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Addressing Challenging Behavior - Part 3

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Hi, Chris here again for Webcast Three. And we are going to be talking about underlying issues. We are continuing to teach you a systematic process for addressing and changing challenging behaviors. In order to build your knowledge step by step, you need to have completed Webcast One and Two before beginning this Webcast Three. Today we will be discussing underlying challenges that affect behavior.

If you choose to work through the process with your own individual, since the last webcast, you were working with a data plan for your individual, and you started listing antecedents and consequences that happen before and after the targeted behavior. There was a lot of information in this webcast, so please be sure to hit that pause button or back up a bit and listen again if you don't get this the first time. It's OK to learn at your own speed.

As a quick review, antecedents are what happens before the behavior, maybe immediately or maybe not directly before the behavior, but in either case, the antecedents have some influence on the behavior that is happening. The behavior is described next in measurable and observable terms. And after that, the consequences, which occur after the behavior.

Consequences that we focus on are those that have a relationship to the behavior and will either increase or decrease the behavior. This gives us a lot of information, but it's not enough when we are working with individuals with complex needs. We need to look under the water level at what is beneath that tip of that iceberg. So let's do that.

In this section, we will look at some underlying issues to help us in completing a support plan. The underlying issues include unique learning styles with uneven skill development, environmental mismatch and environmental changes, sensory biological sensitivities and preferences, the impact of medical concerns, social, emotional, and communication challenges, which we will find is a very important area. And challenges and motivation, and a narrow area of interest.

How do we connect what an individual is experiencing on a daily basis to the above-the-iceberg behaviors we observe? Are we considering the unique personal challenges the individual's experiencing as we examine the behaviors we see? Do we think about their communication challenges, how the environment affects them, the impact of any medical issues, how their social competence affects their anxiety levels, the influence of struggling with learning, being motivated by topics that may not be interesting to them? Are we considering the sum total ramifications of these issues? We need to.

These green stars contain phrases or words you might hear to describe behaviors which may not necessarily be well defined or may not necessarily be measurable. Note again that the iceberg is showing those green behavior stars above the surface as behaviors that can be easily seen or observed. So someone might describe an individual as aggressive, or compliant, or non-compliant, or rude and insensitive, but let's consider where these behaviors might originate.

We are now going below the surface to see the largest part of the iceberg. Each of the following slides lists some factors for the underlying area and then a list of questions to consider. One underlying issue is learning challenges and uneven skill development. You may work with a person who struggles with being organized or knowing what to pay attention to in a situation. A student's school may have difficulty adjusting how they learn best to the teaching style used in a classroom. Individuals may have cognitive challenges, or might have great skills in one area and not so much in another area.

Remember, even if the person is quite gifted, he can still have challenges when it comes to understanding information based on the way it's presented. Does the information come primarily in the form of talking? And yet the person struggles to process auditory information? Is the information visual, but either too overwhelming or not concrete enough for the person? Think carefully about the person's learning style.

The questions on the right are guiding questions to help your team begin to informally assess your individual's challenges in this area. Another underlying issue is environmental mismatch and change. Some persons with complex needs have difficulty adjusting to changes in routines, which can lead to higher levels of anxiety. Some may need to feel in control of their environment, feel their environment is predictable. A person may lack the typical coping skills to compensate for not being able to deal with an environment that seems chaotic.

For example, many times when I do trainings, as soon as we start, some people will inevitably ask when the break or the lunch is scheduled. If I don't tell them ahead of time, some people can become distracted or even anxious. They just need to know. Simply being able to ask, and sometimes even adjusting the schedule, allows them to remain engaged with the training. But if I don't know how to ask or was not allowed to ask, I might just bolt from the room when I had had enough. On the right are some questions to help your team discuss the impact of this area on your individual.

The third area is sensory/biological issues and the impact of medical concerns. An individual with complex needs can have great anxiety build up as they try to regulate their reactions to sensory input and needs. This area is foundational. You cannot place enough importance or underestimate the importance of these issues.

Again, think about yourself. If the room you're working in is too hot or too cold, you simply cannot work or give your best effort. Instead, you may put on a sweater, turn up the heat, open a window, or change rooms. But if you could not do this, if you did not know how to problem solve, you might even have a little meltdown. You see, this is basic neurology. You can't fight it. At some point, your survival mode kicks in, and you must attend to these issues.

