10 Steps to Preventing Problem Behaviors

1.  Apply Your Knowledge of the Child

2.  Use the Problem-Solving Approach to Behavior Change

3.  Teach Functional Communication

4.  Adapt the Environment

5.  Incorporate Visual Cues

6.  Develop Predictable Routines

7.  Adapt Your Interaction Style

8.  Teach Alternative Behaviors

9.  Provide Powerful Rewards

10. Catch ‘em Being Good

1. Understanding the Child

The first step in changing a child’s behavior is to understand the child.  We need to obtain information about the child’s likes, dislikes, strengths, and weaknesses in order to develop a behavior change approach which is individualized to for the child.  In addition to a careful observation, we can obtain important information about the child from his or her parents as they are the experts on their children. Here are some areas that must be explored prior to trying to change a child’s behaviors:

A.  Preferences
What does the child like to do?  To eat?  To drink?  How does he/she like others to behave?  Where does he/she seem most comfortable and calm?  What makes him/her smile?  When is he/she happiest?

B.  Motivations
What seems to “drive” the child’s behavior?  Does he/she seem to constantly want attention?  Does he/she seem to be “driven” to escape from people or demands?  Does he/she seem especially interested in obtaining certain kinds of sensory stimulation?  Are there times when the child is focused on a certain toy or object and cannot be dissuaded to do anything else?

Insight into these two areas gives us ideas about possible rewards as well as determining how and where to teach new behaviors.

C.  Dislikes
What does the child resist doing?  What foods, toys, objects will he/she avoid?  What behaviors in others seem to upset him or her?  Where does he/she seem most uncomfortable?  What makes him/her cry?  When does he/she seem most upset?

This information gives us ideas for adjusting our interaction style, adapting the environment, and tells us where not to teach new behaviors.

D.  Strengths
What is the child good at doing?  Is he/she physically agile?  Does he/she have a good memory?  Is he/she highly visual (e.g., able to recognize letters/shapes quickly, complete puzzles expertly?) Is he/she cooperative and easy-going?  Is he/she able to communicate verbally or nonverbally?  Can he/she understand your communications?  Does he/she respond well to rules or limits?  Can he/she self-entertain?  Does he/she like predictability and structure?

E.  Weaknesses
What’s difficult for the child?  Does he/she need help with physical tasks?  Is it difficult for him/her to pay attention?  Is he/she somewhat irritable at times?  Are his/her communications hard to understand?  Does he/she have difficulty understanding your communications?  Does he/she resist rules and limits?  Does he/she need to be continually entertained?  Does he/she resist structure?

These two areas provide ideas for how to present information to the child, how to structure tasks and activities, and where to start with functional communication.

 

Reinforcer Survey

Child's Name:______________________ Completed By: ______________

Child's Age:   ______________________ Date:_______________________

 

Please indicate how much the child enjoys the following items/activities using the following guidelines:

Not At All -- The child shows no interest when this item/activity is offered.  He/she may push away or throw the item, or fail to participate in the activity.  He/she does not generally show any pleasure or enjoyment when the item or activity is provided.

A Little -- The child accepts this item when it is offered, but rarely requests it or attempts to get it independently.  He/she may show pleasure or enjoyment when the item/activity is presented. 

A Lot -- The child accepts this item/activity when it is offered, and shows pleasure or enjoyment in one of the following ways:  by smiling or laughing, by maintaining his/her attention, or by becoming agitated or upset when the item/activity is removed.  He/she may actively request it or attempt to get it independently.

N/A -- This item/activity is not available to the child.

 

FOOD

How much does the child enjoy each of these foods?

Food

Not at all

A little

A lot

N/A

Crackers

 

 

 

 

Cookies

 

 

 

 

Marshmallows

 

 

 

 

Cupcakes

 

 

 

 

Ice cream

 

 

 

 

Juice

 

 

 

 

Soda

 

 

 

 

Doughnuts

 

 

 

 

Popcorn

 

 

 

 

Corn chips

 

 

 

 

Potato chips

 

 

 

 

Fruit

 

 

 

 

Vegetables

 

 

 

 

Jello

 

 

 

 

Milk

 

 

 

 

Peanut butter

 

 

 

 

Raisins

 

 

 

 

Cereal

 

 

 

 

Pudding

 

 

 

 

Cheese

 

 

 

 

Popsicles

 

 

 

 

Kool-aid

 

 

 

 

Special dessert

 

 

 

 

Other:

 

 

 

 

 

 

 

 

 

 

ACTIVITIES

How much does the child enjoy each of these activities?

