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Autism and the Promotion of Positive BehaviourProfessional Primary Training

• Discuss the core features of autism and how these features impact upon behaviour and learning

• Understand challenging behaviour and possible functions

• Review general principles and key strategies for preventing challenging behaviour

• Identify essential components of a positive plan

Objectives

• In pairs, choose who will have a thought or feeling to communicate (1)

• The other person (2) needs to close his or her eyes so as not to see the following thought or feeling

• The partner (1) will then try to convey the message to you without using speech

Partner A – Close Eyes

Communication Activity

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PARTNER B:

Message to communicate:

Where is my string?

PARTNER B – Close Eyes

PARTNER A: Message to communicate:

Are we going swimming tomorrow?

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Restrictive Interests & Repetitive Behaviours

Frustration and Anxiety

Change and transitions

Restricted/ fixated interests

Sensory processing

Stereotyped / Repetitive Motor movements

Wenn Lawson

‘As I have already hinted at, I have very uneven skills. I have university degrees, I have been married and I have four grown

children.

However, I have huge problems with being disorganised, getting lost, using public transport, understanding others and

just the practical interactions of social situations.

I think many of you might be saying "So what, I do as well." I know that neural-typical individuals might have issues in

these areas but I would suggest to you that it is the degree of the 'issue' that separates us. How many of you need to sit

down on the path outside of a supermarket and do breathing exercises because they have changed the tinned soup isle’.

Challenging Behaviour can be defined as

“any behaviour that interferes with the quality of one’s life, or causes injury to self or others, and inhibits access to learning or

access to the wider community”

•Note: Remember, challenging behaviour is not part of the clinical diagnosis /core features of Autism

What is Challenging Behaviour?

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Co-existing Conditions

Klinger et al 2014

Iceberg Analogy

Understand why students

misbehave

Common forms of Challenging Behaviour

Hitting Biting Kicking Screaming/Shouting

Any self-injurious behaviour

Propertydamage

Defiance ‘Bad’ language /negative comments

But what about . . .

Passivity? Lack of participation?

Inattention/Distraction?

Inability to interact/communicate?

Inability to understand?

Lack of progress with learning

obj’s?

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Phases of an Incident

Calm

Trigger

Agitation

Acceleration/ escalation

Peak

De-escalation

Recovery

• Interferes with teaching and learning

• Impacts social relationships

• May be physically and emotionally harmful to the individual and/or other persons.

• Impacts participation in community-based activities

Implications of Challenging Behaviour

Understanding the Foundations of Behaviour

All behaviouris learned

Behaviourserves a function

Environmentimpacts

behaviour

Skill deficits impact

behaviour

Team approach is critical

Relationship matters!

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Five Principles of Behaviour Support

McClean B., Grey I. 2012 Journal of intellectual disabilities 37, 209 -220

Results of Study

Behaviour are reduced by 85% just by introducing Rapport and low arousal environments.

Five Principles of Behaviour Support

Rapport / RelationshipEnvironment

Predictability / ChoiceCommunication

RewardDr Brian Mc Clean

Rapport / Relationship

CareRespect

LikeFun

Patiencekindness

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Rapport / Relationship

Research now tells us that the success of any intervention is dependant on the client perceiving the therapist as1. Warm2. Genuineand3. has an unconditional positive regard for them as a the client.

The IT FactorSome people have it and some don’t

Brian Mc Clean refers to this as Mindfulness

Mindfulness is :Paying attention

On purposeWithout judgement

In the present moment

‘IF we can apply mindfulness to our interactions with people then a lot more complicated interventions my not be needed’.

Environment /Physical Structure for working

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Form of schedules

Schedules come in different forms

• Object

• Tobi

• Line drawing (varying sizes)

• Word

Transition / Waiting Activities

Structure ‘Down-Time’

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Structure ‘Down-Time’

Indoor Lunch-time Structure Lunch Clubs

Structure ‘Down-Time’

Transition Activities

Timed jumps on trampoline

Jumping Jacks

Wall presses

Chair push-ups

Structure

• Routines

• Timetables

• Consistency

• Predictability

• Visual systems

• Low arousal areas

• Learning breaks

• Timers (where appropriate)

• Explosive exercise

NO SURPRISES

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Communication• PECS• Makaton• Help cards• Need a break card• Talk Talk• Proloquo to go• Grace App

A consequence that causes a behaviour to occur with

greater frequency.

Reward /Positive Reinforcement

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Positive Behaviour Support Plan

Positive Behaviour Support is an approach that helps in understanding the purpose of an individual’s problem behaviour

“the application of an applied science that uses proactive and effective educational methods, behavioural interventions, environmental re-design and systems change methods to

support individuals whom exhibit disruptive, and/or dangerous behaviours in school, work, social, community and

family settings “ (Carr et. Al.,2002: Horner et al., 1990)

Create a Positive Plan

Adapt the Environment

Consider core features of autism . . .

Physical Environment

Learning Environment

Deal with triggers

Teach a new skill / Replacement Behaviour

Teach an appropriate ‘substitute behaviour’ or a functionally equivalent replacement for the challenging behaviour.

