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Tips and Strategies to Address Challenging Behaviors

visualschedulesThis article was contributed by Nancy LaCross, ASNC Autism Resource Specialist in the Raleigh area.

As a parent of an adult child with autism, I understand firsthand how difficult it can be to support a loved one with significant behavioral challenges. I can remember reaching out to one professional after another looking for the magical solution to end the challenging behaviors immediately. Time and time again, I would leave a professional’s office feeling a bit deflated because there wasn’t a quick solution. Though my son had some wonderful skills in some areas, his severe behaviors seemed to impede his ability to access many resources in the community.

Though I don’t have a magical solution for ending challenging behaviors, I do have a parent’s perspective on tips and strategies that have helped my own child.

If your child has negative behaviors, I would first encourage you to identify the target behaviors. A few examples:

  • Physical aggression: hitting, biting, kicking, spitting, and head butting
  • Property destruction: breaking windows, throwing items, and breaking toys
  • Self-injurious behaviors: head banging, pulling out own hair, and biting self
  • Sound-making: humming, yelling, screaming, and making unusual sounds
  • Unusual body movements: tilting head in unusual positions, flapping arms, jumping, and flicking fingers
  • Non-compliance: not completing tasks, not following safety rules, not following rules at school, and refusing to do tasks

Once the target behaviors are clearly identified, figure out the function of the behaviors. What is the person communicating to you with these behaviors? Could it be that the person…

  • feels unsafe
  • doesn’t know what they should be doing
  • feels ill
  • is avoiding a task
  • prefers another activity
  • has sensory issues
  • wants attention

Once you identify the target behaviors and figure out the function of the behaviors, then you might want to investigate whether there are triggers for these behaviors. Are things being done that would increase the likelihood of a behavior to occur? Here are some examples of my own child’s triggers:

  • Not knowing who is in charge
  • Not knowing what to do
  • Hearing negative words such as no, don’t, can’t, and stop
  • Misunderstanding verbal directions or comments
  • Misunderstanding facts vs. opinions
  • Not understanding when to begin and/or end a task
  • Feeling unsafe with people, an environment, or a situation
  • Others aren’t following the rules
  • A change to the schedule
  • Expectations aren’t understood

Once we have identified triggers, then we might be able to avoid some behaviors by making modification and/or accommodations to what we as caregivers do. Below are some examples of how our family and professionals working with my son made modifications to our old way of doing things:

  • Not knowing who is in charge
    • An index card was created with the name of the person that was his go-to person at the time. For a younger child, they might also need a photo of the person.
  • Not knowing what to do
    • A visual schedule was created for him. When he was very young, the schedule was an If –Then schedule but as he got older, we could add more items.
    • My son really benefits from a task analysis: step-by-step directions on what he needs to do during an activity, which is listed on his schedule.
  • Hearing negative words like no, don’t, can’t, and stop
    • We try very hard to avoid using negative words. We had to train ourselves to tell our son what to do, instead of what not to do. For example, if our son was hitting a toy, we would redirect by saying, “hands by your side.” If we said “stop hitting your toy,” it would escalate the behaviors.
  • Misunderstanding verbal directions or comments
    • Keep it simple. Limit words.
    • If possible, use pictures or written words to communicate
    • Now that my son is older, we find texting to be an excellent way to communicate with him.
  • Misunderstanding facts vs. opinions
    • We work on these concepts on a daily basis. He doesn’t understand that other people may have a different perspective or opinion than his own.
  • Not understanding when to begin and/or end a task
    • A schedule and a task analysis are effective tools for creating a clear beginning and end.
    • When he was younger, we used a visual timer.
    • When he was younger we also would tell him how many more times he could do an activity. For example, if he was using the slide at the local playground we would say, “five more slides, then in the car” (holding up 5 fingers), and we would count each turn.
  • He feels unsafe
    • Provide him with the name and contact information for a trusted person to communicate with if he feels unsafe and needs reassurance.
    • Share a list of rules and regulations with him about the setting that he is going to be in.
    • Prepare him for a new environment or situation by reading him a social story in advance.
  • He feels that others are making fun of him
    • We have used role playing and social stories to work on this concept.
    • We also used Jed Baker’s social story picture books.
  • Others aren’t following the rules
    • We used social stories to try to teach him more about this.
  • A change to the schedule
    • Advance notice can be helpful
    • Using a social story to prepare for a change
    • When my son was in middle school, we used to have one activity for the day be “change in activity” or “mystery activity” just to get him used to having something unexpected happen each day.
  • Expectations aren’t understood
    • Again using a schedule and task analyses make expectations much easier to understand.
    • We also had to be sure tasks were within his skill set.

Teaching your child new skills

  • Self-regulation: When my son was very young, he had poor body awareness and often seemed to go from 1 (calm) to 5 (full meltdown) quickly. He might be calmly playing with a peer and then suddenly pushing them to the ground. We found that working with an occupational therapist experienced with sensory integration was helpful. When my son got revved up, we had to find ways to help him calm down. Under the supervision of a private occupational therapist, we used oral motor sensory objects (examples: chewy candies, gum, and chewy tubes), weight-bearing activities (pressing on the wall, weighted blankets, weighted vests, and heavy work), and exercise (jumping on a trampoline, swinging, running in place, jumping to the sky and touching the ground, and rolling on the floor) to work on self-regulation.
  • Replacement behaviors: Sometimes if we understand the function of a behavior, then we can assist the individual in replacing the behavior with something more desirable. For example, my son might tear up a homework sheet or break his pencil while working on his schoolwork. What my son was trying to communicate was that he was frustrated with his homework. Though he was verbal, when he was overwhelmed, his verbal skills disappeared. At that moment, he didn’t have the ability to use his words to ask for help. We learned that if we first provided him with a visual card to ask for help and provided him with homework expectations (“You need to do two problems,” or “You need to work for 10 minutes and the timer is set”) then he was much less likely to rip up his homework sheet and break the pencil.

If you need more support in managing behaviors, here are some people or resources you might consider:

  • Teachers
  • Special education staff at your child’s school or at the central office
  • Pediatrician or primary care doctor for a referral
  • Psychologist
  • Psychiatrist
  • Applied Behavior Analyst: Find a board certified behavior therapist at www.bacb.com.
  • Contact your MCO: My son has benefitted from a service called Specialized Consultative Services. If you need to know more about services and how to obtain them, please read the ASNC Accessing Services Toolkit
  • ASNC Clinical Team
  • Call your local Autism Resource Specialist for options
  • ASNC Bookstore, at www.autismbookstore.com, offers a few of my favorite books for teaching social skills to my son and working on behavioral issues:
    • The Incredible 5-Point Scale assisted my son in identifying behaviors/emotions/anxiety and then having a concrete system in place to know how to manage it. The scale can then transition with my son throughout his day.
    • A 5 is Against the Law! This has been an excellent concrete visual system for my son. We have been using this book to assist our son in understanding how his behaviors are perceived by others, how social expectations change as he ages, and how some behaviors are okay in one settings, like home, but not okay in others, like school or a job.
    • The Ziggurat Model is a good resource for those interested in learning more about behavior plans.
    • The Hidden Curriculum helped me as a parent to identify the areas that my child may find challenging.
    • Social Skills Picture Books: All of Dr. Jed Baker’s social skills picture books were excellent tools for me to read and review with my son. The pictures provided my son with concrete examples of social situations he would encounter in a school setting

Nancy LaCross can be contacted at nlacross@autismsociety-nc.org or 919-865-5093.

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