I did a survey a few years ago as I was creating my first online course and 300 autism professionals and parents responded within a week. They told me that their #1 challenge by far, hands down, was handling problem behavior. As a Board Certified Behavior Analyst at the doctoral level, I have analyzed a lot of different problem behaviors like severe self-injurious behavior. I also had one student who said “Are you happy?” 48 times in 10 minutes and another boy who became aggressive if anyone said the word “OK.” At that point, I realized how much I say OK each and every day!
No matter what the problem behavior is, the first step is to always start with an assessment. And don’t just assess the problem behaviors. Instead assess the whole child and look at the entire situation. Let me tell you about a 6 year old boy, I’ll call him Tony. He was in one of my classrooms and I met him a few times. I was working at school only, not in the home. I was coaching the staff to work on manding and early learner programming. Tony had some words, not a lot and had only a few mastered skills. He ate cereal and corn chips during the time I saw him.
Tony’s mom requested to meet with me and when Tony’s mom came in, she told me that her husband, Tony’s dad, was serving in the military and overseas. She was having financial difficulties and Tony was very disruptive in the community. He was clearing shelves when they went to the grocery store. He was just having a difficult time, which was not really behavior that I would have expected out of Tony. Tony was also not toilet-trained and since he was 6 years old, she was spending a lot of money on diapers.
When I assessed his food intake, she had told me about the french fries, corn chips, and other neutral colored crunchy foods. When I asked her, “Does Tony get any vegetables, fruits or protein in his diet?” she casually said, “Only in the baby food.” Without looking shocked, I said, “Oh, he gets baby food?” She’s replied, “Yes, it’s the only way I can get anything into him of substance.” I said, “How many jars of baby food does he go through?” She said, “52 jars a week of baby food.”
Financially, the diapers, the baby food, the ability to not be able to take him out to the stores to do her grocery shopping – all of these things were so much more important than some of the things we were working on at school. Without an assessment of all these areas, we’re not able to program effectively.
After you do this general assessment, then next I would recommend getting more details about the actual problem behaviors. I want the parent or professionals that work with the child to fully describe the problem behavior or behaviors.
When you describe behaviors, be as specific as possible. So instead of saying, “He melts down” or “He has a tantrum,” tell me what that looks like. To coach other professionals and parents to be more specific, ask them “If he melted down right now, what would that look like? What exactly would I see?” Would a melt-down include flopping to the floor, screaming, hitting mom, biting other peers or his own hand?
When you hear a behavior described such as, “He gets anxious.” What does being anxious for the child look like? Does he pace around the room or verbal stim? Does he script or lay his head down? How do you know he’s anxious and what does it look like?
Being out-of-control, frustrated and being anxious are not specific behaviors that you and I can count reliably. Describe what the behavior looks like in a way we can see and count because it helps us to get an accurate starting point so we can develop interventions. For instance, one boy was hitting his head on the wall during instruction, so while this was certainly not my only recommendation, moving his desk away from the wall was a good start.
As a behavior analyst, I know it’s important to define a behavior clearly, especially when conducting a functional behavior assessment. So instead of saying, “Suzie hits her head,” BCBAs would say something like, “Suzie hits the right side of her head with a closed right-handed fist” or “Suzie bites the knuckle on the index finger of her right hand and will sometimes draw blood and will always make indent marks.” That gives you a sense of how severe the behavior is. If the child causes open wounds, indent marks or lesions, that certainly is important too.
After assessment and a really good description of what the problem behavior looks like when it occurs, we need to determine when and where the problem behavior usually happens. Is it always with mom? Does it usually occur with a particular teacher? Is it usually within an inclusion or community setting or does it occur at home or in the autism classroom?
After assessment and a really good description of what the problem behavior looks like when it occurs, we need to determine when and where the problem behavior usually happens. Is it always with mom? Does it usually occur with a particular teacher? Is it usually within an inclusion or community setting or does it occur at home or in the autism classroom?
Also, it’s just as important to find out if there is a location or situation where the behavior never or rarely occurs. Would the behavior never or rarely occur in a pool or would it never occur with free access to videos or if the child is in bed? If you let your child play on the computer all day or line up cars or eat unlimited snacks, would he not engage in problem behaviors? These are all important clues.
Next we need to look at what happens right before the problem behavior occurs. This is called the antecedent. When Johnny is alone in the crib, he tends to bang his head. Sarah is called to the kitchen table to eat and she whines. Faith is told “no,” so she screams and flops. When TJ is watching movies, he scripts the lines from the movies.
The consequences are the next thing to determine…. what happens right after the problem behavior occurs? What does the parent or teacher usually do when the problem behavior occurs to stop it, if anything? If Faith flops and she’s at home, do they just walk away? Do they walk away for 5 minutes, then if Faith doesn’t get up from flopping does her mom go back and pick her up? Does Faith ever flop in the grocery store or outside? Also what happens if Faith flops and mom needs to go to an appointment?
That’s usually the problem. There are probably a lot of different consequences based on the location and how much time the parent or the teacher has to ignore the behavior or to intervene.
While we’re assessing the actual problem behavior, ideally, you want to take frequency and ABC, and/or a partial interval data over a few days at least to get an accurate baseline. But in a lot of situations this simply can’t be done.
For example, getting a true baseline of how often a problem behavior is occurring is not possible for kids who are having severe problem behaviors that could cause injury.
For instance, I had a client who banged his head on hard surfaces. To the point where he got an open lesion on the back of his head. He was only 2 years old. When I first assessed him, I said to the caregiver “How much of the 9 hours that he’s here at the child care setting does he bang his head?” The person that was watching him said about 3 hours a day. I can’t wait for 3-5 days to establish a baseline. I mean, 3 hours a day of banging his head on hard surfaces, I need to intervene quickly.
If you can’t take a full baseline, I would interview the person that is with the child. Preferably, the parent and the teacher if they’re in school. Get an estimate of the frequency and magnitude. Ask questions like does it happen 3 hours per day, 10 times per day (for 5 minutes each episode) or 2 times per week?
Finally, take a video of the problem behavior when it occurs. Or take a picture if there are any open wounds, scabs, or indent marks. If you are a professional, make sure to obtain video and photograph permission early on. This will help you document the severity of the issues and will provide a nice “before and after” view of the situation after you implement successful interventions.
To wrap up, the first step to tackling any problem behavior is an accurate assessment of the whole child, including a thorough description of the problem behaviors. The second step is to understand when, where, and how often the behavior occurs and what usually comes before and after each occurrence. Download a free Problem Behavior Template so you can start tackling any problem behavior right away.
