Post #37 Behaviour (5) To do or not to do…. Strategies for Everyday
Structure
Always consider structure and routines as part of your everyday strategies. We all need structure and routine in our daily lives. For autistic children and young people, structure and routines are essential to provide information in a meaningful way and to reduce anxiety. The use of structure is empowering. Structured Teaching (TEACCH) strategies increase independence, raise self-esteem and as a result can reduce difficult behaviours. For example, a visual schedule provides vital information about the structure of the day: what, when, where, who. This is not that far removed from our own use of diaries, calendars, electronic organisers and so on. Visual information makes use of visual strengths, personalised to what is most meaningful for the individual. As a young person engages with their schedule, they become more confident about knowing what is happening and their anxiety reduces as they are not living through a day of ‘unknowns’. Visual schedules teach flexibility as, when ready, a young person learns to cope with changes to their day by making alterations to their schedule. Likewise the schedule can prepare the individual for ‘change’ or ‘surprise’ and, through practise, they become less anxious or upset by changes to daily routines.
Sandwich preferred and non-preferred activities
For individuals who are fixated on a particular topic, activity or toy, to the point where they refuse any other activity, the schedule can be a useful tool to encourage them to do or try other things. By sandwiching the preferred activity with a less preferred, you may find they gradually become less resistant and more willing and able to do or try something different. For example:
Once they understand that the item or activity which they prefer becomes available to them again, they may be less resistant to pausing the preferred activity to complete a required activity.
Note here the use of the word 'pause' - teaching your child to pause an activity is most likely to be more successful than requiring them to stop (see TEACCH tips - pause).
Build in strengths, interests and choice
It is essential to ensure the daily schedule includes some activities which the individual is interested in, which make use of their strengths, which they enjoy and which they find relaxing. It is also important for an individual to have some choice. Getting the balance right at home can be important for supporting behaviour. If the schedule is full of challenging activities, or does not include any activity which they are interested in, then we should probably expect to see some difficult behaviour. By including a balance of activities, we should find that the need for us to ‘manage behaviour’ reduces. Ultimately the purpose of the schedule is for the individual to become independent and to learn and use skills which manage their own behaviour – this is much better for their wellbeing (and yours).
De-clutter, containerise and organise
Whilst visual processing is often a strength, be aware that visual overload can sometimes cause problems. If the environment is visually busy, then your child may become visually over-stimulated at times. De-clutter and try to reduce the visual ‘busyness’ of some areas in the home if you can. That does not mean you have to reduce all visual stimulation, far from it! Rather, think about areas where there is too much stuff around which may be causing difficulties. For example, if you child throws ‘stuff’ around the house, maybe throws toys or learning materials, reducing the amount of stuff which is easily available can help. Containerise items where possible as this helps to limit and organise. Introduce a ‘finished’ container and teach your child to ‘throw’ items they have finished with into the container. Gradually this can be modified to placing in ‘finished’ rather than throwing. Likewise if you have busy surfaces, for example in the kitchen or bathroom, this can result in items being pushed to the floor. Again, try to containerise and organise items and this may reduce this behaviour. Some youngsters like to ‘collect’, or keep somewhere safe, their favourite belongings. This in itself is not a problem and can be beneficial. However, this can become a problem when the number of items increases and they start collecting piles of stuff in different locations and then become upset when they cannot locate a particular item. Some youngsters may then accuse others of taking their things and may become angry. If this is the case for your son or daughter, try to help them to containerise their belongings and label each container. This allows them to collect and keep items which are important to them, but in a more organised way which should then help them to locate ‘missing’ items more easily.
Sensory
Consideration of sensory issues should be an everyday essential. Knowing your child’s hypersensitivities and hypo-sensitivities is important as sometimes difficult behaviours occur for sensory reasons. If you know your child’s sensory profile, then you can make adjustments which may impact their behaviour in positive ways. (See my post on sensory needs). If your child already has a ‘sensory diet’ at school, then you might speak to teachers about how this works and what you might try. However, if this is not the case, you can still try some sensory adjustments at home to see which could help.
If you think your child is hypersensitive, try making adjustments in the environment. For example, if they frequently shield their eyes in a specific room, consider changing light bulbs or fitting a dimmer switch; if they shield their eyes outdoors, sunglasses can help. This illustrates how simple adjustments can make a difference.
