Interventions for Children with Challenging Behaviours and Special Needs
by Lynda Orr and Gerald Cavallaro
A child's aggressive and disruptive behaviour is a concern in any day care setting. But when that child has needs requiring special programs, carrying out those programs while trying to deal with difficult behaviours can be overwhelming for a community child care centre with limited resources. Even when parents and child care organizations agree that they desperately need the expertise of professionals trained in behaviour management and psychology, the costs are often so high that they cannot afford it.
Following is a description of a program we developed for Children's Integration Support Services (CISS), a bilingual program of Andrew Fleck Child Care Services funded by the Ontario Ministry of Community and Social Services to provide supports to licensed nursery schools, day care centres and family day care programs integrating children with special needs from six weeks to 10 years old. From our program you may glean some ideas that can work for you. In behaviour management, the key is to head off potential behaviour problems before they become unmanageable.
Our program uses two types of assessments to ascertain where and how to devote its efforts. The first we call an environmental assessment; the second is a functional assessment.
The environmental assessment examines the organization and content of programs as well as how staff and children interact. The first question we ask is: "Does the staff pay more attention to appropriate behaviours than to inappropriate behaviours?" The second question is: "Are staff members consistent in their expectations for individual children and are expectations consistent for all children?" Third: "Do staff members gear instructions to the level of the child's understanding and are they willing to follow through on those instructions, enforce limits and impose reasonable consequences when necessary?" For each of these questions, the consultant tries to enhance communication among staff (to establish consistency) and from staff to child (to improve cooperation). As a fourth step, the consultant assesses program content to ensure that it meets the needs and engages the interest of all the children. If not, programming assistance and resources are provided. Finally, the consultant scrutinizes transitions from one activity to another because most behaviour incidents seem to occur during these times. When the transitions are cleverly structured, the difficulties can be overcome. The most useful strategy is for staff to provide two or three well-spaced warnings that the ongoing activity is about to change. In addition, it can work wonders to give a "helper" role to the child who has the greatest problem with transitions.
Providing feedback and training to staff following the environmental assessment is often enough to solve the majority of behaviour problems. When it is not, consultation for individual children is needed and a functional assessment is undertaken. A functional assessment assumes that the behaviour in question serves a purpose or "function" for the child. Simply put, it "functions" to get the child something she or he wants, such as attention of staff, access to a favourite toy/activity or escape from a disliked activity. In most cases, we find that the behaviour compensates for a skill deficit which is related to the child's special needs. For example, if a child has not yet developed either the communication skills to ask for a toy or the social skills to share it, he or she may see a tantrum as the most effective way to get that toy. This is not necessarily because the child reasons that a tantrum will work, but simply because tantrums have worked in the past. Similarly, a child who cannot sit and listen during circle time may act out and thereby escape a situation he or she finds too demanding.
The key to finding an effective way to deal with difficult behaviour is to assess its function. Knowing the function usually leads to a natural solution -- preventing the disruptive behaviour from serving its purpose while teaching the kind of behaviours that will achieve the purpose better. In the example above, staff would teach the child specific words needed to ask for the toy and encourage the child to use those words. At the same time, staff would support sharing through active modelling and instruction. Later, when a tantrum did occur, staff would ignore it and redirect the child to another activity -- one that did not include the toy.
The following case study from a Head Start Program in Ottawa illustrates the way the program works. A CISS advisor referred Mark, a four-year-old boy with communication difficulties and severe behaviour problems, to the behaviour consultant as soon as the new program began. Mark had been displaying temper tantrums (throwing himself on the floor, screaming), destruction and aggressions (hitting, kicking, biting) in which he injured both staff and children. He had been consistently non-compliant to staff requests and was having difficulty with transitions. The day care indicated that, if his behaviour didn't improve, he would be asked to leave within six weeks. He had been referred to a psychiatric facility as well.
The consultant assessed the day care environment and several changes were made as a result. The level of attention for appropriate behaviour (reinforcement) was increased. Staff were trained in the use and delivery of reinforcement as well as in how and when to ignore inappropriate behaviour. Training was also given for structuring transition times for delivering and following through with instructions and requests. Good communication among staff was strongly encouraged in order to establish consistency. Because of the deadline and the level of stress in the day care, the staff-to-child ratio was enhanced. Finally, items and activities that Mark preferred were worked into structured times in order to encourage him to participate.
The functional assessment showed that the tantrums and aggressions most often occurred in social interactions with peers or in response to limits imposed by staff. The behaviour appeared to be multi-functional. Mark used tantrums and aggression to gain the attention of staff, to obtain access to items and activities he preferred and to escape activities he found demanding. Mark had not developed the language and social skills to initiate interactions with peers and he had difficulty sharing and coping with limits.
In order to prevent Mark's aggression from achieving his purpose, staff were instructed to remove him to a quiet area when he was aggressive. The removal took place with minimal interaction and lasted for a brief, standard period of time. Once calm, he was returned to the environment, redirected to a positive activity and reinforced whenever appropriate social interaction occurred.
Since Mark sometimes acted aggressively in order to escape situations, staff allowed him to leave activities after he had participated for a short period. Any disruptive behaviour was ignored by the teacher who immediately made the activity more interesting for the other children so that they too would ignore Mark's behaviour. Focus was placed on teaching and modelling appropriate social interaction and play. Circle activities taught a theme that supported use of language as the best way to get other people to cooperate.
Although staff were apprehensive initially, the frequency of Mark's tantrums and aggressions dropped substantially within the six-week period and Mark remained in the program as a result of their efforts. Presently, he is doing so well that the extra staffing is not required.
When consultation began, Mark was aggressive -- to the point of needing to be restrained three to four times each day. After one year, aggression was still happening on average once a day, but restraint was no longer required. After two years, aggressions are now fewer than once a week. Mark now interacts with the other children and uses words to express his wants, though he still needs some help with "entrance words" to begin a social interaction. Staff easily recognize when he is not coping and can ward off an outburst. Mark continues to show them that, if they do not remain consistent, his behaviours will re-escalate.
We hope that what is presented here provides practical ideas for dealing with behaviour problems.
If you are looking to change behaviour, first assess the environment in which the behaviour
occurs, then assess the behaviour's function. Examine the behaviour with respect to the child's
weakest skill. The behaviour may be compensating for that weakness. If it does, you will need
to teach or strengthen that skill to significantly improve the behaviour.
Lynda Orr is a Behaviour Consultant with the Ottawa-Carleton Behaviour Management Program.
She has worked for 12 years with children and adults who display behavioural difficulties and
developmental delays. Gerald Cavallaro is a Psychologist with 15 years of experience in the field
of Developmental Disabilities who works for the Rideau Regional Centre in Smiths Falls, Ontario.
He is currently a consultant for the Ottawa-Carleton Behaviour Management Program and the
Children's Aid Society of Ottawa-Carleton.
A Practical Guide to Solving Preschool Behaviour Problems (third edition, 1995) by Eva Essa,
Delmar Publishers: Albany, New York.
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This article appeared in Interaction (Winter 1997), published by the Canadian Child Care Federation. |
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Posted by the Canadian Child Care Federation, July 1997. |
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