TEACHING THE CHILD TO USE "WORDS" INSTEAD OF "TANTRUMS"
Many children with Autism use inappropriate behaviors in order to get their needs met. This can be very frustrating for parents and instructors to deal with because these behaviors can interfere with teaching as well as other activities of daily life. The fact is, people do what works for them! Whatever behaviors the child is exhibiting are continuing to occur because on some level, the behavior "works" for the child. In other words, there is some need that this behavior is meeting. If we can figure out what need is being met, we manipulate the strength of the need (EO) and/or teach the child a more acceptable way to "communicate" the need. In addition, we can teach the child that his "old way" of communicating will no longer work!
The three main "needs"
The three main "needs" that the negative behavior may be communicating (functions of the behavior) are:
1. Gaining a attention or desired items
2. Avoiding or escaping a situation or a demand.
3. The behavior they are engaging in feels good.
The first step when confronted with a behavior problem is to attempt to figure out why the child is responding the way he is. When asked, parents or teachers may give their impressions of why the behavior is occurring. For example, they may report it's because the child is stubborn, sick, hungry or spoiled by grandma! Of course we all have "off" days due to a variety of reasons, but, if a problem behavior is consistent, there's a relationship between the behavior and what happens before and/or after it that is causing the behavior to continue. The job of a behavior analyst is to figure out what that relationship is so that an appropriate plan can be developed to address the behavior. It's important to recognize that the team should not be focusing on who or what is to "blame" for the problem behavior. Doing so can cause the people involved to become defensive or feel hurt which is never healthy for a focused team or family. No one intentionally "teaches" a child to misbehave! Instead, the team should approach this process as a problem solving exercise with a team approach to collecting information needed to address the problem behavior.
In order to determine this relationship, it is important to actually spend time observing and recording what happens right before (antecedent) and right after (consequence) the behavior. This can be recorded by the people working with the child on a day to day basis or by an outside observer. The information recorded should be exactly what behavior was observed, not an impression of what caused it. For example, instead of writing, "Sam was hungry" as an antecedent (what happened right before the behavior), the observer might write, "Sam stood in front of the fridge and mom asked, "What do you want?". Instead of writing, "Sam threw a temper tantrum", as a description of the behavior, the observer might write, "Sam fell to the floor, screamed and kicked his legs." Instead of writing, "mom punished him", to describe what happened right after the behavior occurred (consequence) the observer might write, "mom picked him up and put him in a chair". At this point, we're actually collecting the "facts" not trying to determine the cause. It's also helpful to write the specific times of day the behavior each behavior is occurring and other setting events to help determine if there is a pattern of the behavior.
Once the information is gathered for a period of time, the team reviews the information to look for patterns in the events occurring before and after the behavior. For examples, let's say that when the team looked at Sam's behaviors, the noticed that there was not any consistency with regards to what happened after the behavior. Perhaps one person walked away when the tantrum began, another tried to calm the child and still another put him in time out. The only thing that was consistent was that the tantrum always occurred when someone asked, "What do you want?". So, the team determined that there was a "relationship" between someone asking, "What do you want?" (antecedent event) and the tantrum (behavior).
On the other hand, perhaps the information collected indicated a different relationship. Perhaps one person asked, "What do you want?", another asked "Are you hungry?", and a third opened the fridge and gave Sam his juice. The only thing that was consistent was that after the temper tantrum occurred (consequence), everyone showed Sam different items until they found the one he wanted and he stopped crying. This would indicate the relationship is between the behavior and getting the desired item.
Once the relationship is determined, a plan can be devised to address the problem behavior. Behavior reduction procedures typically involve 1) manipulation of what comes before the behavior (antecedent events) 2) removal of the reinforcer that is maintaining the behavior (extinction) 3) Teaching the child a replacement behavior by providing a higher density of reinforcement for the alternative behavior (differential reinforcement of alternative behavior). The goal is to teach the child a replacement behavior (talking, signing or exchanging pictures/objects) to serve the same function as the negative behavior. The appropriate and inappropriate behavior in this situation are called a "fair pair".
For example, if Sam's team discovered that the tantrum only occurred when he was asked, "What do you want?" (antecedent) part of the plan might include refraining from using those words for a while. Instead, the team may decide to immediately open the fridge and give Sam some choices of items he might want. As he reaches for an item, the team could immediately prompt Sam to use the word, sign, picture or object to request the one he wants. For requesting this way, the team may plan to give him more of the requested item than he typically gets (differential reinforcement of alternative behavior). The prompts would then be gradually faded until Sam was able to request what he wanted even when he wasn't near the refrigerator!
