CHALLENGING
BEHAVIORS
Geoff Bowen
Psychologist, Statewide
Vision Resource Centre
“You cannot solve the problem with the
same kind of thinking that has created
the problem.”
Albert Einstein
Aim Of Presentation
Discuss important issues in dealing with
students with challenging behaviors. With
reference to students with vision
impairment and multiple disabilities.
Topics
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Vision impairment and multiple disabilities.
What is challenging behavior?
The maintenance of your own emotional
control as a basis to effective management
techniques. Quality of life of students.
The distinction between support and
discipline.
A positive, school based systems approach to
promoting behavior change.
Functional Behavioral Analysis and
Assessment.
The use of drugs in assisting students with
challenging behavior.
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Intellectual Disability: ID
Autism Spectrum Disorder: ASD
Self Injurious Behaviour: SIB
Pervasive Developmental Disorder: PDD
Attention Deficit Disorder: ADD
Attention Deficit Hyperactive Disorder:
ADHD
• Behaviour of Concern: BoC
• Psychotropic Medications: PM
V I & Multiple Disabilities
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Vision impairment has multiple causes.
•
A number of students with vision impairment
have multiple disabilities (physical and
intellectual disabilities) and display
challenging behaviors (minority of people
with intellectual disabilities: 6.1% - Emerson,
1995).
Vision, ID, ASD and Psychopathology
• Approximately 75% of visual impairments result
from some problem with aspects of the central
nervous system.
• 60-70% of children with visual impairments will
ultimately be diagnosed as having a secondary
disability.
• 50% of blind students have a learning disability. Of
those with moderate to severe (i.e. IQ 50 or less)
LD 56% have autism.
• Prevalence of mental illness in persons with ID
is greater than that for the general population (4
- 5x higher)
• Range from 30 -70% of the ID population with a
mental illness (sampling issues, diagnostic
criteria and assessment procedures account for
variability).
• 2 -10% have a serious mood disorder; 50%
suffer from dysthymic or depressive disorder
• 10% with ADD; 10 - 25% with anxiety disorder
• Schizophrenia 2-3x higher than that reported in
the general population
• SIB 10 - 20%; stereotyped behaviour 15 - 50%
• 75% of individuals with ASD have a intellectual
disability and usually significant BoC
• Rinck (1998) 12 and 43% of persons with ID
take PM
Disability And Behavior
Typical behavior management strategies may be
less effective with students who have pervasive
developmental delays because of:
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Severe communication difficulties.
Poor understanding of social expectations.
Motivational differences.
Greater prevalence of psychiatric neurological
and disorders.
• Cognitive processing delays.
• Sensory deficits particularly hearing and vision.
• Pervasive self reinforcing self stimulatory
behaviours.
Challenging Behaviors
“Behaviors of such intensity, frequency or
duration that the physical safety of the
person or others are placed in serious
jeopardy, or behavior which seriously limits
the person’s access to ordinary settings,
activities and experiences.”
Emerson et al 1988
Challenging Behaviors
“It was originated by advocates of people with
disabilities who were tired of terms like "behavior
disorder", "disturbed behavior", "inappropriate
behavior" and "behavior problem". They argued
that such terms wrongly attributed ownership and
blame to the person, as if they carried the
behavior around as "symptoms" of their disability.
Instead, the advocates argued, their behavior was
a very understandable response to often
unstimulating, inflexible, dehumanising and
unresponsive services. Their behaviors in fact
represented " symptoms " of a " sick system " and
in this way "challenged" the system to improve
and to become more responsive.” Radler 1990
Types Of Challenging Behaviors
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Running away
Fears, Anxiety, Phobias and Panic
Problems with Transitions
Indiscriminate Arousal
Lack of Motivation
Sleep Problems
Depression and other Mental Health Problems
Rituals/Obsessions
Total Withdrawal
Aggression/Destructive Behavior/Self Injury
Emotional Control
The first step in managing challenging
behaviors is learning to manage
yourself, particularly your stress and
emotions when a student displays a
behavior that you find stressful.
