By Amanda Franklin, Trauma Informed School Practitioner, Emotion Coach Practitioner Trainer, Registered Behaviour Technician (RBT)

Understanding the different behaviour therapy options available

It is important to understand that all behaviour is a form of communication. We all experience this and express ourselves in different ways, at different times, depending on our mood. For some expressing themselves in a ‘socially acceptable’ way is much harder and may need to be learnt.

This article aims to provide an overview of how behaviour can be identified, understood, and supported with the more popular forms of support that are available.

As behaviour is both observable and measurable it is possible to identify the reason (function) for a behaviour and replace the unsuitable behaviour with an acceptable behaviour. Challenging behaviour often occurs because the individual is unable to communicate their wants or needs. When a child can express their needs or wants by alternate means, the unacceptable behaviour is less likely to reappear.

Behaviour therapy is action-based. Because of this, behaviour therapy tends to be highly focused. The behaviour itself is seen as the problem and the goal is to teach new behaviours to minimize or eliminate the issue. Behaviour strategies often aim to increase communication (through both verbal or non-verbal methods) and teach replacement behaviours to help the child express themselves and achieve expression of their wants and needs.

The main functions of behaviour are:

    • social attention
    • access to tangible items or preferred activities
    • escape or avoidance of demands and activities
    • sensory sensitivities (this could be seeking or avoiding sensory input)

Children ususally experience most difficulties with social participation and fall into one of two groups, those that internalise their difficulties and those that externalise.  Both groups need support to improve their social participation in different environments.

ABC (Antecedent, Behaviour, Consequence) charts can be used to record behaviours and identify their function. Understanding what has caused the problem (antecedent) and how the child has reacted (behaviour) helps with knowing how to solve it (consequence).

Change can take time – especially if a new skill needs to be taught. Consistency of your own behaviour in your approach towards the child is very important.

ABA (Applied Behaviour Analysis) and EIBI (Early Intensive Behaviour Intervention) are popular therapies used to promote attention, imitation, language processing, communication, and general life/social skills. The therapy is based on traditional behaviour theory of using reinforcement to change reactions to events. Positive reinforcement, the use of praise and rewards to encourage repetition of a positive behaviour, is a main strategy of behaviour support.

Errorless or Precision Teaching is another widely used strategy, that breaks the learning or following of instructions down into smaller more precise steps. A generic instruction of ‘Tidy the toys please’ will be broken down into multiple instructions given one at a time so that there is no ambiguity.

Therapeutic play techniques involve constant ‘modelling’ or use of correct language and actions to support learning in a play environment. As situations arise (Incidental learning) and Pivotal Response Training are incorporated into sessions. This form of therapy allows work on more general areas of development such as communication and social skills rather than specific behaviours.

Speech and Language Therapy is the assessment and treatment of communication problems and speech disorders. It is performed by speech therapists who provide techniques that are used to improve communication. These include articulation therapy, language intervention activities, and others depending on the type of speech or language disorder. Therapy helps support communication abilities and reduce frustration and ensuing behaviour.

Occupational Therapy works to develop skills for handwriting, fine motor skills and daily living skills. However, the most essential role is also to assess and target the child’s sensory processing differences. This is beneficial to remove barriers to learning and help the students become calmer and more focused.

There are various Communication Interventions that can be used to support both receptive and expressive language skills. In school it is common to find visual timetables and now and next boards in use, both of these tools support understanding of a chain of events that will occur. For children with communication difficulties both PECS (Picture Exchange Communication System) and Makaton (symbol, sign and speech programme) help support the development of essential skills such as attention and listening, comprehension, memory, recall and organisation of language and expression.

All interventions or therapies should work on building relationships, within a calm environment, that follow the principles of PACE (play, acceptance, curiosity and empathy) to support and build feelings of safety and self-worth.

 

For further support with behavioural issues book an appointment with one of our specialists:

Behaviour Therapy in Practice

Case Study

January – September 2020

Over the past nine months I have been using my expertise to work on a daily basis with a child with autistic spectrum disorder (ASD) in Nursery to de-sensitize him to the sound of the electric hand dryer so that he can use it independently. The hand dryer is next to the wash hand basins in the toilet area. De-sensitization is necessary to allow the child to participate in handwashing and drying with his peers. It is also a necessary life skill and will improve his well-being.

The programme has been a slow process using a variety of behaviour techniques learned from an Applied Behaviour Analysis (ABA) course, with much motivation and praise. I ran the ABA programme in school at the same time as the child completed a home programme to desensitize him to the vacuum cleaner and hairdryer. Daily communication between myself and the parents was necessary to facilitate this home-school learning experience.

The behaviour course I implemented used, among other techniques, errorless teaching that breaks a skill down into easier to achieve steps with prompts. These steps were recorded on forms and the success of completion was rated. A score of 100% for three consecutive days is necessary before progression to the next step.

Completion of each step was managed through game play to make the task a fun activity and rewarded with lots of praise and tickles!

The process of de-sensitizing the child started by standing with him at the door of the toilet area whilst his peers used the hand dryer.  This progressed to slowly moving further into the room when it was empty.  Then I introduced standing in the room for a count of 3, then 5 and up to 10 seconds.  The child then progressed to washing his hands in the sink closest to the hand dryer when it was turned off.  He then learnt to touch the hand dryer when it was turned off.  Then he learnt to wash his hands with his peers using the hand dryer.  He became more inquisitive and asked me to use the hand dryer whilst standing next to me. This progressed into him using the hand dryer himself with me next to him.  Final intended outcome was for him to use the hand dryer independently to improve his well-being and transfer the skill across environments in real life, authentic contexts.

This experience was started to aid the child’s integration into class activities and reduce stress of loud noises that affect him and his family. This is part of a de-sensitizing programme his family are also running at home for the vacuum and hair dryer. The joint school and home learning programme has strengthened the relationship between myself and the parents and will improve the well-being of the child and assist them using skills learned in school in the outside world. I discussed the steps I would take in this process with both the class teacher, fellow class teaching assistant and the parents so that everyone was clear on the outcome and how it could be achieved. I was asked to assist with this programme as the use of behaviour management techniques with children with ASD is my area of expertise.

Final intended outcome has now been met. (September 2020) When implementing behaviour programmes, it is important to not rush the process, the child needs to be confident to progress. However irrational you think the reaction of the child is you need to understand their fear and support them patiently to overcome it. The use of praise and motivational language throughout the journey can never be enough and the well-being of the child must always remain integral to their learning.

The teaching of practical tasks expand learning and help the generalisation of skills across situations and environments.

Explore our blog article to discover additional information about behavioural therapy choices: Therapeutic Play

Disclaimer:  The views and opinions expressed in this blog post are those of the author and do not necessarily reflect the official policy or position of any professional organization or guidelines. The information provided is for educational and informational purposes only and is not intended as a substitute for professional advice, diagnosis, or treatment. Always seek the advice of your therapist or other qualified health provider with any questions you may have regarding a medical or mental health condition.