Thursday, April 17, 2014

Recycled Guest Posts: Teaching communication Alternatives to Challenging Behaviors in Young Children.

Shari was a 5 year old girl who just started therapy.  She wasn't producing any words, had minimal eye contact and cried during most of each session.  She really enjoyed ball slide types of toys but became upset when she wasn't allowed to control the entire interaction.  When the clinician touched the ball she cried, tried to throw the toys across the room or threw herself on the ground. 

Sometimes children like this will be described as "behavioral" or "having behaviors."  Behavior is Communication.  Everything that we do is a behavior.

If we label a child or student as "behavioral," it seems to indicate that the blame lies with them.  There is little for us to do or try, we can only provide consequences to the behaviors.  However, it is very rare that the child is capable or able to change without the adult changing their behavior first.  We adjust our expectations or how we are interacting with the child in order to affect change in them.

The first step is to look at our activity choices and consider our own interactive style.  Sometimes our expectations are too high or we may have chosen toys that are less than motivating.  In the case above, I ended up backing off from toys and really focusing on interactive "people" games such as Ring around the Rosy."  When we went back to object play, she was still having a really hard time with any back and forth turn taking.  It seemed like she had learned to use crying/yelling as her "turn" within our interactions.

In general, behavior can be broken up into four different functions:
  • Tangible 
  • Attention 
  • Escape 
  • Sensory
When you are considering trying to replace a behavior with a more socially appropriate communication choice, there are a few things to consider.  We need to make it as easy as possible for them to communicate.  Sign language may not be the best choice as you need to provide hand over hand assistance or the child may have motor delays.  I try to have pictures of the common ones we would teach and then have the child tap it in the earlier stages.  This is a simple motor movement that is easy for the child to complete.  When implementing these programs, it's really important to try to respond as soon as the child touches the picture.  Don't worry, you can work on compliance in a little bit, they only need to get these immediately when they are first learning them.    The Checklist of Communication Functions and Means Assessment is a great way to start looking at different communicative behaviors and how the child is attempting to communicate them.

This refers to behaviors which the child is using in order to try to get an object or do an activity that they want.  We want to teach the child to request the object.  In the example above, the child had learned to request by crying and throwing herself on the floor.  (at a greater frequency than a typical 2 year old.)  We started by breaking the behavior chain.  We started the ball slide activity by just giving her the balls when we played.  Once she understood that she could get the toys, we were able to increase the challenge.  Now, she needed to just touch the toy to get the ball.  Eventually we shaped this into pointing and then holding her hand out to receive the object.  

The function of this behavior is to gain the attention of someone.  Here's what can be tricky-children don't always differentiate between positive vs. negative attention.  When you think the child is trying to gain attention, you can work on teaching them to say things like "Look," "Hey," and calling people (ex. Mom/Dad)   Calling games and hide and seek can be really fun ways to work on gaining attention.  You can hide under a blanket and have the child call out for you.

The function of this behavior is to stop an activity.  I might start by looking at the activities, is it too difficult?  In terms of teaching communication alternatives, we could work on saying "help" or requesting a break.

A big concern of parents and professionals is that if we teach the child to request "all done" or "break" that they will use that all the time and never get any of their work done.  They will try this.  BUT remember, they were already requesting a break.  They were just doing it by throwing or hitting or screaming.  Once the child has had success and understands that they CAN request a break, then we can start to build in tolerance for activities.  For example, "Okay, you can have a break but first we need to finish one more turn.  Eventually you can increase to multiple turns before they can have their break.

Generally if the behavior doesn't fall into the other categories, it can be considered to be meeting some sensory need for the child.  Consultation with an Occupational therapist may be helpful in determining more socially appropriate activities to try to meet the sensory need.

When we know the function of the behavior, we can start to provide more socially acceptable communication alternatives.  Please note, maladaptive behaviors can be complex.  If you attempt a few of these interventions and do not find success, it may be helpful to contact a behavioral analyist to complete formalized assessment in this area.

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