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On 12 June, I attended the second online webinar in the 2020 Autism Expert Series offered by the Autism Resource Centre Learning Academy. This webinar was titled ‘Positive Behaviour Support and Children: Understanding the Child’ and was presented by Dr Tony Osgood. This insightful presentation reminded us to reframe challenging behaviour as meaningful acts of communication, and to recognise children with intellectual disabilities or autism as individuals seeking a better quality of life.
What is challenging behaviour?
Dr Tony Osgood began by encouraging us to change our understanding and response to what is typically called challenging behaviour. Challenging behaviour is often defined as culturally abnormal behaviour that threatens the safety of the individual or others. Examples include hurting others or themselves (aggression), non-compliance, damaging things, eating dangerous or inedible items, as well as socially inappropriate behaviours or interests. The blame is often placed on the child, and the challenging behaviour is often seen as something that should be eliminated or stopped. In doing so, we often neglect understanding the challenging behaviour in the context of the child’s personal life story. In fact, the child’s behaviour can be influenced by a wide range of factors, such as his physical wellbeing, emotional wellbeing, social wellbeing, communication skills, and quality of life.
Dr Tony Osgood recommended that we should change how we think and feel about challenging behaviour, and in turn change how we support children. A key principle to keep in mind is that challenging behaviour happens for legitimate reasons, and is a form of communication conveying meaning (exotic communication). Another key principle is to acknowledge that the child has his own opinions and preferences (autistic legitimacy), and to have his interests at heart (child-centred). In sum, he reminded us that we should focus on the child instead of the programme.
How can we analyse challenging behaviour?
Dr Tony Osgood introduced the arousal curve, with arousal on the vertical axis and time on the horizontal axis. Initially, the child has low arousal, feeling calm and relaxed as well as doing things he likes. However, as arousal increases, the child becomes bombarded with sensory information and becomes ultra sensitive. At peak arousal, there is an incident of challenging behaviour. Thereafter, there is a slow recovery back to low arousal levels, either managed by the individual himself or with other people’s support. It is best to support the child at low arousal levels. Therefore, it is most ideal to pre-empt the incident, which is why knowing the child is important.
Dr Tony Osgood went on to explain the Antecedent-Behaviour-Consequence (ABC) model of analysing the child’s behaviour, which is part of Applied Behaviour Analysis (ABA). Through observation of behaviours over many incidents, we can understanding the pattern of where the behaviours regularly come from. This can help us come up with strategies to reduce the behaviours before, during, or after the incident. He suggested that whenever an incident occurs, we can make quick notes of what happened before (up to 24 hours), during, and after the incident. Then, we can regularly review these notes to look for patterns and obtain information which we can use to design effective intervention.
Antecedent refers to the trigger or predictor for a behaviour. For instance, the child may be unwell, unhappy, or have unmet needs and preferences. The first aspect of the predictor consists of motivating operations, which are environmental stimuli that increase (establishing operations) or decrease (abolishing operations) the need for the consequence. The second aspect of the predictor consists of discriminative stimuli, which are environmental stimuli that signal the availability of a consequence. Moreover, the predictor is also influenced by the setting events, which are the circumstances the child is in.
Behaviour refers to the challenging behaviour which takes place at high arousal levels.
Consequence refers to the reinforcer or escape which follows after a behaviour. For example, the child’s behaviour may allow him to gain escape or avoidance, attention, tangible things, or sensory pleasure. After knowing the function of challenging behaviour, we can ask more detailed questions about the place and person, and think of appropriate strategies. In addition, Dr Tony Osgood noted that, over time, we should try to widen the range of reinforcers the child likes, as well as fade out external and artificial reinforcers in favour of internal and natural reinforcers.
How can we address challenging behaviour?
Dr Tony Osgood proceeded to share 2 case studies demonstrating the ABC approach of understanding children’s behaviour, as well as ways of intervening at different times in the arousal curve.
Case study 1. When Mary is asked to wait or when she is interrupted (antecedent - predictor), she is more likely scream (behaviour), and most often escapes the demand (consequence).
Intervention for antecedent: Teach Mary waiting and turn taking skills, as well as engage Mary in other activities.
Intervention for behaviour: Teach Mary alternative ways of getting the same response, such as by asking, signing, or holding up a symbol.
Intervention for consequence: Make the demand less difficult.
Case study 2. When he is tired (antecedent - setting event), if asked to do too many things (antecedent - predictor), Alfons will scream (behaviour), and by doing so, Alfons usually gains attention from preferred people, as well as escapes demands from demanding people (consequence).
Intervention:
Intervention for antecedent: Ensure that Alfons is not tired by establishing a good night time routine.
Intervention for behaviour: Teach Alfons alternative ways of getting the same response, such as by asking, signing, or holding up a symbol.
Intervention for consequence: Examine what Alfons likes about the preferred people and teach others to be like the preferred people, such as embedding demands in fun activities, or asking instead of telling when making demands.
Dr Tony Osgood reminded us to remember there is always a reason why the child does what he does, as well as to make an effort to build rapport with the child and learn about the child. Ultimately, to provide good support, it is necessary for us to understand the functional relationships operating and the contexts; i.e. identify the antecedent, behaviour, and consequence. Good support is about increasing effective behaviour and decreasing challenging behaviour, as well as equipping the child with the necessary skills and quality of life. It is our hope that the child can live an interesting, active, and enviable life, within a network of respectful relationships comprising people with like him, in places he enjoys.
Interestingly, Dr Tony Osgood wrapped up by sharing about a children’s picture book titled ‘Eat Your Peas’, written by Kes Gray and illustrated by Nick Sharratt. The book told the story of a girl named Daisy did not like to eat peas. Her mother offered increasingly large rewards to encourage her to eat peas, but Daisy resisted. The resolution came when Daisy discovered that her mother did not like to eat brussels. Daisy concluded, 'You don’t like brussels and I don’t like peas. But we both like pudding!' By listening to and respecting children as individuals, we can avoid challenging behaviour and broken relationships. That said, it is unhealthy if a child gets everything he wants. We can strike a balance between listening to the child’s preferences and setting boundaries for learning through negotiation. We can offer the child some choices, albeit within a structure that already exists. For example, we can reduce task difficulty and introduce an element of fun to the child’s math lessons by giving math questions related to his favourite cartoon or sports team. (And in Daisy's case, she can eat other healthy vegetables instead of peas!)
All in all, my main takeaway was that we should seek to respect children and understand their behaviours before making any attempts to intervene. Challenging behaviour does not appear out of nowhere and can communicate underlying issues that need to be addressed. The ABC approach is a systematic way in which we can analyse and address challenging behaviour. Dr Tony Osgood’s webinar definitely helped to put into perspective the value of the ABC charts I had filled in as an early intervention teaching assistant at the Autism Resource Centre. Dr Tony Osgood has also written a book titled ‘Supporting Positive Behaviour in Intellectual Disabilities and Autism: Practical Strategies for Addressing Challenging Behaviour’, which I believe can serve as a practical guide for caregivers of children with intellectual disabilities or autism.
All blogposts on 2020 Autism Expert Series:
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