10th August 2017
Challenging behaviour is functional, serving legitimate needs. 99% of the time it serves as a way of communicating these needs. The challenge is working out what is being said, why and creatively changing conditions so that challenging behaviour is no longer necessary or is replaced by more socially acceptable skills.
Mark is a ten-year-old boy with confirmed diagnoses of autism and severe learning difficulties.
In order to communicate Mark uses a combination of Makaton and visuals as he not yet fluent in his independent use of Makaton. One concern that was raised by his caregiver was that she was unable to tell if Mark was ill or hurting until there was a significant change in his behaviour.
The majority of the time Mark did not engage in any challenging behaviours however there were times when he would become aggressive towards himself and others who happened to be near him.
These behaviours would include biting, hair pulling, pinching, punching, and scratching. Initially his parents stated that these behaviours would “happen out of the blue” with no rhyme nor reason for their occurrence.
A functional behaviour assessment was carried out and Mark’s parents were taught how to record ABA data whenever the behaviours of interest occurred – they were to record when the behaviour happened, what happened immediately prior to the behaviour and what happened immediately after the behaviour. It was explained that they should record episodes of the behaviour as near to the occurrences of them as possible in order to ensure that an accurate portrait was gathered for an effective behaviour support plan to be implemented. It was also stressed that they should be as objective as possible in their recording and try not to record a lot of “I think” etc.
From the data, the function of Mark’s behaviour was attention; that is, Mark would engage in these aggressive behaviours to get attention from another person. However, there was a twist. There was also another pattern. Whenever the behaviours occurred, within a short period of time (maximum of 24 hours) Mark would become ill with a fever or a vomiting bug.
Mark’s challenging behaviour was communicating that he was feeling ill. Mark had to be taught how to use a more appropriate way of communicating his feelings of being unwell.
The first step was to teach Mark how to identify both receptively and expressively body parts. This was done with visuals using a discrete trial teaching procedure. This was then generalised to identifying body parts on himself as well as on other people. Concurrently Mark’s family were also implementing a modelling programme – they would contrive situations where they would pretend to be hurting/ill while pointing to the relevant body part and modelling an appropriate response for Mark to observe. The success of this programme was demonstrated when Mark began sobbing on the chair and attempted to bite his fingers – his Dad went over and said “Mark, where is it sore?” and Mark rubbed his tummy. His Dad was then able to give him medicine and within a short time the behaviours had stopped. Incidences of challenging behaviours have greatly reduced and Mark has generalised this skill to other settings, including school, where all staff are now able to understand Mark’s behaviour instead of implementing a restraint procedure to ‘help’ with the behaviours.