Reinforce the new skill

Ensure the student is motivated to demo the new skill / ‘replacement behaviour’.

Essential Components of a Positive Behaviour Support Plan

1. Identification of Target Behaviour2. Function of behaviour – assessment3. Hazards or setting events – What contributes to

behaviour4. Proactive strategies – modifications to environment .5. Identify new skills needed – teach new skills6. De- escalating strategies7. Crisis management protocol8. Review effectiveness of existing strategies.

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Specify the Behaviour

•To change behaviour, you must be able to specify exactly what the child does.

•General terms like good, disruptive, cooperative, aggressive or lazy• do not pinpoint exactly which behaviours are a

problem • these terms mean different things to different people

Remain objective!!

The Monkey Business Illusion

Specify the Behaviour

• Activity:

Close your eyes and picture a child who is ‘hyperactive’.

• Discussion:

What did you picture the child doing?

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Specify the Behaviour

Hyperactive...

How Behaviour ‘Works’

Scenario:

Cian, a non-verbal 2-year-old with autism bangs the fridge, shouts out

and cries. Mum thinks he may be thirsty, gets juice from the fridge and

offers it to her son. Cian takes the juice and stops crying.

What did Cian learn?

Will he do this again?

What could you teach him instead?

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Scenario:

Dale is a 9 year old student with autism in a mainstream

primary school. His teacher asks him to complete a written

literacy task. However, he immediately scrunches it up,

throws it at her becomes very upset, crying and shouting

aloud. The teacher sees he is agitated, suggests to the SNA

that he needs some time away and to bring him out for a

walk.

What did Dale learn?

Will he do it again?

What could you teach him instead?

How Behaviour Works:

Assess the Function

‘The purpose the behaviour serves’.

• What’s the payoff?

The “WHY” tells you HOW to best address challenging behaviour.

Assess the Function

• Functional Behaviour Assessment: This is the most efficient method of figuring out why a child is engaging in challenging behaviour.

1. When is the behaviour most likely to occur? Least likely to occur?

2. Where is the behaviour most likely to occur?

Least likely to occur?

3. With whom is the behaviour most likely to occur?

Least likely to occur?

4. What consequences are maintaining this behaviour?

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What is the Function?• Crapville

• What is the function?

ABC’s of Behaviour

Antecedent: This is the term used to refer to the situation that occurred before a behaviour (e.g. who, what, where, when).

Behaviour: Precise and objective description which reflects challenging behaviours observed (e.g. kicking others, hitting self, throwing items). Note intensity if relevant.

Consequence: This term is used to refer to what happened immediately following a challenging incident (e.g. what nearby adults did upon noticing occurrence of challenging behaviours).

Antecedents….events that happen before

There are two types of antecedents:

•Slow triggers or Setting Events

e.g. under sleeping; no breakfast; forgotten medication; conflict with sibling/ teacher/mum/dad; tiredness; sick or in pain; different route/routine

•Fast triggers or immediate antecedents

e.g. turning your attention to something/someone else; removal of a preferred object "It's finished/give it back”; asking to do something the student does not like e.g. “time for work / bed”

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Define Behaviour

• Behaviour refers to a specific action that a person does that is measurable and can be observed.

• Everything we do can be described as behaviour.

Examples:

• Kicking others, hitting self, absconding from classroom, dropping to the floor, verbal refusal.

Consequences - How Behaviours are Learned

Consequences: refers to what happens immediately after a behaviour.

• Responses that follow behaviour begin to have an effect on how frequently the target behaviour will occur in the future.

• In general, consequences that are pleasant or rewarding result in the behaviour occurring more often in the future.

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Sample ABC

• :Antecedent Behaviour Consequence

Setting Events

Setting Event Antecedent Behaviour Consequence

Parent report indicated that Dale’s sleep has been very disturbed lately –up at 3am each morning

Bell went - signal that outdoor play had finished. Students lined up. D ran towards student first in line.

D hit out at student using open palm.

Intensity: Palm sounded but no redness or bruising on other student

SNA brought Dale to the classroom to reprimand him for hitting and reminded him of the rules. Incidentally, Dale returned to class ahead of the others

9.30-10.00

10.00-10.30

10.30-11.00

11.00-11.30

11.3012.00

12.00-12.30

12.30-1.00

1.00-1.30

1.30-2.00

2.00-2.30

2.30-3.00

Mon√√ √√√

√

Tues√√ √√ √√ √√

Wed √√ √√

Thurs √√ √√ √√

Fri √√√

√

√√

Name: Richard A Class: A8 DOB: 12.11.09

Date: Week beginning: 2.10.16

Behaviour Topography: Dropping to the floor and remaining there for over 1 min.

Tick in the box each time one event occurs in the given time period.

