feel worse. When children feel better, they behave better.

Anytime I work with teachers, paraprofessionals, and therapists, I always tell them that you have to start by making sure the child wants to be there and they're happy. That's not to say that you give them everything they want, but when children are upset, they're not learning. We have to start by making children feel good about themselves, making them feel supported and making them want to be in the learning environment. 

Positive Behavior Supports

Throughout the duration of this webinar, we will discuss positive behavior supports (PBS). PBS involves looking at behavior differently. There are several key points related to positive behavior supports that we will cover.

  • Empirical basis: What does the research show? What data do we have?
  • Focuses on the “why” behind the behavior: When you see a challenging behavior, the first thing that should go through your mind is to figure out why this is happening, because if you don't start with the "why", the strategies might not work. Behind every challenging behavior, there is a positive need that must be identified. I will teach you some strategies for figuring out the "why". 
  • Based on the assumption that behavior keeps occurring because it is reinforced: People frequently ask me about timeouts and spankings. If these measures are not working, we are going to have to change what we're doing. You might think that you're giving a child negative consequences by giving a timeout. I have seen many situations where every time a child is asked to do an academic activity, they exhibit a negative behavior and receive a timeout. The child avoids doing an academic activity by getting a timeout. They are getting what they want, and you are inadvertently reinforcing their behavior. 
  • Teaches children what to do instead of the problem behavior: Sometimes I will receive calls from schools requesting a consultation. They will tell me about specific children with outrageous behavior (e.g., running down the halls naked). I don't get too caught up in the actual behavior because that does not tell me why they are behaving in that manner. We want to think about what we want them to do instead of just focusing on that problem behavior.
  • Focuses on changing the environment instead of just reacting to the behavior: This can be a big pill for people to swallow, especially when you're talking to teachers. I tell teachers that if you want the behavior to stop, you're going to have to change the classroom and how you're interacting with the student because we need to look at what's going on around the student. We need to look at the environment.
  • Involves planning to prevent and teach behavior versus just reacting to the behavior: Often, I see behavior plans implemented once the challenging behavior starts. They have a plan as to how they will respond when the negative behavior occurs. However, positive behavior support emphasizes what we need to do to prevent the negative behavior (e.g., hitting, spitting). What do we need to teach the student to do, instead of hitting and spitting? PBS aims to prevent and teach, versus just reacting to the behavior. 

I often tell people that these children are doing the best they can with what they have. If they could do it any other way, they would. No child likes to get in trouble. No child likes to sit out in the hallway. If they do it, it's because they want to get out of doing something in the classroom. We need to think about how we can change our behavior in order to have a positive impact on the challenging behavior of the child.

Behavior = Information

Next, we're going to walk through components of behavior and look at behavior more objectively. I like to use the analogy of looking at it as a math formula. We need to analyze the behavior, and look at what is happening before and after the behavior occurs. We need to gather information, as though we are a private investigator looking for clues. When you think about it, behavior is just information. It's how it impacts us that makes us view it as "good" or "bad" behavior.

What would we consider good behavior?  Following directions, following the rules during class time, getting along with others. 

What would we consider bad behavior?  Running away, tearing up worksheets, non-compliance.

Those negative behaviors are working for that student if they get what they want. We have to remove our perception, stop looking at how the behavior impacts us and analyze the components of the behavior. 

Core Deficits of Children with Autism

When we think about individuals with autism, we think about some of their core deficits, including difficulty with communication, social skills, and various sensory preferences. Individuals with autism have a hard time knowing how to interact with people and how to think about things from another person's perspective. They may have various sensory preferences and may be sensitive to sounds or textures. I have one student who cannot handle when other people are chewing gum and he gets upset.

Especially in younger children with autism, they have difficulty communicating and socializing. I worked with a second-grade boy a while back who was exhibiting unusual behavior issues out of the blue that was not characteristic of his typical behavior. As it turned out, they took him to the doctor and he had a double ear infection. He was not able to tell anyone that he had pain in his ears. His behavior was a clue to what was going on with him, physically. We need to remember to look at behavior objectively because all behavior has a meaning.