If your child is hypo-sensitive, i.e., under-responds to certain sensory input, again you can try some adjustments. This is important as hypo-sensitivity can lead to ‘craving’ of certain sensory input and which they may achieve in ways which may hurt them. For example, repeated slapping their face, head banging, biting themselves, kicking walls may quickly become problematic. Once a behaviour such as this has become established, it can be very difficult to change, so trying out sensory strategies is important. A child who needs sensory feedback may, for example, enjoy jumping on a trampoline or being wrapped in a duvet or use a weighted blanket.
Once you have identified your child’s sensory profiles and needs, consider making a sensory box which includes items that they can use to manage their responses to different sensations. For example, you might include sunglasses if you know your child is hypersensitive to lights, or ear-defenders to wear when the vacuum is being used. You might also include a variety of sensory toys and ‘squishies’ which can provide some sensory stimulation. As you child becomes familiar with their sensory box, they can learn to independently manage their sensory experiences, reducing unpleasant sensations and having independent access to safe ways of stimulating their senses.
Stimming
Self-stimulatory behaviour, frequently referred to as ‘stimming’, is important to consider. Stimming includes a wide range of repetitive actions which occur for a variety of reasons. Historically stimming was viewed in a negative light and efforts were made to prevent stimming (unsuccessfully). It is now, thankfully, better understood as autistic people have explained how stimming affects them. Watch this powerful presentation about stimming and the benefits:
When thinking about behaviour, it is always important to consider stimming behaviours (below the waterline of the iceberg) and why they may occur. Stimming behaviours frequently occur for sensory reasons and have different functions:
- Stimming can block or reduce sensory input, this may occur when your child is experiencing hypersensitivity or overstimulation. Stimming might prevent a meltdown.
- If your child is hyposensitive and under-stimulated, stimming can provide the sensory input they need.
- Stimming can have a role in relation to pain, as repeated actions such as banging the head or biting parts of the body can reduce the overall sensation of pain.
- Stimming can be used for emotional and self regulation, triggered by positive and negative emotions. For example, increased hand flapping or jumping may occur when an individual is happy or excited. Anger may intensify stimming which may become destructive. Stims can also be calming and relaxing.
If your child stims, always consider the purpose before thinking you need to change their behaviour. Stimming is part of being autistic for many individuals and we should recognise when stimming behaviours are helpful and be respectful of the purpose stims are serving. Consider adding stim resources to the sensory box and make this accessible at all times. Stimming can be an effective coping strategy and also may be enjoyable, so don’t try to change stimming behaviours unless they create barriers to participating in everyday life, prevent learning or are harmful.
You may
know the purpose of a stim which is harmful to your child, or you may need to
think about possible reasons (iceberg & problem-solving). Try to identify
strategies to support your child and remember, teach what to do, not what not to
do. If you do not teach a more helpful or appropriate stim, and concentrate on
stopping the harmful stim, it may well be replaced by a more harmful action.
For example, if a stim is self-harming, try to find an alternative stim that
can serve the same purpose but which is safe. This may be a short-term strategy
while you think about why a harmful stim is occurring and if there are
adjustments that can be made which would negate the need to stim. For example,
identifying the source of pain and addressing that may stop harmful stimming. If
a child is biting their arm and hand repeatedly, an immediate strategy may be
to provide something to bite or chew to prevent them from harm. You can then
investigate whether they have toothache, mouth ulcers and so on which can be
treated and which may the stop the need to bite. However, biting may serve a
different purpose, for example by providing sensory feedback which is needed
due to hyposensitivity, in which case find ways to fulfil that need in a
harmless way and which your child can use when needed.
Communication
Communication
is fundamental to responding to behaviour. When thinking about strategies, we
should consider how we can support the ways in which our child is communicating
and interacting; we should also consider how WE are communicating and
interacting with our child, particularly when we are finding behaviours
difficult to manage. Supporting communication and interaction is long term and
requires varied strategies which will sometimes be successful and sometimes
less so. I am not posting here about the broader issues regarding communication
and interaction strategies, but offer some general tips when thinking about
communication, interaction and behaviour.
When
behaviours are difficult, or your child is having a meltdown or crisis, there are some steps you can take
which may help:
Say less, not more We have a tendency when someone is feeling upset, angry, afraid and so on, to talk to the person, perhaps even ‘talk them down’. Often this is successful and we can support an individual with how they are feeling by talking to them. For your autistic child this may not be the case. Adding language and non-verbal signals when their behaviour suggests they are experiencing intense feelings does not help; in fact it adds more pressure and more information to process. Indeed, adding too much language might trigger an outburst or meltdown. So, as a general rule, say less not more, or even say nothing. When you do speak, use clear and concise language, speak softly and stay calm (I know it’s not easy). Now is not the time to talk about what they are doing and why. They will most likely be unable to communicate this and you are just adding to their stress.
