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From Chapter 7 Dealing with Difficult Behaviors
Why Did He Do That?
Once your family has decided that something your child does needs to be addressed, several key factors must be considered. Now that you have your focal point--your “target behavior”--you will need to act as a news reporter and determine: Why is this happening? What can we do about it? How can we make a change? Do we have the resources to make this change? And finally, was this a good change?
Let’s consider Rosalie’s situation. Her daughter, Natalie, often screams while they are shopping in the local mall. First, Rosalie must consider why this be happening. To simplify the possibilities, we will consider three main factors. One, Natalie may be screaming in order to gain something--possibly her mother’s attention or something material. Perhaps in the past, when Natalie screamed, Rosalie bought her some candy to calm her down. In this case, Natalie has learned that the best way to get candy is to scream. Another broad possibility is that Natalie is trying to avoid or escape something. For example, maybe Rosalie leaves the mall whenever Natalie screams and that is precisely what Natalie wants--to get out of the noisy, crowded situation. The final general possibility we will consider is that Natalie’s screams are elicited in a manner similar to reflexes. These actions are somewhat different than actions that reliably lead to a predictable outcome and are often thought of as “emotionally driven.” Think about not only how you feel but also the often useless behaviors you engage in while waiting for an elevator to arrive or when you’ve just been told that the baseball or football game you’ve been waiting to watch has been cancelled due to rain. You might even scream at the TV, knowing full well that this will not help the situation. Similarly, Natalie may scream because she is frustrated over waiting to get to her favorite store, or because her shoes are too tight and hurt.
Why is it important to figure out what is leading to the contextually inappropriate behavior (CIB)? Let’s assume that Natalie is screaming because she wants candy. Now, suppose that we magically eliminate her screaming. What does she still want? Right, she still wants candy and may not have calm communication skills that would help her get candy when she wants it. So, even if we could magically get rid of her screaming, she now will have to figure out some other way to get candy while at the mall. And it is not likely that her next solution to this problem will be more pleasant. Furthermore, her mother doesn’t think that having candy is a bad thing for Natalie--it is the screaming that she doesn’t like.
Similarly, if Natalie were screaming to leave the mall, even if we could magically get her to stop screaming, she would still want to leave and may not have another calm way of indicating that to her mother. Finally, if she is screaming because she is frustrated about how long it is taking to get to her favorite store, then her mother must either rearrange her shopping schedule or teach Natalie to improve her ability to wait for things she likes.
In each scenario, Rosalie must first determine what is leading Natalie to scream in order to determine the best course of action.
To summarize, functions of behavior are often categorized as:
1. to obtain a desired object or activity, including social outcomes;
2. to escape or avoid someone or something;
3. elicited by the properties of the situation.
We cannot go into great detail here about how you determine what function is controlling your child’s behavior. Briefly, you need to not only monitor the behavior itself but also important factors that occur both before (e.g., location, time, activity, people present, and other types of relevant stimuli) and after the behavior (e.g., consequences introduced or removed, both social and materials). It may be helpful to try to guess at which of the three key functions the behavior seems to be serving for your child on each occasion it occurs and see if there is a pattern over time. For more information on determining the purpose of your child’s behavior, you may want to read Functional Behavior Assessment for People with Autism by Beth Glasberg.
Choosing a Replacement Behavior
The best course of action will not focus just on eliminating the problematic behavior, because that leaves the root cause in place. We must also focus on teaching the child a more appropriate way to meet his or her goal. For example, Natalie’s mother will have to help Natalie learn a more appropriate way to achieve her own goal--whether it is to get something she likes, such as candy; to get away from something she doesn’t like; such as the noise level; or to improve her ability to wait for things she likes, and thus improve her emotional responding. Unless Natalie learns these replacement skills, when the old needs arise, she will likely revert to her old ways or try something else that her mother will not be pleased to witness.
Notice that the potential replacement behaviors for Natalie involve those critical functional communication skills that we stressed teaching and supporting earlier in this book. In general, we advocate teaching functional communication skills as early and as strongly as possible. This way, when CIBs do arise, their potential alternatives are skills that the child has already acquired. If your child has not learned the replacement skill for a particular CIB, then you will have to spend time on developing that skill, as opposed to more simply making sure your child uses the skill.
Another important point--although some replacement skills involve expressive communication, such as asking for a favorite item, a break, or help, other replacement skills involve receptive skills, such as learning to wait. Simply being able to express needs, such as, “I want to go to the music store now!” or even pointing out the problem, such as, “I’m getting upset that it’s taking so long to get to the music store!” may not solve the problem. That is, no matter what your child is able to express, getting to the music store will take some time.
There are several things you’ll want to consider when selecting replacement behaviors. For example, it is easier to pick a replacement that your child can already do as opposed to needing to reach a new skill. The replacement should be relatively easy and efficient to perform so that there is no natural preference for the original behavior. Of course, the replacement also should be one that is socially acceptable.
If waiting is the issue, then remember to plan for something that your child can do while waiting for the main goal. Rosalie needs to consider what Natalie can do while waiting to get to the music store. She should not expect her daughter to simply not get upset. That would be a hard goal for anyone. Depending on Natalie’s skill level, Rosalie might ask her to try to find five people with red hair, or find the letter “Q” in five store signs, or simply talk to her about what happened at school that day. What Natalie is asked to do while waiting should be relatively easy--not a new or difficult skill--just something to help pass the time.
