I was thinking about autism and challenging behavior today and the behavior management strategies to go with them. Whether it's related to medication or controlling behavior or it's a meltdown due to over-stimulation or a need to engage in repetitive behavior, behavior management techniques are really important for everyone's sanity.
I'll talk about challenging behavior strategies a lot more, but for today, I thought of a situation we had when our son was young and thought about the importance of preventative strategies. So here's my anecdote about antecedents (triggers):
I remember when Dude was in about 3rd grade, and I was getting regular calls from the principal for a variety of behavior outbursts. One day, I saw the phone ring. “Oh boy,” I thought, “What is it this time?”
Principal: “Hi Mrs. J, Dude threw a book at another student's head today. He's in my office right now.”
Me: “Oh no! What happened?”
Principal: “Not sure, yet, but I think it would be best if you came in.”
I go to the school, into the principal's office. There he is, rolling around on the floor, kicking at the desk and garbage can. I walk in and give a stern, “Hey!” and he gets these wide eyes and sits right up. He knows not to mess with me. Ha!
Anyway, it took some time to find out what happened. But here was the string of events:
- Out at recess (sensory overload), playing 4-square or wall ball or something (competition was a trigger for him).
- Recess ended, had to stand in line (people in his space bubble). Had a little tussle with another boy in line about who was first.
- Came into class, teacher immediately tells them to take their books out for writing (his least favorite task).
- Another kid said something to him about his book (don't remember what it was), so the book ended up in the back of his head.
What causes challenging behavior in autism?
Not just in autism, but really, in any person, disability or not. Challenging behavior comes down to three things in my mind: something physical, something psychological, or something sensory or a compulsion.
Physical: Is the person sick? Feeling unwell? Is their medication off? Do they need to poop?!? Are they tired? Have they had too much screen time? (Oh boy, this is a big one.) Are they hungry (or hangry)?
If you can identify the physical need, this is the easiest one to work on for next time! Make sure the individual has a good sleep routine, is fed regularly, has their medication managed regularly (maybe they've been through a growth spurt and need an adjustment, for example).
Psychological: Did something happen to make the person feel angry, confused, anxious, or frustrated? Has there been a change in their family circumstance? Are they being bullied or having problems at school? Has there been a change in their routine?
Provide a supported and understanding environment for the person. Surround them with caring individuals, provide enough instruction to help them learn at their level, give them the words (in any format) to get their wants and needs known. Be aware of past trauma events so you can be mindful of situations that come up and avoid them. Have a contingency in place for when (not if) the challenging behavior does arise and make sure everyone knows the plan so there is consistency. And love on the person!
Sensory: Other smart people loop sensory into psychological or other mental factors. I see it as separate. A person can have all their physical needs met, and their life situation is going fine, but some completely internal need to rebalance their sensory system or to fulfill an obsession or compulsion to do something triggers a challenging behavior.
Give the individual opportunities throughout the day to get their internal needs met. Consult with an OT if they need frequent sensory input (or need a lack of). Often, individuals with autism needs time in their day to wind down, and that may include repetitive movements (stimming). There is nothing wrong with stimming! It helps regulate the system. In rare situations, stimming may need to be shaped or taught to occur only in certain environments, but for the most part, it's really not a big deal. If there is a compulsive need to do something that is causing the challenging behavior, this there a time and place you can set up to get that need met before a behavior arises?
What are some possible triggers of challenging behavior?
So here ya go. Common triggers I've seen (I'll talk about the 4 functions in a later blog):
- Not being able to communicate a need
- Wanting something they can't have
- Wanting attention from someone
- Wanting to get AWAY from someone
- Being sick
- Not enough sleep
- Too much screen time
- A change in family circumstances
- A change in routine
- A change of environment (e.g. starting a new school)
- Being bullied or teased
- Something too hard
- Something too easy
- A need to do something that isn't being allowed
- And. So. Many. More
Prevention strategies for challenging behavior (not during)
Here are my quick tips. I will talk about the functions of behavior and what to do WHEN they occur, but for prevention, here are some ideas:
- Identify the function and be prepared to address the need the next time.
- Prepare for next time, have a plan in place. Make sure everyone involved knows the plan and can implement it.
- Have a safe environment. Think, “If the behavior occurs here, will the individual be safe? Will others in the environment be safe?” What objects can be moved or placed out of reach so that in the moment of crisis, you're not trying to prepare the area (too late, then).
- Think ahead. When going somewhere or doing something, think, “What can I do to support the individual and help them have a good experience doing ….?”
- Provide supported learning system. Teach at their level, not too hard, not too easy. Break down goals into small chunks that can be taught and mastered and allow for lots of success!
- Provide routine and predictability. Some change is good and healthy and important to learn to deal with, but regular routines are excellent for the flow of a day. For example, going to bed at a certain time, having a bedtime routine that is loose but followed each night, will help a little one go to sleep much better than a constantly changing and evolving evening.
- Fulfill sensory needs. Make sure you have an OT to consult with, but also just give the individual opportunities and space to reset their system.
- Read subtle body language and communication cues. Be mindful of what the individual may NOT be saying. Be prepared for changes in demeanor and increase in agitation before it gets too big!
- Provide information at the same level. By this, I mean if the person is minimally verbal, then provide instruction or learning opportunities with minimal verbal input. Match where the person is.
- Reduce verbals when you identify precursor behavior. If you see the person getting agitated, Stop. The Freaking. Talk Talk Talk. Probably the biggest thing I see in crisis and the easiest thing for providers to fix! There's some sort of weird need to keep talk-talk-talking when someone is in crisis. It just makes them more mad, I'm telling ya! Just slow down, provide simple and clear language at their level, and provide space.
- Medical management. Always make sure medical needs are met, medications are up-to-date, and any illness is addressed.
There are, of course, many other things that can be discussed, but the biggest thing is to get to know THAT person and what THAT person's needs are and to do whatever we can around that person to support and provide for those individual needs.