By Libby Kumin and Jessica Pearsall
Editor’s note: Dr. Libby Kumin is a professor of speech language pathology at Loyola College in Maryland, and an author, speaker and researcher on communication skills in people with Down syndrome. Jessica Pearsall, mother of a 12-year-old son with DS, is a parent advocate, presenter and support partner with Shared Support in MD.
Every behavior is a form of communication. When a child displays behaviors that are difficult or undesirable, understanding what the child is communicating through the behavior is the most important step in changing the behavior.
A behavior can have many underlying causes.
- Emotional: fear, anxiety, isolation, frustration
- Physical: metabolic, ADHD, sensory, hunger, thirst, tactile sensitivities
- Environmental: noise, movement, allergies, temperature
- Response to abuse and bullying
- Inability to ask for help
- Situation avoidance
When children and adults can’t tell us what is bothering them, it is often difficult to determine the behavior’s cause. A behavior may have multiple causes and peeling back the onion to find the origin is not always easy. One day, a fifth grade student with Down syndrome slapped several typical peers. The school team attempted to interpret what the behavior was communicating by investigating what happened right before the slaps. In a water fountain incident, the peer let the student with DS go in front of him and the student received a slap. The confused team could find no apparent reason for the slapping. Luckily, an insightful team member remembered that the slapping happened on the day the student visited the middle school he would attend the next year. This was a major change after six years at the elementary school. After exploring and addressing his fears, the slapping ceased.
Sometimes, a Functional Behavior Assessment (FBA) can determine the behavior’s cause and an intervention plan developed to provide an alternative way of communicating. The FBA should lead to a positive behavior intervention plan (PBIP) to help reinforce good behavior and extinguish noncompliant or troublesome behavior. A proper FBA includes everyone who has information about the child’s problematic behavior and includes:
- the antecedents (what happens before the behavior),
- the behavior, and
- the consequences (what happens after the behavior)
For example, when the teacher asks children to get in line, one child runs up without pushing his chair in, causing other children to trip. So, the teacher’s announcement is the antecedent and the child running to the area and failing to push in his chair is the behavior. What is the consequence? It might be, that he is always first in line because he was the first one to get there. Does he want to be first in line? Or, is he sensitive to the clamor of moving children and chairs on the tile floor and trying to protect himself? By determining the underlying reason, the FBA team can remedy the situation through a PBIP that helps develop alternative acceptable communication skills.
Here are 23 strategies that support appropriate behaviors. Try them and see what works for you.
1) Prepare for expected situations. Sometimes, you are aware of upcoming situations and can help prepare your child in advance. If you anticipate a stressful situation, talk about feelings and emotions using pictures and discuss what each emotion feels like, when it might happen, calming strategies and appropriate expression. For specific situations, practice how to behave by using scripts, social stories or video modeling. If a setting has been traumatic or confusing in the past, it may help to write a combination script and social story to prepare for the future.
2) Develop skills for telling what happened. Just as with other children, it is likely that your child will want to tell you about situations and events that occur at school, camp, community activities or jobs. Help your child learn how to retell a story. Provide visual cues, pictures or written cues and practice telling what happened.
Start with this simple form and ask:
- Who was there?
- When did it happen?
- What happened?
- Where did it happen?
After the child masters who, what, when and where, another form (next column) supports the child in adding more details as he is retelling a story:
3) Create an agenda. Whenever possible, communicate the planned activities for the day, week, or month depending on the child’s age and understanding of time concepts.
4) Prepare for change. Being able to transition and deviate from routines when necessary are important school and home skills. Communicate changes and transitions ahead of time. For younger children, use pictures.
5) Give choices. Always help people feel they have control. Try to use real choices. Don’t use threats disguised as choices, such as “You can either wash your hands or go to bed” or “You can either finish this work or go to time out.”
6) Try the Speak and Spin technique. If the child is in “debate” mode or talking on and on to avoid an activity, state simply what needs to be done, turn your back and walk away. Once clear instructions have been given, end the conversation.
7) Investigate a reaction to internal states. Hunger, thirst or sensory issues such as a scratchy sweater can manifest into a behavior. Consider this possibility and address it to stop a behavior.
Heap praise. Positive words go a long way. Every chance you get, catch children doing something right. Try giving two positive comments for every negative one. Use specific and real praise, e.g. “Amy, it was very polite of you to introduce your new friend to our class. Thank you.”
