Blog #212~DS-ASD Behavior Management
Behavior problems are common for individuals having a dual diagnosis of Down syndrome and autism. Speech deficits hinder a person’s ability to communicate wants and needs, leading to these challenging behavior problems. As I’ve mentioned in previous blogs, every behavior even the bad ones, are an attempt to communicate something. For the past 24 years, I have experienced this on the front lines with my son Nick, who has a dual diagnosis of Down syndrome and autism. It’s important to get a clear picture of what is triggering the problem behavior. To do this, try taking a step back and determine what is causing the behavior.
For individuals with a dual diagnosis of Down syndrome and autism, some challenging behaviors include property destruction (such as dropping, throwing, dumping things on the floor, and breaking objects). Other behaviors might include elopement, dropping and plopping, stimming, yelling, repetitive movements and physical aggression to name a few.
There are 5 steps you can take to discover the causes of a problem behavior and prevent it from occurring. It is important to mention here that, these steps should be taken with the support of a child’s IEP team and ideally using a Functional Behavior Assessment (FBA) with a Board Certified Behavior Analyst (BCBA). It starts with doing a little detective work.
1.What is the problem behavior, describe it?
2. Observe when the behavior occurs and when it doesn’t?
3. Make a guess about what could be triggering the behavior and what might be reinforcing it.
4. Come up with a plan to prevent the behavior including supports that will help improve it in the future.
5. Track the behavior to see if the plan and supports are working.
Let’s put this into practice with the behavior of a child throwing, dropping, breaking and dumping out things around the house (property destruction):
1.”Billy” returns home from school and goes upstairs to his parents bedroom. He turns on the water faucets full blast, and takes a photo frame and throws it down from the top of the stairwell where is shatters to pieces.
2. The behavior occurs after school, as his mom is unloading the backpack and reading the communication notebook. It also occurs when parent’s attention are diverted, (doing chores, talking on the phone) and while the child has down time.
3. The antecedents are sensory seeking, lack of attention, unstructured down tome and boredom. Billy is reinforced by getting negative attention from his parents, who naturally get upset when something gets broken or a mess is made in the house.
4. The plan is for Billy to have a more structured routine during those down times when parents are busy working around the house:
-Create an afternoon visual schedule for Billy to put away the contents of his backpack and engage him in the chores with heavy work (a calming sensory activity).
-Replacement activities will include jumping on his mini trampoline, carrying laundry baskets to the washing machine and loading it, or vacuuming.
-Billy will be reinforced with high fives and praise, followed by a reward, upon completion of these replacement activities. Rewards may include a choice of a favorite toy, iPad, movie, or snack.
-Billy will also be redirected to use his AAC device (talker) to express his needs.
-Parents are encouraged remain calm, matter of fact with little emotion, making minimal eye contact while using a soft voice, when the child engages property destruction.
5. Parent and teachers will keep a log to track this behavior both at home and in the school setting.
Sample ABC Chart used to do a Functional Behavior Analysis:
Before identifying the antecedent, behavior and consequence on the ABC chart, it is important to look at the setting prior to when the behavior occurred. Note any changes in medications. Is the child sleepy, overheated or too cold? Are there any disruptions in staff or transportation to and from school? Is the environment to noisy or quiet? These factors will attribute to more behavior problems.
The best behavior plans have proactive strategies and supports to encourage good behavior. In my experience, the behavior plan must be revisited several times a year and tweaked accordingly. This will help to support positive behavior in a child with a dual diagnosis of Down syndrome and autism. The key to behavior management is to step back and do the detective work, and come up with a plan to cut these behaviors off at the pass. Working with the IEP team and a certified BCBA behaviorist to develop a behavior plan will lead to better responding thoughtfully to what the child is trying to communicate in their wants and needs.
That’s what is in my noggin this week.
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