Talking about what happened and how they felt may be useful for some youngsters, after the event. Choose a time when they are calm and relaxed. Try a visual communication strategy such as Carol Gray's Comic-Strip Conversations, which basically uses ‘draw as you talk’. This slows down conversation and shifts the focus to drawings and colours (for emotions) which give you an idea of your child’s experience and perspective. This can be more successful than the traditional “why did you do that?” which may well provoke a negative response. See: Comic strip conversations or Comic strip conversations booklet
Find alternative ways to communicate
Communication is harder for your child to understand and to express when they are in an anxious or highly emotional state. As their behaviour may increase, so their ability to process and express communication drops. So use an alternative means of communicating with them that is easier to process and may be more meaningful and helpful to your child.
As a general rule, make communication visual. With verbal youngsters, we may have to adjust our communication at times when they are experiencing intense feelings, when they may lash out and when they withdraw. Communication may be more successful if you text/message/email your son or daughter; this gives them time to process the information and takes away the pressure of face to face communication. Visual communication taps into visual processing strengths and while spoken words vanish, once said, a written note can be read as many times as your child needs/wants. So if for example your child is behaving in a difficult way because there has been a change to their routine, write a ‘mini schedule’ that makes the change clear and shows what will happen instead. Hand them the mini schedule or note, or place it where they can see it, and leave them to process the information. As they process, they may begin to calm and when they are ready they can move on by following the mini schedule or note.
Whatever communication means your child usually understands, adjust your communication to a level which they can process more easily when they are anxious or experiencing intense emotions. If they usually understand signs, but these are proving unsuccessful when they are upset, try using pictures which are more concrete and can remain in place for them to look at and process. Likewise, if they usually understand symbols, you may need to use pictures when they are distressed, or pair symbols with pictures. If they usually understand picture communication, such as PECS, you may find they need more concrete communication when stressed; for example, use objects to communicate or pair their picture with an object for greater clarity. You may not have a picture to hand, but you can show a picture of ‘drink’ via a smart phone or tablet.
Support your child to communicate
Make sure you have ‘backups’ for your child to communicate when they are feeling upset, angry, withdrawn and so on. Just as you may need to adjust your means of communication, so they may need support to communicate. Many youngsters will need more concrete and visual means of communicating during difficult times. Just as you adjust your communication, make sure they have communication tools available if they are unable to communicate in their usual way. If your child is usually verbal, they may need alternatives to communicate, so make sure these are available. This may include using their phone to communicate with you, or using a card system to indicate they are upset or angry or need a break.
Children who already use visual means of communication may need more concrete ways of communicating when upset. For example, if they usually use a PECS book, they may not use this when very upset so ensure there are photos or objects available for them to use. If previously to using PECS or other symbol communication strategies they communicated using photos, make these available. This is not taking a backwards step; rather you are recognising that when upset their communication ability changes (as does ours). It is a good idea when they move to a new communication system to always keep the original communication tools for when they might be needed.
Again, this is not rewarding any potentially difficult behaviour. Rather you are providing a more visually clear and concrete communication tool for Pravin to communicate his needs before he becomes so upset he becomes overloaded or has a ‘meltdown’.
Learning to communicate about emotions and feelings is essential. There are things you can do as a proactive strategy to teach communicating about emotions. This is important so that when your son or daughter is upset, they have the words to use to communicate how they feel. Learning the words for emotions is important. Try to use emotions vocabulary every day, supported with visual communication tools. Label how family members are feeling on a daily basis. Use stories and videos with your child’s favourite characters to label feelings. Take photographs of family members showing facial expressions and label these to teach emotions words.
Emotional and self-regulation
Learning emotional and self regulation is important for your child’s wellbeing. We all have ways of regulating how we feel which helps us to cope when we are anxious, upset, angry and so on. This is so important for your son or daughter. If they can self-regulate, this will have a positive impact upon their behaviour. There are lots of ideas in my posts on sensory strategies/ideas and also wellbeing: emotional aspects of wellbeing. Teaching how to use strategies at home is a proactive way of supporting your son or daughter to self-regulate and may prevent or reduce behaviours which may feel challenging.
Key points:
- Think about structure
- Always consider sensory aspects
- Adjust communication
- Teach self-regulation strategies
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