Behavior Domains addressed

Safety Issues

Environmental safety is more important than any other issues. When a child is placing himself in danger by ignoring automobile traffic, eating inedibles or harming himself through self-injurious behavior, immediate action is required. Self-injury is often a symptom of a painful condition. Tooth pain can produce head-banging or head-slapping as the child struggles to “make it go away.” Some children are drawn to dangerous behavior because it is physically exciting to jump from heights, or to go closer to the cars that are zooming by on the street. Each situation is different. It is important to try to understand what is motivating the child to engage in the dangerous behavior. If it is known what the child is seeking, it may be possible to provide it safely, and the child’s need for the dangerous behavior disappears. Several intervention principles are noteworthy in addressing safety issues:

Every child who is at-risk of a safety problem (nonverbal, cognitively impaired, communication disorder, etc) should be identified by their parent to law enforcement and other first-responder authorities. The child should be acquainted with these people and their uniforms so that the child is less likely to flee from such persons in emergencies. Special programs like the Premise Alert program in Pennsylvania are especially helpful in getting necessary safety information to 911 systems and should be a part of every child’s treatment plan, when safety issues are involved.

Environmental modification is necessary – never trust the conscientiousness of any adult caretaker as the sole means of preventing elopement (running away) or access to dangerous objects, chemicals or places. The placement of “childproof” locks is effective only until the child figures out how to open them, which is inevitable in most cases. Alarms are necessary to detect opened doors and windows, when elopement is a concern.

Repeated practice, with various adult caretakers in a variety of settings, is a prerequisite to acquiring strong safety habits. Children who learn safety skills in the home, at school, in the daycare setting, at Grandma’s house and in different stores are much safer than children who learn “safety skills” in a special education classroom, no matter how often those skills are taught.

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Communication Deficits

Ideas about the causes and treatments of Communication Deficits vary tremendously across professions and even from one professional to another within a given profession. Some authorities believe it is a good practice to teach a child to point to a picture, rather than use his voice, even when the child can speak. This practice teaches the child to communicate and can be a springboard to verbal communication; however, it could also create a reliance on the use of pictures instead of speech. Although it is advantageous to show a child that any means of communication is better than not communicating at all, it is important to relentlessly seek to reinforce speaking if the use of speech is a desired means of consistent communication. Although the approaches to the treatment of communication deficits vary tremendously, several intervention principles are common in addressing communication deficits from a behavioral perspective:

Identification of physical barriers to speech production is necessary. Children who have hearing deficits often display speech deficits – if they can’t hear speech, they really can’t figure out how to produce it or refine it for clarity.

The use of ancillary communication devices or methods (the Picture Exchange Communication System (PECS) methodology, devices to simulate speech) may be helpful and expedient. However, if the child is capable of making any speech sounds, it is probably possible to teach the child to make those sounds more consistently and intentionally, with a wider range of sounds, as a means of communicating. This is the foundation for most training in “verbal behavior” skills.

The training of communication skills can be approached just like any other behavioral training process. It starts at a basic level, takes small steps that build on success, and has a developmental plan to guide the process. Obtaining advice from a speech pathologist is invaluable in terms of creating the “developmental plan” for a given child’s communication behavioral training program.

Training in communication skills can be approached from the perspective of teaching the child to become more tolerant of age-appropriate performance expectations. Speech is a normal performance expectation for any child over the age of 1 year, so a mental health professional can assist any child over the age of 1 in acquiring speech skills by addressing the child’s behavior (escape, avoidance) in response to attempts to teach the child age-appropriate communication skills. The treatment provider is not teaching the child how to speak, which is a “life skill.” Rather, the treatment provider is behaviorally intervening to help the child tolerate the age-appropriate expectation of learning how to speak.

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  Physical Aggression

The definition of Physical Aggression varies from professional to professional. Some do not distinguish between aggression directed against objects (more accurately characterized as “property destruction”), aggression directed against the self (more accurately characterized as “self-injurious” behavior) and aggression directed against others through verbal means (more accurately characterized as “verbal aggression”). Although the definition of physical aggression may be more or less inclusive of these various behavioral anomalies, several intervention principles are common in addressing aggressive behavior:

An immediate limit-setting response is necessary. It is inappropriate to “ignore” aggression, especially if someone is being injured.

The immediate limit-setting response must not be reinforcing – if the child wants to leave the room, and you take the child out of the room when he behaves aggressively, then you’ve effectively reinforced aggression.

It may not be possible, or legally permissible, for the treatment provider to implement “contingent exclusion” without the assistance of the adult caretaker. Regulations regarding the use of physical restraint vary from location to location. Physical restraint (holding the child to prevent movement) is not recommended by most professionals, may jeopardize the health and safety of the child, and may be illegal, depending upon its implementation.

