Managing, changing and supporting behaviour positively

To read on Down’s Syndrome Association website:

For Families and Carers : Supporting behaviour positively

What do we mean by behaviour? Behaviour refers to everything
that human beings (and animals) DO.

behaviour


We all react to situations and communicate through our behaviour.
For people who have difficulties with other forms of communication, behaviour – things that they do – can be the most effective form of communication.

To call something behaviour you need to be able to see it, count it and describe it.
So, a behaviour (running out of the building) is different from an emotion (feeling scared) and also different from a thought/motivation (“get me out of here!”).

Behaviour can be positive, helpful and useful to the person.
We sometimes call this adaptive behaviour and it can include skills like asking for help, waiting in a queue, getting on with work, doing chores, going on the trampoline to work off energy, listening to music to calm down…….and many other things.

However, behaviour can be problematic to the individual or to other people around them.
This is sometimes called maladaptive or challenging behaviour.
So-called challenging behaviours are often more extreme versions of quite ordinary behaviours.

These behaviours may occur for the first time by chance or by imitating others. The person may continue the behaviour because it is reinforced, or useful to them. We call this learned behaviour.

The following factors influence whether behaviour is seen as acceptable/appropriate, or not:

  • The strength of the behaviour (a heavy shove, rather than a gentle nudge; a tantrum that lasts an hour rather than a minute)
  • The situation in which it occurs (jumping up and down and shouting out in a cinema rather than at a football match)
  • The consequences of that behaviour (banging a toy on the window as opposed to rearranging the sofa cushions)
  • The degree of tolerance of other people – (a baby yanks your hair as opposed to your 15-year-old daughter)

The following diagram (which you can download as a pdf if you wish) shows the many factors that influence our behaviour and that of the people we care for.

You will see that some of these are fixed – age, gender (usually), life experiences for example – but that others can be changed – expectations, physical environment, others’ behaviour and reactions, triggers and results of behaviour.

These factors are the ones we need to use in managing, changing and supporting behaviour positively.

Behaviour support planning


The diagram below outlines the different stages of behaviour support planning.

Click on the green boxes to go to guidance on that section of the process.

Green box - Deciding where to start
 Green box - Understanding behaviour - complete ABC record
     
 Green box - Working out what the behaviour means - functional analysis
 Green box - choosing possible strategies and creating an individual behaviour support plan
     

Where to start


First be clear about the behaviour, or behaviours that you are concerned about.
If there is more than one, you may need to prioritise and decide which to tackle first.

Where ever possible use ‘doing’ words – hitting, kicking, spitting, sitting down in the middle of the pavement, and so on – rather than thinking in terms of being ‘aggressive’, naughtiness or “having a meltdown”.

Secondly ask the question – does this behaviour need to change?
Behaviour may be challenging because it:

  • makes you feel unable to manage the situation
  • is contrary to social norms
  • interferes with everyday activities
  • causes stress to others
  • happens a lot
  • seems to last a long time
  • happens when it is hard to deal with – in public or at dif?cult times
  • is risky and puts others in danger

You can use the following questions to help you decide/answer this question:

  • Does it restrict his or her access to important experiences?
  • How much stress does it cause and for whom?
  • How frequent is it, how intense and how long does it last?
  • Is it typical behaviour for the person’s developmental age/stage of development?

Completing an ABC record is the next step.

You can download a blank ABC record chart here.

AAntecedents

Antecedents are things that proceed the behaviour/happen before the behaviour or are contributory factors.
They can be divided into SETTINGS and TRIGGERS.

SETTINGS
These are things like the environment …time/place/number of people around but can also be things that affect the person like being tired or hungry.

TRIGGERS
These are more immediate, temporary antecedents…the things that seem to spark off the behaviour, or happen just before. These could be:

  • noises
  • the behaviour of another child or adult
  • being asked to do something
  • an activity coming to an end

B – Accurate description of the Behaviour

  • What did you see?
  • How many times?
  • How long for?

CConsequences/results: what happens next?

When we think about the consequences of behaviour, we are trying to work out what happens as a result of the behaviour. What happens directly after or what happens because the behaviour occurred.

  • Does the person get attention? Are they given something they might like? Are they given more space to themselves?
  • Does the behaviour stop something from happening? Is there a specific task, activity or demand that is avoided?
  • How do other people react or respond to the behaviour?

You can download some example ABC records here.

Working out what the behaviour means


Before planning what to do about a behaviour you want to change, Positive Behavioural Support suggests that you need to spend a bit of time thinking and working out what function or purpose this behaviour is serving for the person.

The ABC records should help you to do this and will be useful in answering some of the questions below.

This will help you to work out the “communicative function” of the behaviour…in other words what is the person trying to say or what need do they want to be met?

It is important to remember also, that the reason a behaviour started in the first place may not be the reason it continues.

This step in behaviour support is sometimes missed out as people are anxious to get on with management strategies. That risks trying out strategies, on a trial and error basis, that are not appropriate so will not work, leading to frustration and disappointment.

That is not to say that there are not some general “good practice” guidelines/hints and tips for managing behaviour in people with Downs’s syndrome.

A Functional Analysis will be needed where behaviour is more complex, entrenched or difficult to understand what is causing it and keeping it going.

Working out the function of a behaviour

Basic functions of behaviours that challenge include:

A bit more about functions of behaviour

The same behaviour can serve different functions for different people or different functions for the same person at different times.

Pamela Lewis gives the following example:

“One child (or adult) might scream because she likes the sound. Another child might scream because she likes the attention that results from screaming. Another child might scream to express frustration at what is being asked of her, with no interest in the resulting sound or attention. A child might scream for all those reasons at different times.” Pamela Lewis, Achieving Best Behavior for Children with Developmental Disabilities: A Step-by-Step Workbook for Parents and Carers, Jessica Kingsley, 2005.

Some more common functions of behaviour are listed below – please bear in mind that these can overlap:

  • Discomfort – physiological or environmental (hunger, pain, temperature etc.)
  • Developmental levels (expectations are either too high or too low)
  • Seeking rewards – in general this is often involved
  • Escape/avoidance of a task or a demand
  • Seeking sensory stimulation e.g. likes the sight of spinning objects, or the feel of water
  • Avoiding sensory stimulation e.g. dislikes certain sounds, or the feel of tags on shirts
  • Difficulty with organisation needed to initiate an appropriate activity
  • Attention seeking/wanting to interact and not knowing how to do this appropriately
  • Getting a reaction/making something happen (function is control, rather than social attention)
  • Expressing frustration/anger
  • Expressing fear
  • Difficulty waiting
  • Expressing “Wait! Let me finish!”
  • Expressing “No!”
  • Other communication e.g. “I need some help”, “I don’t understand”, “Go away”

(…)

Read more…

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