The topic of behavior comes up all the time for me professionally. It seems that I am having a never-ending conversation with IEP teams about how to view autistic students' behaviors, and how to address them.
Sometimes a family contacts me because their child who has been doing well in inclusion is now having problems like acting out, meltdowns, not following directions, leaving the classroom, being rude to teachers, refusing to do work, etc. Sometimes a school proposes a different placement for a child because there are "behavioral issues" in the classroom. The team sees the student as too disruptive and believes that they need to be moved to a more specialized classroom. Sometimes behavioral issues are long-standing and the school and parents are at wit's end as to how to help the child.
We all know the expression "behavior is communication." But how many times have we been to an IEP meeting in which there was a thoughtful and careful discussion about what specifically a child is communicating to us through his behavior? I have been to a few, but that approach is not common. Usually, a Functional Behavior Assessment (FBA) is done. It considers four possible goals of behavior, which are attention, escape (i.e. avoiding a demand), sensory (obtaining sensory input) and tangible (obtaining the desired item). Then a behavioral support plan is created with the goal of reducing the undesirable behaviors. Sometimes, the behavioral plan works in that some behaviors are reduced, but others will pop up. Other times, behaviors only get worse. Why?
Because in reality, there are so many more reasons for behavior than a FBA addresses. FBA is a helpful tool, but it is important to understand that due to it being rooted in the philosophy and techniques of ABA, FBA is only focused on what can be observed. It cannot assess the student's levels of skill, emotional state, state of arousal or how the student is affected by sensory factors and difficulty of demands.
Let's consider a couple of examples, starting with a student who does not participate in a writing group. FBA says the primary purpose of this behavior is "escape," the secondary is "attention." Yet when we look at this child's occupational therapy evaluations, we see that the fine motor component of writing is laborious for him. He struggles with it and becomes physically exhausted very quickly. When the challenging motor component is combined with another challenging demand, for example, a need to develop three sentences on the topic, that pushes this student over the edge.
Does the student "choose" not to participate? No. The student isn't participating because the tasks are very difficult for him and likely his anxiety shoots up right as the group is starting. The student might be experiencing what is known as "freezing," feeling "paralyzed, stuck, unable to act. He might lose his executive functioning abilities, i.e. ability to self-monitor behavior, and as a result, he might act out.
Furthermore, let's consider this student's communication abilities and self-regulation skills. The speech and language evaluation reports deficits in the area of expressive and pragmatic language. It also states that the ability to recognize and manage emotions and states of arousal is a challenge for this student. This is a child who cannot recognize his anxiety, and is not able to communicate his challenges, especially when anxious. He cannot say, "This is hard for me, and I am feeling overwhelmed. Can I get help in breaking this assignment down into small tasks? And can I please get a scribe?" Because the student cannot recognize his challenges and then formulate and communicate this complex message, he is communicating his difficulties through the behavior.
Let's look at another example of an autistic child who fidgets in class during large groups and when the teacher is reading aloud. It is a behavior that is very distracting to the child's classmates, and the teacher has been admonishing this child to sit still and pay attention, to no avail. A system was implemented that allowed the child to earn special activities for sitting still, but it did not help. The teacher is saying, "I have been prompting and redirecting her. She is just refusing to pay attention." How can we help this child "behave"?
Let's think about different options for why this child is fidgeting. Can this student be experiencing discomfort from some of the sensory inputs in the classroom (noise, light, cluttered visual field)? Is it possible that she cannot filter out sensory input and it gets in the way of clearly hearing the teacher's voice, so the child is lost? Does this child need proprioceptive feedback to know where his body is in space? Is her seating not supportive enough, so the student's core strength and postural control challenges are making it hard for her to sit for that long? Is it possible that the student can’t understand the vocabulary used, or has difficulty processing the large chunks of spoken language unaccompanied by visual supports? Does this student have trouble regulating her attention? Is she experiencing anxiety? Is this student understanding the gestalt what’s going on in the classroom? Is the task at hand too difficult for her to manage without support?
It is up to the professionals working with the child to act as detectives to understand the reasons behind the behaviors. Once you understand the reasons, you can understand what needs to be done. Ask a few simple questions:
does the child have all the skills needed to complete this task?
are there alternative ways to show knowledge that would not require the child to do things that are taxing, or that do not require skills that the child does not have?
what is the environment in which this demand occurs? How is this environment affecting the child? Is there an environment in which a child can be more successful with this task?
does the child have the skills to communicate difficulties and ask for help?
can this task be modified in some way to be less demanding for the child?
what accommodations can we put in place to meet the child where he or she is in regards to this task?
what skills do we need to teach the child in order for him or her to be able to manage this task independently in the future?
This approach can be combined with an FBA. FBA can clarify the specific circumstances when the behaviors occur, and describe possible patterns, i.e. always in the afternoon, or always in the writing group. It can also describe some of the things the student might be looking for and provide guidance for the skills that need to be taught. For example, if sensory input is overwhelming, the student needs to learn about her sensory needs and how to ask for a sensory break.
The starting point of intervening is by changing the student's environment. The fancy word for that is "antecedent management." This means that those factors in the environment that are leading up to the behavior and that the student is not able to handle should be modified. That is called providing accommodations. Accommodations will remove the challenges that the student is communicating via the behaviors and the behaviors should subside.
At the same time, since in special education we are working towards independence, the student should be provided with instruction in the skills that he or she doesn't have. Gradually, as those skills are acquired over time, the student will be able to handle more and more aspects of the tasks and situations that were previously unmanageable. For example, a child who fidgets from boredom because he does not understand spoken language will do much better with a preview of the content, pre-teaching of relevant vocabulary, speech and language therapy focused on receptive language, and post-teaching to ensure understanding of the material.