Working Through Behavior Issues: The Process

When working with children who have behavior issues, these are the four steps that we need to follow:

  • Identify the behavior and components (antecedent, behavior, consequence)
  • Hypothesize function (get or get away?)
  • Test hypothesis (implement intervention)
  • Monitor for effectiveness (effective-->continue; not effective-->new hypothesis)

Identify the Behavior

First, we have to identify the target behavior. This seems easy, but it can be challenging. We have to think about it in a way that it's measurable. Frequently, I'll hear words like meltdown, upset, aggressive, disengaged, hyperactive, inattentive -- none of those words are measurable. Those are subjective terms. Instead, we might observe the child's outward physical cues as being clues to their behavior. For example, if a child is quiet for more than 30 minutes, or when he's clenching his fists, it means he's upset. Those are measurable descriptions that can be observed by anyone.


tara warwick

Tara Warwick, MS, OTR/L

Tara Warwick is an occupational therapist and co-owner of Today’s Therapy Solutions, a pediatric outpatient clinic, and Today’s Consulting Solutions, a professional development and consulting company. Tara has over fifteen years of experience working with children and adults with developmental disabilities. She has experience in private practice, schools, hospital and university settings.

Tara also provides professional development and consultation services to schools and private practices. Her areas of expertise include self-help training, challenging behaviors, feeding therapy, and social skill development. 



Related Courses

Introduction to Autism Spectrum Disorders: Characteristics and Learning Styles
Presented by Tara Warwick, MS, OTR/L
Recorded Webinar
Course: #2768 2 Hours
The following course will increase participants understanding of the autism spectrum disorder as it currently is in the DSMIV. Participants will also gain knowledge on the upcoming DSMV and how it relates to autism spectrum orders. The course will discuss current literature related to general autism treatment strategies as well as current literature related to autism spectrum disorders. This course is directly related to the practice of physical therapy and therefore appropriate for the PT and PTA.

Editor's Note: Regarding Pennsylvania credits, this course is approved by the PA State Board of Physical Therapy for 2 hours of general CE credit from 7/15/2017-12/31/2018.

What to Teach and How to Teach It: Evidence-Based Strategies for Teaching Critical Skills to Children with Autism.
Presented by Tara Warwick, MS, OTR/L
Recorded Webinar
Course: #2766 2 Hours
This seminar will teach participants effective strategies for teaching children with autism new skills. Participants will increase their understanding of critical skills to target with children with autism. The seminar will walk participants through how to perform a task analysis on these skills and how to teach this skills to children with autism. This course is directly related to the practice of physical therapy and is therefore appropriate for the PT and PTA.

Editor's Note: Regarding Pennsylvania credits, this course is approved by the PA State Board of Physical Therapy for 2 hours of general CE credit from 8/21/2017-12/31/2018.

Five Strategies to Help Students with Autism in the Classroom
Presented by Tara Warwick, MS, OTR/L
Recorded Webinar
Course: #2769 2 Hours
The seminar will focus on five strategies to help students with autism in the classroom. The strategies can easily be implemented in an everyday school setting without a lot of time or preparation. This course is directly related to the practice of physical therapy and is therefore appropriate from the PT and PTA.

Editor's Note: Regarding Pennsylvania credits, this course is approved by the PA State Board of Physical Therapy for 2 hours of general CE credit from 8/21/2017-12/31/2018.

Effective Strategies for Decreasing Challenging Behavior in Individuals with Autism Spectrum Disorders
Presented by Tara Warwick, MS, OTR/L
Recorded Webinar
Course: #2771 2 Hours
The following course will provide the participants with a framework for better understanding challenging behavior and strategies for decreasing challenging behavior. The course is directly related to the practice of physical therapy and is therefore appropriate for the PT and PTA.

Editor's Note: Regarding Pennsylvania credits, this course is approved by the PA State Board of Physical Therapy for 2 hours of general CE credit from 8/21/2017-12/31/2018.

Discrete Trial Training: What It Is and How Can I Use It When Working with Children?
Presented by Tara Warwick, MS, OTR/L
Recorded Webinar
Course: #2772 2 Hours
The seminar will describe the components of a discrete trial in detail and will provide examples of implementing the strategy into physical therapy practice. This course is directly related to the practice of physical therapy and is therefore appropriate for the PT and PTA.

Editor's Note: Regarding Pennsylvania credits, this course is approved by the PA State Board of Physical Therapy for 2 hours of general CE credit from 9/26/2017-12/31/2018.