Activity

Not at all

A little

A lot

N/A

Going to the park

 

 

 

 

Listening to stories

 

 

 

 

Singing songs

 

 

 

 

Playing musical instruments

 

 

 

 

Playing on a swingset

 

 

 

 

Playing in a sandbox

 

 

 

 

Rocking

 

 

 

 

Playing a board game

 

 

 

 

Dressing up

 

 

 

 

Playing in the yard

 

 

 

 

Taking pictures

 

 

 

 

Talking into a tape recorder

 

 

 

 

Listening to music

 

 

 

 

Going out for a treat

 

 

 

 

Playing with clay

 

 

 

 

Finger-painting

 

 

 

 

Coloring

 

 

 

 

Blowing bubbles

 

 

 

 

Bathtime

 

 

 

 

Riding in the car

 

 

 

 

Riding a trike or bike

 

 

 

 

Staying up later at bedtime

 

 

 

 

Watching TV

 

 

 

 

Walking outside

 

 

 

 

Swimming

 

 

 

 

Being pulled in a wagon

 

 

 

 

Balloons

 

 

 

 

Water play

 

 

 

 

Building with blocks/Legos

 

 

 

 

Puzzles

 

 

 

 

Playing with cars/trucks

 

 

 

 

Playing with noisemakers

 

 

 

 

Looking at magazines/books

 

 

 

 

Dancing

 

 

 

 

Playing with pots and pans

 

 

 

 

Playing with tools

 

 

 

 

Climbing

 

 

 

 

Being lifted into the air

 

 

 

 

Having a “horsey ride”

 

 

 

 

Being spun around or swung

 

 

 

 

Bouncing on the bed

 

 

 

 

Playing with dolls/action figures

 

 

 

 

Playing with mirror

 

 

 

 

Time alone

 

 

 

 

Playing with animals (specify)

 

 

 

 

Favorite toys (specify)

 

 

 

 

Other:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SOCIAL

How much does the child enjoy each of these activities?

Activity

Not at all

A little

A lot

N/A

Playing hide and seek

 

 

 

 

Playing tag/chase games

 

 

 

 

“Gimme five”

 

 

 

 

Watching others play

 

 

 

 

Playing catch

 

 

 

 

Being read to

 

 

 

 

Playing peek-a-boo

 

 

 

 

Playing pat-a-cake

 

 

 

 

Playing with siblings

 

 

 

 

Helping Mom or Dad

 

 

 

 

Sitting with Mom or Dad

 

 

 

 

Being hugged

 

 

 

 

Being kissed

 

 

 

 

Being tickled

 

 

 

 

Verbal praise

 

 

 

 

Playing with preferred friends (list who)

 

 

 

 

Playing with preferred adults (list who)

 

 

 

 

Visiting a preferred person (list who)

 

 

 

 

Having a visitor (list who)

 

 

 

 

 

TANGIBLE/MATERIAL

How much does the child enjoy each of these items?

Item

Not at all

A little

A lot

N/A

Pennies

 

 

 

 

Keys

 

 

 

 

Shiny objects

 

 

 

 

Cars/truck

 

 

 

 

Prizes out of a grab bag

 

 

 

 

Jewelry

 

 

 

 

Dolls

 

 

 

 

Stickers

 

 

 

 

Baseball cards

 

 

 

 

Other trading cards (specify)

 

 

 

 

Clothing items (specify)

 

 

 

 

Other:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2.  Use the Problem-Solving Approach to Behavior Change

If you want to change your child’s behavior in a lasting way, we have found that it is very important to use a problem-solving approach like the one outlined below.  It requires planning, observation, patience, and flexibility.  It is not always easy to use, but it works.  This is the approach we are using as we work with each of you to create individualized behavior change plans for your child.