Of course, it would also be important to teach Sam to tolerate hearing "what do you want?" because somewhere, someone will be bound to ask him that question! Sam obviously has an aversion to hearing those words most likely due to something he didn't like happening at the same time he heard those words. For example, maybe someone held his favorite toy in full view and continued to ask, "what do you want?" over and over without allowing him access to the toy. It's important not to spend too much time focusing on HOW it happened because as stated earlier, fault finding is rarely healthy for any team or family. But it is important that everyone on the team understand how different teaching strategies may affect the child. Still, the primary focus should remain on solving the problem. In this case, part of Sam's program might be prompting him to request small amounts of the desired item and gradually "slipping in" the question between lots and lots of his favorite item. Or perhaps the team would decide to just "pair" those words with reinforcement by saying them while Sam was engaged in a favorite activity but not requiring a response. For example, while watching the Sam's favorite video with him, they may say, "What do you want? Video" in a calm soothing voice. It would be important to say both the question and answer in this situation so the child doesn't get used to the question being followed by no response. Then, perhaps the video would gradually be paused a few seconds and Sam would be prompted to ask for the video in whatever response form he was using. (Words, pictures, signs, objects).
Doing these things may keep the tantrum from happening in the first place, however, there also needs to be a plan to address the tantrum if it does occur. Reinforcement, by its definition, is what happens after the behavior occurs. Even though each person in the first example reacted differently, the behavior must be reinforced because it is continuing. If fact, if a behavior is being reinforced inconsistently (variable ratio schedule), it is even harder to extinguish! So, as part of the plan, the team may decide that anytime Sam tantrums instead of requesting, they will use the counting procedure to be described later. As soon as Sam stops crying for up to a count of 10, they will prompt him to request what he wants. When a child is tantruming as a way to request things, it is critical that he never gain access to things he wants (reinforcers) by tantruming ever again. Unfortunately, when a child is given what he wants when he tantrums even on occasion, it is more likely that he will tantrum in the future whenever he wants something. Think about the slot machine in Las Vegas. The fact that it doesn't "pay out" (reinforce) every time a person puts money in it actually causes people to put in more and more money with the thought that perhaps that next quarter will be the one that hits the jackpot! The author is not suggesting that the child is deliberately planning this, it's just what happens when the child gets what he wants after a tantrum some of the time. (Variable ratio reinforcement schedule) In fact, if the child was given what he wanted (reinforced) every time he tantrumed (continuous reinforcement schedule) before our attempts to intervene, it would actually be easier for us to extinguish the behavior. Consider a candy machine as an example. If in the past we always got candy every time we put money in then all of a sudden we stopped getting candy every time, we would not be likely to put more money in that machine in the future. Unlike the case of the slot machine, our behavior of putting money in would stop quite quickly!
It's important to understand that we typical see an increase in the child's behavior when we first begin denying access to the reinforcer (extinction). In this case, Sam's temper tantrum might escalate or last longer than usual. This is called an "extinction burst" and will lessen quite quickly as long we are consistent in not allowing access to the reinforcer. An example of this extinction burst would be if the person who expected to get candy from the candy machine hit the machine or kicked it a few times in effort to get the reinforcement he was used to getting. It's important to "ride out" this extinction burst rather than assume it means our intervention isn't working.
Sometimes, even after a behavior is stopped by not allowing access to the reinforcer (extinction), the child will suddenly exhibit the same behavior again. Again, it's very important that the same procedure be followed to not allow the child access to the reinforcer. If not, the behavior may come back in full force and be even more resistant to extinction in the future!
Due to the importance of consistency when dealing with a child's behavior, it's critical that everyone working or interacting with the child be notified of the plan. It's typically best to explain the procedures very clearly so everyone understands what to do. In addition, it's best to explain why the procedures are being used as well as the importance of everyone reacting in a consistent manner. If the behavior is reinforced sometimes and not others, it will be more and more resistant to extinction. For example, let's say that Sam's parents had worked hard to teach Sam to use signs to request things but then a babysitter came over to spend an evening. This babysitter didn't know anything about Sam's history of tantrums or the procedures used to stop them, so, when Sam went to the fridge and started crying, the babysitter began showing him things until she figured out what he wanted. All the work the parents had done to extinguish the tantrum would be lost and in fact, the behavior would be more resistant to extinction because the tantrum was again reinforced!
In essence, we must teach the child that using signs, words or pictures/objects is the way to communicate his wants and needs. As part of this, we must also teach him that negative behaviors will not be successful in getting his needs met!