It is also important to support replacement skills that truly meet the child’s needs, rather than being something that you want to see instead. For example, while Mandy is watching TV at home, her son, Frank, frequently runs around the room, often knocking things over and making a mess. Mandy would prefer that he sit in a chair while she watches her TV show. She knows that he likes licorice so she tries to make a deal--if he sits, she’ll give him some licorice.
Although this type of arrangement may work for a short time, Mandy has not determined why her son was running around in the first place. It is very unlikely that Frank has been running around to get licorice. It is more likely that other factors are at play. He may run around to get her attention. And even though he likes licorice, when he really wants her attention, he will run once more. He may be running because he does not like her show and he is trying to get her to turn it off. He may be running because he is bored and frustrated that, from his point of view, nothing worthwhile will happen until after the TV show. Therefore, Mandy cannot just pick a replacement behavior for her son and an arbitrary reward for that behavior, but must figure out why Frank is running around before she tries to intervene and help him to change his ways.
Determining the function of the CIB and the best possible replacement that will meet the same needs may require the assistance of a specialist--especially if the behavior is particularly dangerous. The field of applied behavior analysis (ABA) provides training and support to help families and schools make this type of determination in complex cases. The Association for Behavior Analysis International (www.abainternational.org) has a special interest group (SIG) for autism and this group can help families find competent specialists to help in this endeavor.
Whether or not you consult with a specialist in behavior analysis in selecting a replacement behavior, your family should involve your child’s school (or other program). You and the school staff need to coordinate what you are doing since it can be confusing to children to have to cope with different rules in different situations.
Once you have selected a replacement behavior, you also will need to implement a plan to assure that this replacement meets with success. That is, you must plan to reward your child when he uses the replacement behavior, and even encourage him to practice the particular skill when the CIB is not occurring, to be certain that it is well developed and readily used. In chapter 2, we described several ways of “catching them being good.” Use these strategies whenever you are trying to improve the likelihood that your child will use the replacement skill instead of the CIB. Remember, if you do not adequately reward your child for the replacement skill, then he will use whatever CIB has been effective.
In general, the key to long-term successful intervention with contextually inappropriate behaviors rests with:
1. identifying the function of the behavior, and
2. systematically replacing it with a socially appropriate and
functionally comparable alternative.
If a child screams to get attention, he can be taught to communicate via words, or signs that he wants someone to interact with him. If a child is hitting his head because he sees a toy that is out of reach, he can be taught to communicate to request the toy directly or to ask for help to get to the toy. If a child slaps his face when the toy he is playing with stops working, he can be taught to communicate to ask for help. If a child is putting his head down on the dining room table midway through setting the table, he can be taught to ask for a brief break. And if a child is punching the wall when he is told he cannot go outside to play right now, he can be taught how to wait for gradually longer and longer periods of time. In each of these examples, the solution--including choosing the replacement behavior—depends upon understanding why the target behavior is occurring.
Altering the Environment vs. Teaching Replacement Behaviors
Many people try to avoid situations that provoke the problem behavior. For example, if the child with autism does not like noisy or visually stimulating environments, then they avoid going into such settings. Some families and schools have their children work long hours alone in cubicles that visually block the typical stimulation of classrooms or rooms within the house. While these types of strategies will lead to fewer behavior problems, they will not teach the child how to cope with noisy or stimulating environments when they are unavoidable.
Sometimes a better strategy to help the child pay attention to critical parts of the environment is to increase the motivation (positive outcomes) for paying attention. Let’s examine a fairly common experience for adults before we think of applying this strategy for our children. Imagine that you are at a noisy party talking to someone who is rather boring. Most likely, you are having problems hearing that person talk because of the surrounding (and distracting) noise. Suddenly, the person you’ve been waiting to talk to comes over and starts a conversation--the very thing you’ve been hoping for! Do you now have any trouble hearing what is being said to you? Of course not. And not because the room really became quieter but because it is now much more rewarding to hear what is being said to you. In the same manner, rather than always trying to turn down the noise of the room for your child, you may want to design a system that strongly rewards him for paying attention and doing whatever it is that you are aiming for. These aims can include substituting replacement behaviors for those unwanted CIBs.
For example, your child may be able to set the table when only the two of you are in the room but you want to improve his ability to complete the task in the face of distractions. We’ll also assume that you’ve successfully used a token system to reward your child when he has successfully set the table. Once your child begins to set the table, ask someone else in your home to come into room and begin talking to you. As long as your child continues to set the table, give him tokens. If he stops setting the table, remind him about what he is working for--the reward you’ve set up. Once he is able to set the table in this circumstance, gradually add other distractions--other people coming into the kitchen, turning on the radio or TV, turning on noisy appliances like the dishwasher or a blender, and other similarly distracting but natural events. Notice that you should not introduce all of these at once but rather teach your child to pay attention by gradually increasing distractions while continuing to use the powerful reward system.
We are not saying that you should never try to reduce annoying circumstances. For example, many people use noise-attenuating headphones on airplanes and in other noisy environments, and those with autism can well adopt these same strategies. Our main point is to try to prepare the child for situations in which the headset doesn’t work, or being in a noisy, visually distracting situation is unavoidable, without the child having to resort to a CIB.