9) Ask for help. Your child can learn that everybody needs help sometimes and it’s okay to ask. Specifically point out when, how, and who to ask for help. Let her see you and other family members seeking and accepting help in many situations. Thank others enthusiastically for their help. Work on scripts that your child can use to ask for help, such as “Excuse me” and “Could you help me?” Children must know they will not be penalized or ridiculed or they will avoid asking for help.
Use Social Stories (see resources) to specifically teach your child how to handle difficult situations. For example, if he will need help applying bug spray on a Boy Scouts camping trip, write a Social Story about what will happen at the campsite, including what to say to get the help he needs.
10) Ask for clarification and make repairs. Children need to ask for clarification when they don’t understand what to do. They are more likely to ask at home than at school or in the community. They also need to be able to explain more fully (making repairs) when someone does not understand them. For more information on clarifications and repairs, see Helping Children with Down Syndrome Communicate Better (see resources).
11) Follow rules and routines. When a child does not follow the rules, behavior and cooperation are usually blamed. Consider other possible underlying causes, such as hearing loss, sensory processing disorder or auditory memory and receptive language problems.
12) Promote generosity. Children and adults with disabilities often receive help; however, nothing is more rewarding than being able to give to others. Ensure opportunities for responsibility and giving back to the community.
13) Empower leadership. Provide leadership opportunities, e.g. running a family meeting, making the family meeting agenda, planning a meal, making morning announcements at school, serving on student council, etc.
14) Discourage imitating inappropriate behavior. Children with DS often model typical peers — both appropriately and inappropriately. They get into trouble by repeating “bad” words or staying put when everyone else runs away. To help children learn appropriate behavior for a situation, use video modeling or self-modeling (see resources).
15) Set boundaries and consequences. Be a person of your word. Set boundaries and consequences ahead of time and stick to them.
16) Offer breaks. Give natural breaks when working on difficult or stressful tasks. At school, walking to the rest room or water fountain, returning media books or taking notes to the front office are natural breaks.
17) Give simple, clear instructions. Keep instructions short. If possible, wait until the child responds to the instruction before you go on to the next instruction. Don’t give a long list of instructions verbally. If possible, provide a check list or written instructions for children or adults who can read.
18) Try diversion. Redirect the child or adult to a different activity when possible.
19) Use humor. Almost everyone responds well to using humor.
20) Provide information on consequences (positive and negative). Use “if/when” strategies, e.g. “When you finish this activity you can use the computer.”
21) Work with strengths whenever possible. Acknowledge efforts to use appropriate behavior, even with limited success.
22) Match the consequence to the behavior. Consequences or punishment should relate to and reduce the behavior. For a student who writes graffiti on the school walls, washing the walls would be appropriate. Writing a paper on proper school behavior would not be.
23) It is essential to communicate between home and school. Parents, teachers and community activity leaders can all reinforce and practice the same behaviors when they communicate and are on the same page.
As we stated at the beginning, every behavior is a form of communication. The cornerstone to effectively changing behavior is understanding why a child behaves that way.
Baker, J. (2001) Social Skills Picture Book. Arlington, TX: Future Horizons
Bellini, S., & Akullian, J. (2007). Video modeling and video self-modeling. In B. S. Myles, T. C. Swanson, & J. Holverstott (Eds.), Autism Spectrum Disorders: A Handbook for Parents and Professionals. Westport, CT: Greenwood Publishing.
Crimmins, D. B. (1999). Positive Behavioral Support: Analyzing, preventing, and replacing problem behaviors. In Hassold, T. & Patterson, D. Down syndrome, A promising future together. New York: Wiley-Liss, 127-132.
Faber, A. & Mazlich. E. (1990). Liberated parents, liberated children: Guide to a happier family. New York: Avon Books.
Gray, C. Social Stories. www.thegraycenter.org.
Kumin, L. (2008). Helping Children with Down Syndrome Communicate Better: Speech and Language Skills for Ages 6-14. Bethesda, MD: Woodbine House Publishers.
Pitonyak, D. (2008). http://www.dimagine.com/index.html
Snow, K. (2001). Disability is Natural. New York: Braveheart Press.
Social stories videos- Find at www.modelmekids.com
Success Stories. Social learning stories that can be personalized. Find at www.sandbox-learning.com.