Recently Autism Parenting Magazine received a question about an 8-year-old boy with autism who engaged in challenging behavior in a school. Specifically, a grandparent was worried about the child’s meltdowns which included kicking, hitting and saying some bad words.
The person had concerns regarding the effectiveness of what was being done by a Behavior Therapist as it did not appear the challenging behavior was getting any better, and she was also concerned for the future of this child.
Specifically, she was concerned that he would become a violent adult and that he may be expelled or removed from the school that he attends.
It can be very difficult to see our loved one in distress or to hear that they were in the manner described above.
Putting ourselves in the shoes of the child with autism, imagine not being able to get your needs met without engaging in some sort of distressful, or what I like to call challenging behavior.
For some children with autism this may mean hurting themselves by hitting themselves or engaging in head banging. For other children with autism this may mean hurting others by kicking or hitting.
Whatever it is that they are doing, it is always important to remember that it is just a behavior, it is not a reflection of the child him/herself. That this challenging behavior is fulfilling a need for that person.
It absolutely does not mean that they are a bad person or that they will become a bad, violent person. This challenging behavior is how he/she has learned to get the help needed in that moment.
It is critical to address it as early as possible so that we can empower them with a better way to get his/her needs met, ultimately improving his/her quality of life now, and for his/her future. This article offers tips on how to mitigate the type of situation described above.
Tip #1 Check in with the Behavior Therapist
This may seem like common sense and it is unfortunate that it appears that the Behavior Therapist may not have been proactive in this regard in this particular instance. Whenever I am working with a family and a child with autism that presents with some challenging behavior it is important to keep the family involved as much as possible. This means keeping them up-to-date on how the behavior plan is going and if there are changes to it that the family is on board with those changes. If the Behavior Therapist is not volunteering information then you must seek it out.
Sometimes we may be expecting too much too soon. On occasion, it may take a little longer than we would like to see meaningful changes in the behavior we are trying to address. This may be because we are collecting information or facts around why it is happening. The information and/or facts collected will inform what we do to address the challenging behavior. Recall, challenging behavior is serving a purpose, it is fulfilling a need for that child. In order to help them find a better way to get their need met we must get to the bottom of why they are doing it. The plan will outline very different procedures if he/she is doing it because he/she finds the work too hard and can’t tell anyone vs. whether or not he/she is doing it because he/she has a headache.
A qualified Board Certified Behavior Analyst (BCBA) would be able to identify the why and develop a suitable plan that is informed by that child’s unique reasons for engaging in the challenging behavior. This assessment can take some time to complete but it is well worth the wait. The Behavior Analyst should keep you posted on how it is going.
On the other hand, if your Behavior Therapist already completed this functional behavior assessment and you still think it is taking too long or is not working, you should be able to get to the bottom of what is going on by speaking with them. The Behavior Therapist will be tracking how often, or long or intensely the behavior is occurring depending on the child’s unique situation. If the plan was designed based upon a well-conducted functional behavior assessment you should start to see a positive impact on the behavior. Sometimes this is only evident when looking at the data at first so you would want to check in to find that out for sure. Depending on the situation, it is possible that the behavior may get worse for a few days before it gets better.
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Your Behavior Therapist should go through all of this with you and you should consent to the procedures being used. Having consented to the procedures would require that the Behavior Therapist review the procedures in detail with you and outline any potential risks. In summary, check in with the Behavior Therapist to find out how it is going and what is being done to address any problems with the process.
It is important to keep in mind though, that sometimes it is getting better and we just can’t tell yet by watching, sometimes it is not doing any better because there are some assessments being completed first and sometimes, depending on the procedures it will get worse before it gets better. In the unfortunate situation where there are no data being collected or the plan is indeed not working, it would be in your best interest to address it as soon as possible by speaking with the Behavior Therapist and have them report on how they are going to deal with it. The bottom line here is check in with them to have them explain what is going on with the plan and what is going to be done if the plan is not working.
Tip #2 Ensure the Behavior Plan is Developed Appropriately
A well-designed behavior plan will help reduce the challenging behavior and empower a child with autism with a more appropriate way to get his/her needs met. These are the things you would want to ensure are included or considered:
- Functional behavior assessment completed by a qualified BCBA with the relevant clinical experience.
- Behavior Plan designed and informed based upon the results of that assessment.
- Objective measurement of the challenging behavior is ongoing and reviewed on a regular basis.
- That the plan includes teaching an alternative response to the challenging behavior. For example, if he/she is engaging in hitting and we found out it was because the worksheet is too hard, we would want to make sure that there is something in the plan to teach him/her how to ask for help.
- That there is a plan in the event that revisions are needed. That the data are monitored regularly for the need to make revisions.
- That family and other caregivers are involved in the development and implementation of the plan. This means that the child with autism will be empowered with the same skills everywhere he/she goes.
That there is a plan for ensuring that the plan is implemented with fidelity and that this is a priority on an ongoing basis (e.g., how are staff and family members going to be trained).
My hope is that these tips will help parents and/or caregivers advocate for the right supports for his/her child with autism. Fortunately there are plenty of well qualified BCBAs doing exceptional work to help children with autism and their families. A properly-designed and implemented behavior plan that is based on Applied Behavior Analysis (ABA) should help children with autism like the 8-year-old boy described in the question submitted to Autism Parenting Magazine. It is about empowering him with skills that will improve his quality of life, that will lead to him getting his needs met in a safe way that does not interfere with his ability to be integrated and learn new skills with his peers. I know there is a lot of information in this article, if there is anything that you would like me to review in greater detail please feel free to submit a question.
CHECKLIST FOR PARENTS AND CAREGIVERS TO DETERMINE IF BEHAVIOR PLAN INCLUDES CRITICAL ELEMENTS.
|Was a functional behavior assessment (FBA) completed?||Y/N|
|Does the FBA inform the design of the Behavior plan?||Y/N|
|Measurement system explained and demonstrated?||Y/N|
|Is there a plan to review the data on ongoing basis?||Y/N|
|Does the plan include teaching a replacement behavior to the child with autism?||Y/N|
|Was the process for making revisions to the Behavior Plan reviewed and accepted?||Y/N|
|Is there a plan for training parents/caregivers to support the child with autism with respect to this Behavior Plan?||Y/ N|
|Is there a plan for ensuring that the Behavior Plan is implemented with fidelity on an ongoing basis?||Y/N|
This article was featured in Issue 45 – Protecting Your Child with Autism