Managing Yourself
The challenge of “challenging behavior” is
to look at our behavior first and ask am I
managing myself effectively? Is what I am
saying to myself and doing in my best
interest and is it helping the student learn
what to do? Remember the worst judge of
what you are actually doing in the
classroom may be yourself!
Rules To Promote Rational Thinking
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It doesn’t do anything to me.
The situation doesn’t make me angry, anxious
or afraid. I say things to myself that produce
anger, anxiety or fear.
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Everything is exactly the way it should be.
The conditions for things to be otherwise
don’t exist. To say that things should be other
than what they are is to believe in magic. They
are the way they are because of a long series
of causal events, including interpretations,
responses from irrational self-talk etc. To say
things should be different is to throw out
causality.
• All humans are fallible creatures.
This is inescapable. If you haven’t set
reasonable quotas of failure for yourself and
others, you increase the prospects for
disappointment and unhappiness. It becomes all
too easy to attack yourself and others as
worthless, bad etc.
• It takes two to conflict.
Before beginning a course of accusation and
blame, consider the 30% rule. Any party to a
conflict is contributing at least 30% of the fuel to
keep it going.
• The original cause is lost in antiquity.
It is a waste of time who did what first. The
search for the original cause of chronic painful
emotions is extremely difficult. The best strategy
is to make decisions to change your behaviour
now.
• We feel the way we think.
This is the positively stated principle behind the
first statement on the list. It reinforces the idea
that events don’t cause emotions – our
interpretation of events causes emotions.
Quality Of Life
In recent years there has been a
movement for the guiding principle about
catering for students with challenging
behaviors to consider helping that student
and their families to have the best quality
of life possible.
Quality Of Life
“ Children with a disability can lead positive,
happy lives and bring joy to themselves and
many people. Quality of life is not about
ability - we all have different abilities. Quality
of life is about your child feeling well, being
safe and comfortable, having experiences to
enjoy, feeling that she is a lovable person,
and having some things that she can feel
proud of being able to do.”
( Disabilities: www.cyh.com/HealthTopics/ )
Geoff’s Big Four For Carer Sanity
1.
2.
3.
4.
To sleep through the night.
To be toilet trained.
To be able to occupy themselves without
doing damage to themselves, others or
property.
To be able to go to public places with carers
and remain relatively unobtrusive.
Discipline Vs Support
The general approach to dealing with
student’s behavior has been based on
a discipline model rather than a support
model.
(Robert Cooke Promoting Positive
Student Behavior, 1999.
Discipline
“Discipline is usually thought of as with
rules established for the common good. The
goal is to eliminate or reduce the likelihood
of inappropriate and non-compliant
behavior. As such, "discipline" is about the
sophisticated idea of learning what not to
do.”
Support
“Support is about teaching the student what
to do. First it is about supporting the student
in working out what is wanted or what is
wrong given the context and situation.
Whenever possible, the student is then
provided or assisted to obtain what is
wanted.”
Discipline & Support
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Discipline generally leads to emotional
distancing between the teacher and the
student.
With Support relationships are
strengthened and the teacher becomes part
of the solution to the student's problems.
Practical Objections To Punishment
• Ineffective in the long run.
• Causes unwanted side effects e.g. fear.
• Indicates what not to do rather than what to
do.
• Justifies inflicting pain.
• Relates only to particular situation of
punishment.
• Elicits aggression towards punisher or others.
• Replaces one undesirable behavior with
another.
School Based Systems Approach
The following gives ten key features of a
systematic, positive, school-based
approach to promoting behavior change
developed by Robert Cooke in
consultation with a team of teachers in
Victorian schools and outlined in
Promoting Positive Student Behavior,
1999
Working together: the school leaders
takes responsibility for forming a team to
work together with, and support teachers
in all aspects of planning and intervention.
The team includes people who do not have
daily contact with the student. The team
monitors teacher needs, tailoring support
according to concerns and aspirations.
Proactive: the school accepts
responsibility for change and sets realistic
goals and plans, acting on the belief that
positive outcomes will be achieved while
continuing to manage setbacks that occur.
This requires establishing and acting on
both short and long-term objectives at the
same time within a context of constant
review.
Promotion: the whole school, including
staff other than teachers, is alert to
opportunities to recognise accomplishment
and promote appropriate, positive behavior
and the skills and competencies the
student has already.