1.  Name and define the behavior you want to change.  This is called the target behavior.

2.  Watch the behavior for a few days and try to answer the following questions:

  • How often does it occur?  (i.e., How many times an hour do you see the behavior? How many times per day?)
  • What sets the behavior into motion?  (i.e., Where is the child when the behavior tends to occur?  What is he/she doing?  Where are you?  What are you doing? What happens just before the behavior occurs?)
  • What’s the short-term result of the behavior?  (i.e., What happens just after the behavior occurs?)
  • What’s the long-term effect of the behavior?  (i.e., What happens in the distant future because the behavior occurred?)

3.  Look for patterns in the behavior.

4.  Find a way to prevent the situations which set the behavior into motion AND find a way to intervene so that the behavior loses some of its power.

5.  Try these two new approaches (prevention and intervention) for at least two weeks.

6.  Evaluate the progress and decide to either:

  • keep handling the behavior in this way, or
  • change your approach (go back to step 2).

 

3.  Teach Functional Communication

Using “functional communication” means being able to express one’s needs and desires so that everybody understands what is being communicated.  A child does not need to be verbal to communicate functionally. 

To be functional, or useful, a method of communicating must be practical, constantly available, and able to meet the specific needs of the child.  Methods of communicating functionally include using words (speech), pointing to pictures, exchanging pictures, and using gestures.  A “Total Communication Approach” involves using combinations of these methods at the same time.  Research suggests that children with autism and PDDNOS learn language more quickly and express themselves more often when a Total Communication Approach is used by their parents and teachers.

For purposes of behavior management, functional communication also means making sure that your child has a way of communicating certain very important concepts.  As stated previously, behavior is a form of communication.  If a child cannot communicate appropriately to get his or her needs met, that child will use his/her behavior to meet his/her needs.  Often, disruptive behaviors send very clear messages.  To prevent problem behaviors, we need to teach children another way to send these messages.

Every child needs to have an appropriate way to send these messages:

“I want your attention.”

“Please go away”

“I want that.”

“I don’t want that.”

“Help!”

“I’m finished.”

Teaching a child a functional way of communicating to meet those needs is perhaps the most effective means of promoting positive behavior and reducing negative behavior.  We highly recommend that you consult with your child’s speech therapist in order to determine the best way to teach your child to communicate these messages.

Functional Communication Worksheet

To assist you in determining the responses your child needs to learn, consider these questions:

1.  How does the child currently communicate that he/she wants your attention?

 

2.  What would be a more appropriate way to request your attention?

 

3.  How does the child currently communicate that he/she does not want to do something?

 

4.  What would be a more appropriate way to reject an activity?

 

5.  How does the child currently ask for help?

 

6.  What would be a more appropriate way to ask for help?

 

7.  How does your child request an object?

 

8.  What would be a more appropriate way to request an object?

 

4. Adapting the Environment -- Suggestions for Parents

Adapting the environment to meet the needs of the child is one way of preventing negative behaviors from occurring.  These ideas have been suggested by other parents of young children.  We offer them for your consideration.

To ensure safety:

1.  Fence-in a portion of the backyard.

2.  Place gates in doorways, such as the child’s bedroom.

3.  Place alarms in the doorways leading outside.

4.  Install child-proof locks on cabinets, etc.

5.  Keep delicate high-tech equipment out of the child’s reach (i.e., perhaps mounted on a wall).

6.  Temporarily remove objects that are misused by the child.

To encourage independence:

1.  Have a box/place for toys in the child’s room and in the play area.

2.  Have a basket for your child’s favorite objects and encourage him/her to keep them there.

3.  Use adaptive equipment when it is helpful (e.g., grips for utensils if child has fine motor difficulty, velcro fasteners instead of shoe laces).

4.  Use rugs to delineate boundaries for activities, such as toy play.

5.  Use a specific seat at the dinner table for your child.

6.  Use a specific placemat at your child’s seat which includes pictures to indicate “food”   and “drink” and “all done”. Use these pictures during dinner to communicate.

7.  Use a visual schedule to indicate the day’s events (see “Using Visual Cues”).

8.  Use a color scheme to indicate what is available to the child (green) and what is off-limits (red).  For example, a red circle might be placed on the door to mom’s study, while a green dot is placed on the door to the play room.

