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Hi and thank you for joining us today for Part two of the “Understanding and Addressing Challenging Behaviors of Individuals with Complex Needs” webinar series.  My name is Wendy Szakacs and I am the Regional Coach for Autism and Low Incidence at OCALI in the northeast and eastern parts of Ohio.

And I am Chris Filler, the coordinator of the Lifespan Transition Center at OCALI, the Ohio Center for Autism and Low Incidence. We serve families, educators and professionals working with individuals with autism, low incidence disabilities, and complex needs.

This series will teach you a systematic process for addressing and changing challenging behaviors.  We will be building your knowledge step by step through each of the webinars in this 5 part series.  Today we will be looking at underlying challenges that affect behavior.

If you chose to work through the process with your own individual, since the last webinar, you were working on defining a challenging behavior that was observable and measurable.  In this webinar, you will be learning about identifying antecedents and consequences.

In a functional behavior assessment, we look at A-B-C, or antecedent, behavior, consequence.  Antecedents are what happens before the behavior, maybe immediately or maybe a period of time before it.  The antecedents have some influence on the behavior happening.  Then we have the measurable, observable behavior. And after that, the consequences, which occur after the behavior.  Consequences have a relationship to the behavior, and will either increase or decrease the behavior.  Let’s look at an example of this using Molly’s case study from webinar one.

As you remember, Molly’s behavior is “screaming loud enough to interrupt the teacher’s instruction to the class”.  Some antecedents her team identified about the behavior is that it is more likely to occur: on a Monday; during circle time; when she is sitting near Shelly, a classmate; when she is not able to finish an activity before transitioning to circle time; and when she is being touched.  When examining possible consequences, Molly’s team found that when the behavior begins, first an aide approaches Molly and hugs her, which stops the screaming, but leads to hitting.  Next, Molly’s classmates and other adults move away from her and most times Molly is given a break.  Sometimes, she is allowed to finish the work she left.  This information gets us started in gaining an understanding of Molly’s challenging behavior, but there is more to consider.

In this next section, we will look at each of these areas to help complete the iceberg.  This will also help us in completing a support plan. The underlying issues include: learning challenges and uneven skill development; environmental mismatch and change; sensory and biological sensitivities and preferences; impact of medical concerns; social, emotional, and communication challenges; difficult to motivate; and narrow areas of interest.

How do we correlate what a student is going through on a daily basis to the “above the iceberg” behaviors we observe?  Are we considering all the personal challenges the individual is 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 interest them?  Are we considering the sum total ramifications of these issues?

These green stars contain phrases or words you might hear to describe behaviors, which may not necessarily be well defined or 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 noncompliant, or rude and insensitive. But let’s consider where those behaviors might originate from. We are now going below the surface to the largest part of the iceberg.
One underlying issue is learning challenges and uneven skill development.  You may have a person who struggles with being organized or knowing what to pay attention to in a situation.  A student in 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 in others.  
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 really need to feel in control of their environment.  Coping skills to compensate for not being able to deal with an environment that seems chaotic to the individual may be lacking.
The third area is sensory/biological sensitivities 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.  Medical conditions can exacerbate their ability to manage emotions and reactions to the expectations of home, school, or work.  
Another area to consider is motivation.  Typical reinforcers, such as verbal praise or classroom token systems, do not motivate some 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.
And finally, we want to examine social, emotional, and communication challenges.  Individuals with complex needs may have problems with being able to communicate and understand what is being communicated to them, especially considering the social messages that may be harder to comprehend.  Problem solving can be a particular challenge that raises frustration levels.  And again, 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.
As you think about these five areas, and at times how the sum of these challenges can amp up the frustration and anxiety levels, it is easier to see how the “above the water” behaviors might evolve.

This slide lists some questions for each of the areas we just discussed that can help you assess your individual’s underlying challenges.  This form is included in your handout.  This list isn't inclusive of all possible questions, so at the bottom of each column there is room for you to add your own questions to each area.  

When we think about the antecedents-behavior-consequences as we start developing this positive behavior plan, considering the underlying issues is paramount to our understanding the A-B-C and to choosing interventions that will support improvement.

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 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 during circle time.  Finally, Molly has communication and social challenges that are impacting circle time.  She is not able to verbally express how frustrated she is becoming from the sensory and academic challenges and does not have coping skills to avoid the touch situations.  She is communicating with behaviors.  It is easier to see where the behavior is coming from when we consider all of the challenges Molly brings to circle time.  And these observations will help when we get ready to choose replacement behaviors and skills to teach.

This is the Interventions form that is going to help you develop your positive behavior plan.  In section one, we will be summarizing the challenges of the individual.  Let’s look at Molly’s form.

Here are the major points that we discovered about Molly’s challenges.  You can see we summarized the information from her challenges sheet in section one.  We will continue to fill in the sections of this form and it will allow you to have all of your thoughts from the different steps in this process in one place.  

The Underlying Challenges sheet is an informal assessment that can help identify some issues.  If you are considering more formalized assessment, the OCALI web site 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.

As we discussed in the first webinar, if you have chosen to practice this process with the forms included in the downloadable file, this is one activity to complete before the next webinar.  Using the behavior you identified, list the antecedents and consequences that happen before and after the behavior.

Also, use this list of questions to think about what underlying challenges might be affecting the occurrence of the behavior.

And finally, summarize the underlying challenges in section one of the Interventions form.  Keep in mind that as you begin this process, you can keep adding to your initial thoughts and make changes as you keep learning.

Thanks for attending Webinar two.  We’ll see you soon for part three.