The use of physical guidance, physical prompting or other means of redirecting (moving) the child to a less-stimulating or less-dangerous setting is usually permissible, but it is always preferable to redirect the child through the use of verbal means. This depends upon the existence of rapport between the child and the treatment provider.

The treatment provider is always “icing on somebody else’s cake.” In a school, the “cake” is the teacher or classroom aide. At home and in the community, the “cake” is the parent, adult babysitter, or other adult, who is responsible for the child (daycare staff, etc). When physical aggression occurs, it is almost always necessary to “get the cake involved” quickly.

Aggression is usually “the tactic of last resort,” when other modes of communication have failed. To reduce aggressive tendencies in children, it is almost always necessary to work on improving communication skills.

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Socialization Deficits

Socialization deficits occur in enormous variety, running from extreme shyness and withdrawal to extreme intrusiveness. Children with socialization deficits may simply not care about the social implications of their behavior, may really not be aware of how their behavior affects others, or may be so self-focused that there are no “others” to affect as far as they are concerned. No matter where the social deficits lie, however, the treatment of every socialization deficit requires improvement in the child’s awareness of other people and their feelings. When a child does not have the ability to “put himself in another person’s shoes,” which affects many children with Autism spectrum disorders, the child is capable of learning “social skills” only by practicing them consistently so they become habits. Maintaining these habits will result in less self-stigmatizing social behavior and consequently greater access to socialization opportunities. Several intervention principles are noteworthy in addressing socialization deficits from a behavioral perspective:

Identification of cognitive or thought-process deficits that present a barrier to learning social skills is necessary.  Children who have autism or significant cognitive (intelligence) deficits often have great difficulty “putting themselves in another person’s shoes” and will need to practice social skills conscientiously over relatively longer periods of time in order for these skills to become habits.

Abstract thinking (the ability to see a link between two objects or events) may be impaired in children who display socialization deficits. Accordingly, it may not be productive to use analogies, metaphors or other abstractions when teaching socialization skills.

Visual cues are often helpful to children who are learning social skills. Ongoing visual feed-back regarding behavior through the use of a device like the Behavior Barometer is more effective than verbal prompting alone for most children. Programs like “star charts” that provide just one feed-back point (usually at the end of the school day) are usually insufficient to teach new social skills.

For many children, the learning of social skills may create anxiety and requires practice in “safe” settings. Practicing a social interaction in a “dry run,” before the actual event is called “behavioral rehearsal” and is often very helpful. “Social Stories” give opportunities for the child to learn about a social behavior before it must be “demonstrated” it in a real-life situation.

A technique like “role playing” is inappropriate for children with deficits in the ability to “put themselves in another person’s shoes,” since role playing requires the child to switch roles with an adult (the adult “plays” the role of the child).

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Noncompliance with Adult Prompts

Noncompliance issues are often a symptom for underlying feelings of worthlessness, frustration, or alienation. When children experience age-appropriate privacy and are allowed to preserve their dignity, they are much more likely to be compliant, cooperative, willing to engage, and tolerant of redirection and limit-setting. When privacy and dignity are deprived, children (all people, really) tend to become depressed, aggressive, withdrawn and/or noncompliant. The restoration of privacy and dignity by avoiding sarcasm, preserving confidentiality, responding reasonably and consistently to misbehavior and modeling cooperative, collaborative behavior are all prerequisites to treating children who display noncompliance issues. Several intervention principles are noteworthy in addressing noncompliance issues:

Don’t hit a tack with a sledgehammer. The consequence for a given misbehavior must be reasonable. When in doubt consult someone else who likes the child to get a fresh perspective on the problem behavior and possible responses. 

Plan responses ahead of time and stick to the plan when the time comes. It is possible to anticipate the child’s behavior pattern, so you should be able to “build a staircase” of increasingly intensive responses so that the treatment provider can “climb the staircase” if the child’s behavior does not respond to the first, or second, or third level of response. The top of the staircase is always “911” and the treatment provider should not be afraid to contact local law enforcement authorities if the child requires limit setting beyond a level at which the treatment provider is capable.

Always use an approach that encourages “forward” motion on the child’s part – toward a more optimistic future, a better day tomorrow, the restoration of privileges, and a better relationship with all involved. Avoid sarcasm and harsh, painful or punitive disciplinary practices that encourage the child to harbor resentment, experience embarrassment or humiliation. 

Work out responses to misbehavior with the child in advance. A behavior plan that includes consistent responses to the child’s misbehavior will be much more effective if the child participates in the creation of the plan. Include both rewards for good behavior and reasonable consequences for misbehavior. 

Never run to a fight. Emotions will be excited by the misbehavior, obstinacy or refusal (and perhaps embarrassing behavior) of the child. Delaying a response, in order to get emotions under control, will have a greater positive long-term effect than an immediate, intense over-reaction.

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