9.  For bathtime to encourage washing self:  color-code the faucets, use a bath mitten, post laminated symbols of body parts in order of washing, use liquid soap, use a shower           extender, try roll-on soap applicators, use colored soap so child can see what has been washed already.

10.  For toothbrushing:  strap brush to hand with rubber-band or use bicycle grips to help grasp toothbrush, consider flavored toothpaste, play music or sing a song to set the duration of the activity.

To prevent specific behavioral problems:

1.  Have a rocking chair available if your child likes to rock, or a mini-tramp available if s/he likes to jump.

2.  Prepare a bag for outings which has a few favorite toys, books, juice, etc.

3.  Have music available in various places (e.g., car, bathroom, etc.)

4.  Create an area of the house which is okay for rough-housing and make the boundaries visually clear to the child.

5.  Create an area of the house which is for calming down (preferably the bedroom) and consider decorating it in muted colors and using music or a water-bubbler or a fan to provide calming sounds.

 

5.  Incorporate Visual Cues

Using visual cues means using your child’s sense of sight to help you to communicate with him or her.  Visual cues are signals, like spoken words are signals.  For children who do not consistently and fully understand spoken language, visual cues become instrumental in helping you to send clear messages to your child.  Over time, your child can use these visual cues to communicate back to you.

Visual cues can help you to communicate to your child about:

  • physical boundaries
  • daily routines
  • transitions/changes
  • appropriate behavior
  • inappropriate behavior
  • availability of invisible items/experiences

As a result, they serve to prevent negative behaviors and encourage positive behaviors. 

In general, it is helpful to:

  • always pair the visual cue with spoken language
  • use the same visual cues for similar situations (e.g., snack and mealtime)
  • use the same visual cues across different environments (e.g., school and home)
  • have multiple people use the visual cues (e.g., mom and dad and the teacher)
  • use the visual cues as often as you can

Visual cues can take the form of:

  • actual objects (e.g., giving the child a spoon when it’s time to eat)
  • photographs
  • symbols
  • gestures

 

6.  Develop Predictable Routines

A routine is defined as a set of behaviors which usually occur in roughly the same order and roughly under the same circumstances.  A routine is a predictable way of doing a daily activity, such as going to bed; or negotiating a change, such as leaving an outdoor play activity to come inside.

Establishing routines is an important part of parenting any child.  Psychologists have shown that children feel more secure when there is a predictable sequence to events.  In fact, children create their own routines and often ask their parents to re-enact them over and over again.  For example, most children like to be put to bed the same way each evening; maybe with a story or a song or some quiet time with a parent.  As children grow, their desire for routines changes.  Some children outgrow most of them quickly; others hold onto them for a long time.  Others seem to return to old routines when things are changing or when they feel a little anxious.

Parents of children with autism often report that routines are extremely important to their son or daughter.  Theoretically, there are probably at least three good reasons for this increased interest in doing things the same way each time.  First, children with autism often have difficulty understanding language so they need predictable cues to tell them what is happening around them and to clarify what is expected of them.  Second, many children with autism have difficulty processing information from their senses in a consistent manner.  This increases their sense of unpredictability in the world around them.  Third, children with autism have been shown to have trouble organizing their thoughts and translating their thoughts into actions.  Mastering a routine, or a predictable “script” of behaviors makes it easier for them to become more independent in daily activities.

Developing positive routines can prevent problem behaviors during transitions, when changes occur, and when demands are present.  The use of routines can also facilitate skill acquisition, communication, and social interactions. 

A note of caution -- using positive routines does not mean making sure that nothing ever changes around your child.  Routines are use as an anchor, a framework for events.  Changes will constantly occur and coping with changes is an important skill for your child to learn.  Using routines at key points during the day can actually help your chld to cope more effectively.

Here are some examples of how using routines can help to encourage independence and appropriate behavior:

Everett, age three, played with his toys for a few seconds at a time and then abandoned them.  Consequently, he left a wake of toys throughout the house.  His favorite activity was swinging outside.  Each day, usually while dinner was cooking, Everett’s mother brought out a laundry basket and took Everett’s hands and guided him through placing his toys into the basket.  Then Everett’s mother praised him and said “Let’s swing.”  She immediately took him outside and pushed him on the swingset.

