Building Strategies to Support Communication and Address Challenging Behaviors
Photo credit: S:US
Autism Spectrum News
By Amanda Duva, BCBA, S:US Director of Behavior Services
Spring 2019
Individuals with Intellectual and Developmental Disabilities who face the greatest challenges most often have failed to acquire a means of effective communication. Most adults and children alike without verbal behavior are likely to develop a strong repertoire of challenging behavior. The young adult who has not learned an effective way to tell his mother when he has a migraine may hit his head with a fist as a way to try to make the pain go away, if only for a second. The toddler who wants a snack may bite his teacher because in the past, his teacher has tried to calm him down by giving him choices of snacks and preferred games as a means to ending the challenging behavior. While these examples are specific, they are in no way unique to the majority of people who have not developed verbal language.
Applied Behavior Analysis is a widely used methodology in which evidence-based practices are applied to identify the function, or the reason, that a behavioral response is presented by a learner. ABA practitioners use this information to develop a behavior support plan inclusive of both proactive and reactive strategies to increase adaptive, or appropriate behaviors, and thus decreasing the motivation for problematic behaviors.
According to Skinner (2012), requesting, or manding, is typically the first communicative response form taught to a person who has limited communication skills. Manding uses the principle of motivation to produce an immediate benefit for the speaker and more generally, teaches the value of communicating to others. Following the use of a preference assessment, a contingency is set up that requires the learner to communicate the ‘wanting’ of an item. Upon making the request through the appropriate form, the learner then immediately receives access to the requested item. This contingency is taught through practice repetition of only providing access to a preferred item/person/activity/ environment upon the request being made by the speaker. Once manding becomes a skill in the learner’s repertoire, the door now opens for additional verbal behavior modalities to be taught.
What at times can be confusing to support providers and caregivers is what constitutes “language.” Similar to how there are different tongues and native languages, such as English, Spanish, French, there are also different forms within the umbrella of “verbal behavior.” Skinner details and reviews the different forms of verbal behavior, including vocal language (spoken word), sign language, gestures, device output, and picture exchange. A common mistake when discussing someone’s skillset would be by saying the person is “non-verbal” yet really they are able to communicate via sign language, making them “non-vocal.” Through sign language this person is able to make their wants and needs known, which is ultimately the purpose of being able to communicate with others.
As such, an important step in teaching language is for the support providers to assess and select an appropriate response form. If there are strong echoic skills, providers should strive for vocal language; if there is minimal or no echoic skill present, but imitative behaviors are good, sign language may be the focus; for a learner with minimal or no echoic or imitative skills, but good matching skills, a picture exchange or augmentative device is likely the best route. While these beginner skills may not be apparent in the initial phase of assessment, there should be thoughtful consideration of motor functioning, the availability of the system for the learner, and other disabilities that may impede the learning of the above-mentioned skills. Most importantly, it is essential for the support system to understand the pros and cons of all systems, understand the literature associated with each and to always strive for vocalizations by pairing the modality with the spoken word.
While teaching communication as a means to replace problematic behavior proactively, it is still imperative to understand that it is not a fully inclusive process. In order to improve appropriate communication but also to minimize the challenging behavior, the behavior must be placed on what ABA terms “extinction.” Cooper, et al. (2007) defines extinction to mean that a behavioral response does not allow the person to access the ‘relief’ or the sought-after result. This, after time, removes the desire to respond in the problematic form. As supporters of children or adults, it is up to the practitioners to implement this balancing act of reinforcing the associations with appropriate behaviors and minimizing the association with challenging behaviors.
With these strategies and methods, support providers and caregivers now have at least some essential basic tools to help their leaner. In the case of the young adult with the migraine, the Board Certified Behavior Analyst (BCBA) or Board Certified Assistant Behavior Analyst (BCaBA) would identify the function (pain) of self-injury, and develop a protocol to teach this young man to communicate that he is in pain. Through the association of the mand for ‘help’ with the presentation of pain medication, he can now learn that signal to others means he will get the medication to help his pain. For the toddler who wants a snack, the same teaching and pairing process can teach him an appropriate way to mand for ‘crackers’ when he is hungry. By placing biting on extinction, meaning he will not get the crackers following that behavior, the contingencies have now changed such that there will no longer be a rationale for biting, but plenty of motivation for manding.
Imagine for a moment being unable to tell the person closest to you when something hurts, that you are hungry, or that someone mistreated you. Communication is a vital part of everyone’s daily lives. Delays in learning effective communication have such a detrimental effect on the interactions a person has with their surroundings; At the root of most behavioral challenges is a deficit in being able to effectively communicate. Putting ABA technology to use through the use of preference assessments and observations, it is amazing to see how making a simple request can open so many doors not believed to be available before.
References
Carbone, V.J. (2003). Guiding the Development and Implementation of an Intensive Program for Teaching Language and Basic Learner Skills To Children With Autism: Workbook for Consultants And Instructional Leaders. Carbone Clinic: Valley College, NY
Carr, E. G., & Durand, V. M. (1985). Reducing behavior problems through functional communication training. Journal of Applied Behavior Analysis, 18, 111–126.
Cooper, J.O., Heron, T.E., & Heward, W.L. (2007). Applied behavior analysis: 2nd edition. Upper Saddle River, New Jersey: Pearson Prentice Hall.
Skinner, B. F. (2012). Science And Human Behavior. Riverside: Free Press.