Prevention: the school makes changes
and actions to prevent or reduce the
likelihood of problem events occurring or
escalating to a crisis.
Communication: it is recognises that
components of problem behavior include
adaptive attempts to communicate that
have gone wrong due to restricted
student ability, faulty learning and
limitations of the environment. These
adaptive attempts have real meanings,
may be appropriate and urgent on some
occasions, and have different meanings
as circumstances change.
Multiple influences: there is acceptance
that multiple influences contribute and
interact to maintain the problem behavior;
there is rarely a single causal factor. This
requires a comprehensive investigation,
analysis and monitoring of variables rather
than single-point assessment of the student
or the behavior.
Systematic process: the school action
plan for managing challenging behavior is
an individualised, sustained process using
multiple, systematic strategies; it is not a
curriculum or discipline package.
Strategies and plans are managed in the
social context and through the regular
curriculum activities planned for all
students. All aspects of the plan are clearly
documented and distributed and discussed
with all staff.
Systematic process: the school action
plan for managing challenging behavior
is an individualised, sustained process
using multiple, systematic strategies; it is
not a curriculum or discipline package.
Strategies and plans are managed in the
social context and through the regular
curriculum activities planned for all
students. All aspects of the plan are
clearly documented and distributed and
discussed with all staff.
Instructional focus: strategies include
curriculum change, positive programming,
and gently teaching alternate behaviors,
new patterns of social skills and meaningful
interaction based on trust. New skills with
replacement value are taught before the
student can be expected to no longer need
the problem behavior.
Addressing life-style issues:
interventions address changing a range of
lifestyle, environmental and school issues
to put the student at advantage in both
present and future settings.
Behavioral Interventions Quality
Assurance Issues
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Does the behavior warrant intervention?
Have the physical/psychiatric aspects of
the behavior been assessed?
Have the situational aspects of the
behavior been assessed?
Has the function of behavior been
determined?
Have systematic influences on behavior
been determined?
Have the assessments led to a diagnostic
hypothesis?
7. Is the recommended intervention
consistent with the diagnostic hypothesis?
8. Is the intervention the least
intrusive/restrictive option?
9. Is the intervention "crisis intervention" or
"therapeutic intervention?"
10. Has student (parent) provided informed
consent for the intervention?
11. Are the effects and side effects of the
intervention monitored?
6.
12. What
is the time limit of the intervention?
13. Is the intervention given an adequate
treatment trial?
14. Is there increasing escalation of behaviour
intervention?
(Adapted from Griffiths 1989 by Dr Stewart
McDonald and Dr Linda McDonald, 1993)
Functional Behavioral Analysis
(FBA)
Functional analysis -- systematic
observation to determine the function
served by challenging behavior, the
consequences that maintain it, and the
circumstances that occasion it -- should be
an ongoing process. Once is not enough!
The Professional Advisory Committee
National Down Syndrome Congress
January, 1990
The Rationale Behind FBA
• Practically all behavior serves a purpose: it
allows students to “get” something
desirable, “escape” or “avoid” something
undesirable, or communicate some other
message or need.
• Behavior occurs within a particular context.
It may occur in certain settings (e.g. in the
gym), under certain conditions (e.g. only
when there is a substitute teacher), or
during different types of activities (e.g.,
during recess).
• Students will change the inappropriate
behavior only when it is clear to them that
a different response will more effectively
and efficiently accomplish the same thing.
• Therefore identifying the causes of a
behavior— what the student “gets,”
“escapes,” or “avoids,” or is attempting to
communicate through the behavior—can
provide the information necessary to
develop effective strategies to address
those behaviors that interfere with learning
or threaten safety.
Why do a Functional Assessment
and Analysis?
• Prevents intervention constructed around
‘surface level’ behaviour only.
• Assists in altering interventions from
reactive to proactive.
• Collaborative development lessens
chance of locating ‘blame’ on one person.
• Provides opportunity to see situations from
other points of view - and emotions.
Functional Behavioral Assessment
(FBAs)
• A FBAs is a problem-solving process that
relies on a variety of techniques and
strategies to identify the purposes of
specific behaviour.