Everett never went to the swingset without first picking up a few toys.  Over time, all his mother had to do was bring out the laundry basket and he put his toys inside and then approached her to go swing.  Eventually, she didn’t have to follow his cleaning up with swinging every time and she substituted other fun activities.  Soon Everett mastered putting his toys away independently whenever he saw the laundry basket and before leaving the room to do something else.

Stacey, age three, enjoyed throwing rocks into the creek behind her house.  She cried whenever her mother tried to end the activity and get her to come inside.  By creating a routine around the rock-tossing activity, Stacey’s mother was able to avoid a lot of tantrum behaviors when it was time to come inside.

First, Stacey’s mother made sure someone took Stacey to the creek after school and after dinner each day.  The adult brought a small bucket and filled it with rocks.  Stacey stayed at the creek until the last rock had been tossed into the water.  When the bucket was empty, the adult said “All done” and gestured to signal that the activity was over.  The the adult showed Stacey two pictures, representing two activities that Stacey enjoyed.  The pictures changed depending upon the day and examples included a picture of a Bambi video and one of a bathtub.  The adult then prompted Stacey to make a choice by touching one of the pictures.  Whatever picture she chose, that activity came next.  The adult then walked with Stacey into the house for the next activity.  In the beginning it helped to have Stacey carry the picture.

If Stacey resisted the adult remained consistent and helped her inside.  Over time, Stacey stopped resisting because it did not change the adult’s behavior.  Also, she was quickly distracted by the allure of the next activity. 

Since rock-tossing happened at least twice a day and continued until the bucket was empty each day, Stacey had a clear sense of what to expect from her creek plan and therefore became less driven to participate in it indefinitely.

What can you do to increase predictability for your child?

  • Focus on being consistent whenever you can
  • Create routines around daily activities (e.g., sleeping, eating, dressing, toileting)
  • Practice daily routines every day
  • Involve other family members in the routines you create
  • Show your child a picture of what is going to happen next
  • Give advance notice when an activity is going to begin or end
  • Use simple, concrete language and use the same phrases each time
  • Use hand gestures to support your words
  • Follow a verbal direction by physically guiding your child through the behavior you want
  • Be mindful of the order of activities:  Always save the best for last!!

 

7.  Adapt Your Interaction Style

Parents know better than anyone else how to interact with their child.  It is very important that you share this information with teachers, therapists, physicians, or other people who interact with your child.  One family made a booklet with pictures and brief text to describe the preferences and interaction style of their six-year old son who has autism.  His peers at school could read through this booklet and gain a greater understanding of him.  Whether you decide to put the information in writing or simply communicate it to others verbally, it will probably be very useful to share what you know with those who interact with your child.

Sometimes it is the most obvious tips that we forget to share with others.  Here are a few interactional tips that parents have suggested are important to cover:

  • Use simple language.
  • Pair words with gestures.
  • Gain the child’s attention prior to interacting.
  • Give advanced notice of your actions and delay briefly before acting.
  • Approach the child from the side.
  • Be sensitive to tactile, visual, and auditory preferences.
  • Engage the child in physical/stimulatory activities which he/she enjoys before and after social demands.
  • Consider imitating the child or following his/her lead in order to foster rapport.

 

8.  Teach Alternative Behaviors

In order to reduce a negative behavior, it is often a good idea to teach the child a positive behavior which can serve the same function as the negative behavior, but do so in a manner that you can accept.  These new positive behaviors are called alternative behaviors.  We often will write a behavior plan so that the negative behavior does not get the child what he/she wants, but the alternative positive behavior does get the child what he/she wants.  Here are some examples of negative behaviors you might want to discourage and the positive alternative behaviors you might want to encourage:

Negative Behavior

Tantrums

Hits others

Runs away

Throws toys

Bites hand

Screams

Noncompliance

Lack of initiative

Resists change

Positive Alternative Behavior

Sits quietly

Hands down

Stops when asked

Uses toys appropriately

Squeezes hands

Communicates

Follows directions

Begins activity

Tolerates change

 

When you are first teaching an alternative positive behavior, you want to reward your child every time he or she performs the behavior.

