Addressing Challenging Behavior and ASD – Going Beyond What We See
Every week, I receive detailed e-mails describing various aspects of challenging behavior. The person has made a list of everything the child has broken, what they said, and the advice and strategies they have tried to help the child. When talking about challenging behavior, we have to go deeper and look beyond the behavior itself. Think of the behavior you observe as just the tip of an iceberg; below the surface of the waterline lies the cause of behavior. We need to delve below the waterline and address the root cause, not the behavior itself.
One of my colleagues and long time speaker at our conferences, Bo Hejlskov Elvén, says, “People behave if they can.” If a person is able to self-regulate, use calming strategies, can interact well within an environment, and express needs and wishes, you will likely not have challenging or distressed behavior from that person. They have effective ways of communicating and coping. If the person being supported is exhibiting signs of distress, something is amiss and that needs to be explored and understood. We juggle this balancing act every day with our two young adults with autism – even more so during the COVID-19 pandemic with the daily changes and restrictions.
In order to support a person who has challenging behavior, the observer must change the lens through which they view behavior. This can start with the language used to describe challenging behavior – words like obsessive, controlling, manipulative, deliberate place the blame on the individual with ASD. Carers often feel shame and guilt about how a situation unfolded, but we have to reflect and review how we are handling things and be honest about what isn’t working or makes us uncomfortable. We have to:
- evaluate our contribution to a stressful or challenging situation
- question our response and what we are doing to contribute
- ask questions and examine to gain deeper insight into why a situation escalated to a crisis point
- identify and eradicate harmful practices such as restraint
- not focus on the individual, but recognize that the whole system around that individual has an impact on well-being
- foster better relationships between staff and service users, parents and children
- look at staff/parental stress levels by debriefing after a crisis situation
What are the causes of challenging and distressed behavior?
Challenging behavior occurs because of high levels of stress, physical discomfort, or the lack of physical or mental well-being. By identifying the causes rather than focusing on the behavior itself, this can reduce behavioral situations while improving the person’s quality of life.
Some possible causes of distressed behavior are:
Physical Health – lack of regular exercise, constipation, dental problems, undiagnosed conditions such as diabetes. Pain is a subjective emotional response and the physical experience of it has to be interpreted. This is where interoceptive awareness comes in.
Lack of Structure and Predictability – Having a predictable routine is calming. All of us need routines to keep ourselves centered.
Anxiety – Learn to recognize the early signs of anxiety and support with calming strategies before things escalate.
Sensory Overload – When the sensory systems become overloaded, a person will feel overwhelmed. Learn the sensory profile of the individual and what help they need to regulate. Look at developing a sensory diet. Have tools available that help with stress such as a ball to squeeze or a fidget toy. Address interoceptive awareness as well a person can learn to interpret their own body signals.
Frustration – Can happen due to communication issues, boredom, or lack of autonomy.
Demands and Requests – The main cause of distress is demands from carers. Studio III UK found that 65% of incidences of distressed behavior were preceded by a demand or request from a carer.
How can we help?
In order to help, we first have to figure out the function of the behavior. Is it:
- communication and interaction?
- sensation – addressing a sensory or emotional need?
- tangible benefit? – The person is trying to get something they want such as food, drink, or time with a favorite thing, for example.
- demand avoidance? – may not understand what the request is, refusal to cooperate
- social avoidance? – Social anxiety and/or avoidance of social situations, which can also be perceived as a threat. (I wrote about this in the anger rumination post.)
Assess Behavior Using ABC (Antecedent, Behavior, Consequence)
ABC has been around for a long time. When gathering this information, it helps to write it down.
Antecedent – This is what happens before the behavior occurs. Look at the setting/environment, internal state of the person, and variables such as who is in the room, new people, a change in routine. Make notes and try not to make assumptions.
Behavior – These are the actions you are trying to find an explanation for. Record information about frequency, intensity, duration of behavior, how many times it has happened, and any specific details like self-injury, throwing things etc.
Consequences – Look at what happens over and over again. Does the person get a hug, something unexpected that they find rewarding like what you say, tone of voice, an activity stops, or the person gets to escape.
Antecedents and consequences can make a behavior more or less likely to occur. Behaviors are often learned and a person may need to be shown a better way to get the result that they want. Again, we are identifying the root cause of behavior and not focusing on the behavior itself. We are exploring the function of the behavior and the reasons why it may be occurring.
How do we de-escalate a challenging behavior situation?
When a crisis situation is happening, reduce demands and requests. Appear calm yourself, which is shown through body language. Avoiding folding your arms, clenching fists, or grinding teeth. Breathe slowly and regularly. It takes practice to appear calm on the outside when you are scared and stressed on the inside.
Personal space – Keep a minimum distance of 3 feet. Moving towards the person can be perceived as a threat
Eye Contact – Sustained eye contact is a universal sign of aggression in the animal world. Avoid staring when a person is aroused, but do try and maintain regular intermittent contact
Touch – Avoid touching when a person is in a state of arousal. When they are calming down, it may be appropriate to touch them, but be aware that they may not interpret this as you intended it.
Noise – Get the environment quiet – no TV, radio, music etc.
Listen to the Person – Sometimes it’s something simple that is bothering them. It may not be a big deal to us, but a big deal to the person. Validate what they are saying. Watch your body language and maintain space.
Communication- Speak slowly, softly and use simple sentences. Don’t engage in arguing.
Distract – Try changing the subject, talking about something they like. This is my most used technique with my 21 year old daughter and it really works.
Remove other people – Remove the other people around the person who is getting upset, not the upset person.
None of these strategies are giving in or letting a person get their own way. These are strategies that diffuse an escalating situation.
The Low Arousal Environment
Create a low arousal environment to lessen the chances of challenging behavior. Think about:
- having safe quiet, spaces.
- the person has their own room, if possible.
- reduce overlapping sounds (TV, music, people talking).
- reduce stimulation.
- keep routines for predictability which lessen anxiety.
Adopting a reflective practice to examine our role in challenging behavior can be hard because of the emotions we have around our contribution to a crisis situation. Changing our responses takes time, but we must always strive to do better. The health and well-being of the individuals we support depends on it.
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