Scatterplot Example

9.30-10.00

10.00-10.30

10.30-11.00

11.00-11.30 11.3012.00

12. -12.30

12.30-1.pm

1.00-1.30 1.30-2.00

2.00-2.30

2.30-3.00

Mon √√ 2 E √√2D √√ 1F

Tues √√2E √√ B √√2D √√B √√ 1F √√1C

Wed √√2E √√2D √√1F

Thurs √√2E √√2D √√B √√1F

Fri √√√2E √√2D √√1F √1A

Key for recording behaviour. Write code for where behaviour was

observed in each occasion and who was present

1. Whole department group >20 people

2. Whole class group

3. Smaller group with < 8 people

4. 1:1 with adult

A-Soft play

B- playground

C- Bus Line up

D- Classroom group work

E-Break area

F-Dinner area

Name: Richard A Class: A8 DOB: 12.11.09

Date: Week beginning: 2.10.16Behaviour Topography: Dropping to the floor and remaining there for over 1 min.

Tick in the box each time one event occurs in the given time period.

.

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It’s only when we know what

is driving the behaviour, that

we can set the appropriate

strategies in place

Analyse the ABC’s to Identify Functions of Behaviour

• Changing how we think about challenging behaviour . . .

Changing our Thinking

Behaviour Problems Skill deficits or

Learning differences

Bold; naughty; manipulative; knows better; controlling.

What skills are missing? What do I need to teach?

“if a child doesn’t know how to read, we teach”.

if a child doesn’t know how to write, we teach

if a child doesn’t know how to multiply, we teach

if a child doesn’t know how to swim, we teach

if a person doesn’t know how to drive, we teach

if a child doesn’t know how to behave, we .....

..........teach?......assume they will “get it”.......punish?”

At times the last sentence is not finished as automatically as the others. WHY?

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Sample 1: Social SKills

Jed Baker – Website You Tube Clip of teaching skills/role play

• https://www.pinterest.com/pin/185492078378715940/

Teaching New Skills – 4 R’s

•Rehearse: Teach and practice the skill out of context.

•Remind: the child about the steps before presenting a potentially difficult task.

•Reinforce: Immediately

•Reflect: What could be done differently next time?

Teaching New Skills

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Principles of Reinforcement

Reinforcement works best when it is :

1. Provided contingent on correct response (e.g. new replacement behaviour)

2. Provided immediately following the correct response.

3. Provided for every correct response (when teaching a new behaviour).

4. Provided only when the correct response occurs.

So how do we motivate a child to engage in the selected replacement behaviour?

Follow the desired replacement behaviour with the addition (positive) or removal (negative) of something in order to increase the future likelihood that the child will engage in that behaviour again.

We reinforce the behaviour.

Both negative and positive reinforcement strengthen behaviour.

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Video 3

Sheldon-Positive Reinforcement

Reinforcement

Token economy

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Token Economy

Token Economy

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Ref Tony Attwood, 2015

70

Energy Accounting

•Concept of an energy bank account•Energy withdrawals and deposits•To keep in the black and avoid going

into the red•Healthy energy bank balance•Physical and mental health

Energy Bank: Withdrawals and Deposits

Withdrawal• Socializing

• Change

• Memories

• Making a mistake

• Sensory sensitivity

• ‘Tide’ of anxiety

• Daily living skills

• Managing emotions

• Lack of structure & Predictability

Deposit• Solitude

• Special interest

• Physical activity

• Animals and nature

• Meditation

• Nutrition

• Sleep

• Structure & predictability

Essential Components of a Positive Behaviour Support Plan

1. Identification of Target Behaviour2. Function of behaviour – assessment3. Hazards or setting events – What contributes to

behaviour4. Proactive strategies – modifications to

environment .5. Identify new skills needed – teach new skills6. De- escalating strategies7. Crisis management protocol8. Review effectiveness of existing strategies.

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De -escalating Strategies

Offer choiceTake a break card or queOffer preferred activityDistraction humourRe- directionPhysical Exercise – trampoline or bicycleOffer calming techniques – quiet room, movement break, listening to music, take ten appSensory processing strategies - Deep pressure

Crisis Management Strategies – Reactive strategies

Health and Safety

Tool Box – High motivators

Team Teach

• Review all elements of behaviour support plan periodically

• All new skills become the IEP targets for each pupil so review targets termly / 6 weeks.

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Reminders from Previous Trainings.

• Recognise stress and anxiety – support pupil to empty their bucket.

• Plan for Transitions• Provide a form of communication• Use visuals• Account for sensory difficulties• Teach the skills deficits

• Use the communication Passport

Balancing the Books

• Scheduled ‘deposit time’ in daily & evening schedule

• Know when to stop ‘spending’

• New sources of ‘income’

• Having enough reserve in the account

• Economic or energy depression

5 Principals of behaviour support

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Spilling over

What happens at home has an impact

on your child at school.

What happens at school has an

impact on your child at home.

ASK App – Autistic space kit.

Recommended by Wenn Lawson as a good tool.

It is an app designed by autistic people for Autistic people. It is an all in one tool kit to help autistic people express themselves particularly in times of stress.

Four Key Messages

Behaviour is communication

Detect the hidden messages

Employ 5 principals of behaviour management before fn assessment.

Prioritise proactive strategies

Teach new skills.

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