Medical conditions can also exacerbate the ability to manage emotional states and to manage reactions to those expectations of home, school, or work. The questions on the right can help your team identify an individual's challenges. This is an important area to be aware of while building a behavior plan, so spend some time looking at this.

Next we want to examine social challenges. Individuals may have difficulty with successfully navigating social situations with their peers. Understanding social environments in school, in the community, or at a job can be a challenge. Even though social skills that seem simple to you and me maybe terribly confusing to someone that sees the world through different eyes. So don't assume people are just going to get it when it comes to social skills.

Part of your assessment should be identifying the social expectations of a situation and determining just how well a person understands those expectations and how well they can be met. These difficulties can cause anxiety, withdrawal, or upset. Your team can use the questions here to think about the social challenges of your individual.

Emotional challenges may be seen as difficulty identifying one's own emotions and how to deal with what the individual is feeling. As social and communication situations occur, persons with complex needs may not have the coping skills to deal with them and to regulate their emotional reactions. Attempting to problem solve these situations can be a challenge that raises frustration levels even higher. Again, here are some questions for this area. Emotions can play a big role in challenging behaviors.

Communication and behavior. Yes, these two are often closely linked, so pay close attention in this area. I believe that most behavior challenges are at least partially related to communication. In the face-to-face trainings that we conduct, we find that almost every team identifies communication challenges to have some impact on the behavior of concern. Individuals with complex needs may have difficulties being able to communicate to others as well as understand what is being communicated to them. This includes the complexities of that social message that may be even harder to comprehend.

For example, the words I use are only a small part of the message I intend. Right? (Surprised) Right? (Enthusiastically) Right? (Thoughtfully) Right. Same word, but my intonation delivers the message. If you were not keying in on my sound of my voice as well as my body language, you could miss the message entirely. Right? Use these questions to identify your individual's communication challenges.

Another area to consider is motivation. Typical reinforcers such as verbal praise or classroom-wide token systems sometimes do not motivate individuals with complex needs. Some may have special interest areas that override their thinking. Some may not see why it is important to learn about a variety of topics and to develop a range of skills. They just don't care. These questions can help your team think about your individual's challenges with motivation. As you think about these areas and, at times, how the sum of these challenges can amp up the frustration and anxiety levels, it is easier to see how those above-the-water behaviors might evolve.

This form is included in your packet of guidance forms. It lists the questions to get you started identifying the underlying challenges of your individual. The underlying challenges sheet is an informal assessment that can help you identify some issues. If you are considering more formalized assessment, the OCALI website has a section you can access about assessment at the link listed on this slide. There are many, including a link to evaluation instruments that address many of the areas on the underlying challenges sheet. Although these are on an autism site, some cross disability areas, so check them out.

Let's look through Molly's underlying challenges. In the area of learning challenges and uneven skill development, she does better with motor activities and is less interested in academics. Sometimes she uses behaviors to avoid those academic activities. In the area of environmental mismatch and change, Molly struggles with how little personal space she has at circle time, and she uses behaviors to also escape that situation.

For Molly, her senses are being overloaded by the touches she is experiencing. And she doesn't have the coping skills to handle the situation, so she hits. Molly's interests include hands-on activities, music, and movement, which are not happening at circle time right now. Finally, Molly has communication and social challenges that are impacting circle time. She is not able to verbally express how frustrated she is becoming with the sensory and academic challenges and does not have coping skills to avoid the touch situations. She is communicating with her behaviors. See, I told you communication was going to come in.

It is now easier to see where the behavior is coming from when we consider all of those challenges that Molly brings to circle time. And these observations will help when we get ready to choose replacement behaviors and skills to teach.

If you are working on this process with an individual, here's your next step. Complete Section One from this form using the list of questions in your guidance forms to help you think about underlying challenges and what might be affecting the occurrence of the behavior, and summarize those challenges on the individuals' underlying challenges sheet. Thanks for attending Webcast Three. We'll see you would soon for Webcast Four.

Learn about sensory and biological sensitivities and preferences, unique learning styles and uneven skill development, medical concerns and more. This segment asks us to look at the question: Have we considered the complexities that children, youth and adults with multiple challenges face on a daily basis? We will examine these complexities and the underlying challenges that result.

View all the Documents in this series here