9.  Provide Powerful Rewards

5  General Considerations:

1.  Choose rewards in light of the child’s preferences.

2.  Make sure that access to the rewards is controlled by an adult or a peer.

3.  Rewards must be delivered by more than one person in more than one place.

4.  Continuallly assess the potency of rewards by providing the child with chance to choose his or her rewards.

5.  Choose rewards which match the function of the behavior you are trying to change.

4 Kinds of Rewards:

1.  Social/Attention (children with autism or PDDNOS often like rewards)

2.  Tangible (that are in the escape or stimulatory categories)

3.  Stimulatory

4.  Escape

3  Levels of Availability:

1.  Always available  (e.g., praise, hugs, drink)

2.  Sometimes available  (e.g., playground, car ride, snack treat)

3.  Rarely available (e.g., trip to Opryland, going out for pizza)

2  Ways of Delivering:

1.  Immediate (when you are getting started, use immediate rewards

2.  Delayed (and over time, use delayed rewards)

1  Criteria to be a Reward:

1. Must increase the likelihood that a positive behavior will occur.

 

10. Reinforcing Good Behaviors

Definition:  A reinforcer is an item or event which follows a behavior and increases the likelihood that the behavior will occur again.  Reinforcers are rewards for appropriate behavior.  Reinforcers will differ from child to child, and will vary over time.

How to Use Reinforcers to Reward Appropriate Behavior

1.  Identify a specific behavior to reinforce. Examples:

  • sitting, using toys appropriately, following directions,
  • initiating activities, trying new things, transitioning calmly,
  • making choices, following rules, playing near/with others,
  • making eye contact, eating new foods, responding to name, etc.

2.  Identify effective reinforcers for the specific behavior.

a.  Choose the type of reinforcers to use based upon what motivates your child and brings him/her pleasure.  The types of reinforcers are:

  • Social/Attention:  Paying a lot of attention to your child's good behavior through praise, hugs, etc.
  • Tangible:  Providing access to special items/objects when your child is behaving well.
  • Stimulatory:  Providing access to special activities when your child is behaving well.
  • Escape/Avoidance:  Allowing your child to take a break from stress caused by demands, changes, or other people when he/she is behaving well.

b.  Choose specific reinforcers which are natural to the situation where the good behavior occurs:

Behavior

Sitting at table

Using toys appropriately

Situation

Dinner time

Play time

Reinforcer

Food (Tangible)

Toys (Tangible)

c.  Find ways to combine reinforcers as they are often more effective when used together:

Behavior

Following directions

Calm Transitioning

Situation

Store

School

Reinforcer

Praise (attention) + Toys (Tangible)

Break (escape) + Calming activity (Stim)

d.  Choose reinforcers which are readily available and can be given to your child frequently and consistently.

3.  Control how often your child is rewarded.  Make sure that your child receives the reinforcers only when he/she is behaving appropriately.

Example:  If you are using a special toy to reward calm behavior, make sure the toy is not available all the time, but rather is brought out only when the child is behaving well.

4.  Observe whether or not the reinforcers you have chosen are effective.  If, after reinforcing a behavior in a certain way for a few days, the behavior is increasing, then the reinforcer is effective.  If the behavior does not change, try changing the reinforcer.

Note:  Do not assume that praise is rewarding to your child.  Observe how effective it is in increasing your child's appropriate behavior.  If praise alone does not increase appropriate behavior, combine it with other reinforcers which naturally motivate your child.

5.   Be ready to continually change the reinforcers so that the child does not tire of them.  Keep delivering the rewards that appear to bring your child pleasure and change the rewards which he/she does not actively seek.

6.  Deliver the reinforcers immediately after the behavior has occurred. 

7.  Deliver the reinforcers consistently after the behavior has occurred. In the beginning, reward your child every time the appropriate behavior occurs.  As your child shows the behavior more often, you can reward it less often. 

8.  Deliver the reinforcers in as many settings as possible.

9.  Involve as many other people as possible in delivering reinforcers.

10.  If the appropriate behavior is not increasing as you would like, consider:

  • changing the reinforcer
  • delivering the reinforcer more frequently
  • combining reinforcers
  • setting up more opportunities for the behavior to occur
  • selecting a simpler behavior to reinforce