• The assessment helps in the selection of
interventions to directly address the
problem behaviour.
(Quinn et al., 1998, p. 3)
Functional Analysis
• A functional analysis is the manipulation of
antecedents and consequences based on
information gathered during the functional
assessment.
• Analysis of behaviour throughout a
functional assessment leads to the
development of a hypothesis about the
function of a behaviour.
Overview Of FBA
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Collect information
Describe the behavior
Determine the functions of behavior
Develop a plan of intervention
Implement the plan correctly
Evaluate the outcome of the plan
Functional Behavioral Assessment
1. Describe and verify the seriousness of the
problem.
2. Refine the definition of the problem behavior
3. Collect information on possible functions of
the problem behavior.
4. Analyze information using data
triangulation and/or problem pathway
analysis.
5. Generate a hypothesis statement
regarding the probable function of the
problem behavior.
6. Test the hypothesis statement regarding
the function of the problem behavior.
FBA A Method for Developing,
Implementing and Monitoring a behavior
Intervention Plan:
7. Develop and implement a behavioral
intervention plan.
8. Monitor the faithfulness of implementation of
the plan.
9. Evaluate effectiveness of the behavior
intervention plan.
10. Modify behavior intervention plan, as
needed.
CREATING POSITIVE BEHAVIORAL INTERVENTION
PLANS AND SUPPORTS Robert A. Gable et al 2000
Functional Behavior Assessment
(Description)
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Data Sources
Describe behavior
Settings
Frequency
Intensity
Duration
Describe previous interventions
Educational impact
Emphasis On Proactive Strategies
Ecological Interventions
 Positive Programming
 Focused Intervention Strategies
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Less Emphasis on Reactive Strategies
(mainly for incident management)
(Donnellan, LaVigna, Zambitto, Thvedt, 1985;
LaVigna & Willis, 1995; LaVigna, Willis,&
Donnellan, 1989; Willis & LaVigna,1995).

• Ecological Interventions: creating a better fit
between the person and their environment.
• Positive Programming: skill building
interventions that will lead to the
development of general skills, functionally
equivalent skills, functionally related skills
and coping skills.
• Focused intervention strategies
(e.g.,differential schedules of reinforcement,
stimulus control, stimulus satiation)that aim
to produce rapid behavior change while the
slower acting ecological and positive
programming interventions take affect.
Behavior Intervention Plan
• Describe the expected outcomes and goals
for the plan.
• Specify the interventions used to achieve
the goals.
• Specify person who is responsible for
specific interventions.
• Specify a review date.
Standards Of Good Intervention
 Treatment Validity
An intervention effectively treats the
challenging behavior
An intervention is logically related to the
functions of the behavior
 Treatment Integrity
The degree to which an intervention was
conducted correctly and consistently
Maintain The Plan
• Consistent, Systematic, Cumulative
• Behavior change does not have to be
absolute
• Looking for reasonable improvement in
behavior (it takes time)
• Maintain the plan if it is effective, but needs to
be continued
Drugs
• Drugs are not evil. So-called natural substances
are not natural as they are chemicals that come
from factories and they often don’t work.
• Recent developments in medication have given
many people the possibility of some reasonable
quality of life.
• Working with the doctor and parents and observing
the child’s behavior closely will reveal the most
efficacious level of medication (this is the lowest
level of medication that clearly improves the child’s
and your quality of life).
“A comprehensive assessment should address:
a functional assessment of behaviour,
underlying medical and organic factors,
psychological/psychiatric factors, communication
and social/environmental factors. Detailed
functional assessment and diagnoses are both
integral features of an assessment of
challenging behaviour [behaviours of concern]
and should lead to a clear formulation of the
presenting problem”
(Royal College of Psychiatrists, 2007)
In Conclusion!
• Be a diligent observer
• Be Practical
• Be Systematic
• Prioritize
• Be Realistic – not every strategy will work in every
situation.
• Take the long view but plans/interventions will need
to be modified over time.
• Better now than later, right?
• If you need to give in, give in early.
• Pick your battles.
• Don’t avoid teaching it because it may be hard!
• These things can really work, and can really help
increase quality of life for everyone involved!