Autism, Challenging behaviour and Communication. A case study illustrating the relationship between the three elements and describing the process of formulating behavioural strategies.
Introduction Literature review Context Method Information Analysis Behavioural Strategies Evaluation of the Strategies Conclusions References
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“Behaviour in ways that others identify as “challenging” or problematic is not exclusive to people with autism. It is part of being human. Most of our behaviours reflect attempts to meet our needs, satisfy our desires, cope with frustrations and high levels of emotion” (Clements and Zarkowska 2000) p.47 What is considered „challenging behaviour‟ to one person may not be challenging to another depending upon the way each person interprets a particular behaviour displayed by an individual with autism. In this assignment I will consider the nature of challenging behaviour and autism, why it might be associated with communication and suggest possible strategies to deal with it. I will look at the problems associated with communication experienced by an individual with autism and how it affects their behaviour primarily within a classroom setting. I will do this through observation of a child, Mark, within a Primary school who has been diagnosed as having an Autistic Spectrum Disorder (ASD). The results will then be analysed and specific behavioural strategies put into place in association with class teacher, teaching assistants, parents and any other professionals involved with the child during the course of the Summer term. I will assess the effectiveness of the strategies with
everyone involved and either continue with or make amendments to the behavioural strategies set out as the term progresses.
I work with children with special needs as part of the Support Service for Special Educational Needs for a local Education Authority. In my role I teach children in mainstream schools, either one to one or as part of small groups, who have a statement of Educational Needs. The children have a wide range of disabilities including cerebral palsy, dyslexia, dyspraxia, ADHD, SLD, MLD, 3
Asperger syndrome, Autism and behavioural difficulties. As part of my role I assess children and devise and instigate appropriate IEP targets to meet the objectives outlined in the children‟s Statements in association with class teachers, teaching assistants, other professionals and parents.
Over the last three years, the number of children in my caseload and supported by the service as a whole, diagnosed with Autism, Asperger syndrome and other ASD‟s including semantic pragmatics appears to have increased. No two have been alike but all have displayed some degree of challenging behaviour from simple obsessions to biting, hitting, screaming for no apparent reas on or simply reliving scenes from a movie, word perfect. whilst completing other work.
The child I have chosen for this assignment is one from my caseload who has as one of the objectives on his Statement of Special Educational Needs; To help Mark develop appropriate strategies to control anger and frustration in most settings and to return to a calm state as quickly as possible.
Before embarking on my case study I will consider some of the information provided by individual authors relating to communication, autism and challenging behaviour. I will look at how an understanding of communicational difficulties relating to autism may have a bearing on what is perceived as challenging behaviour or is it behaviour that can be manipulated to benefit the instigator if correctly interpreted through proper observational techniques and the implementing of appropriate strategies.
Literature Review “Difficult or challenging behaviour is not a part of an autistic spectrum disorder, but it is a common reaction of pupils with these disorders, faced with a confusing world and with limited abilities to communicate their frustrations or control other people.” (Jordan and Jones 1998)
The Triad of Impairments identified by Lorna Wing and Judith Gould in 1979 (cited Cumine et al 2000) out lined the components identified with autism as being a co-occurrence of the impairment of social interaction, social communication and social imagination and flexibility of thought. A
communication deficit, irrespective of input by speech therapy programmes to develop receptive and expressive language skills, appears to remain central to the disorder (Howlins 1998) and is a major factor in understanding why an Individual with an ASD displays challenging behaviour.
In all the literature I have read, the words „challenging behaviour‟ and „communication‟ difficulties seem to run together (Clements and Zarkowska 2000, Cumine et al 2000, Howlin 1998, Jordan and Powell 1999, O‟Brien
1998, Smith Myles and Simpson 1998, Waterhouse 2000,). Whether it is an inability to process the verbal and non-verbal information given or an inability on the individual‟s part with an ASD to verbalise their needs or frustrations, both play an important part in the resulting challenging behaviour displayed.
Before being able to address challenging behaviour there is a need to identify and observe behaviour patterns taking note of specific details and behaviours. When they occur, how often they occur, what level of communication is adopted and the resulting outcome-i.e. the challenging behaviour displayed
and how it is dealt with. Different methods of recording observations include ABC—Antecedent, Behaviour Consequence (Cumines et al 2000) STAR— Settings, Triggers, Actions, Results (Zarkowska and Clements 1994) TOAD— Talking out of turn, Out of seat behaviour, Attention seeking ,Disruptive behaviour (Wragg 1994. cited O‟Brien 1998). Observation encourages the
observer to be analytical and reflective about everything they do, how they do it and note everything they say and how they say it, the manner of their voice, the words used (O‟Brien 1998). Whichever method of recording is used, the outcome of the resulting analysis should lead to implementation of appropriate strategies to help with the individuals challenging behaviour.
Most of the publications identify the need to educate the carers and professionals dealing with ASD in how to communicate effectively with their charges (Howlin 1998, Jordan and Jones 1999).
It is important for carers to understand a child‟s literal interpretation of language and their difficulties with abstract and metaphorical concepts. They must be aware of what they are saying so that they are not surprised by the resulting challenging behaviour—e.g. “That wasn‟t a bad lesson.” The meaning implied by the teacher being that everything had gone well and that she was pleased with the child‟s contribution. To the child, the word bad is paramount and has a totally different meaning to the one the teacher intended resulting in confusion and frustration and a possible display of unacceptable behaviour. Likewise, literal interpretation of a seemingly innocent expression—e.g. “I‟m keeping my eye on you.” or “Come on, pull yourself together.” can produce anxiety and lead to an outburst of challenging behaviour. 6
There is a need to ensure carers and professionals are consistent in giving simple and concise instructions, in most cases using the child‟s name so they are aware the instructions include them. Metaphors, colloquialisms and slang are difficult for the child with an ASD to understand. In some displays of
challenging behaviour the individual with ASD can resort to shouting, screaming, hitting, pinching or kicking. It is important that staff work together and are consistent with the language they use to address any outburst of challenging behaviour within the classroom, including normal verbal and nonverbal language.
Consequences, Choices, Strategies, Simulation (Smith Myles and Simpson 1998) have been proven to help with social interaction of children with ASD. All of these depend on having adults structure their behaviour through stories, pictures or role play and using effective communication skills verbal or nonverbal to improve what was a difficult situation/concept for the child to understand. The repetition of the stories and the sameness being of Once a difficult situation has been
paramount importance to the child.
identified, social stories can be developed to explain and show the child how to behave next time to attempt to alleviate the challenging behaviour displayed. It is important that the stories are not presented when the challenging behaviour is occurring. The child needs to be reminded of the situation at calm moments of the day (Attwood 1998, Clements and Zarkowska 2000, Gray 1995 cited Howlin 1998).
For the child with an ASD a failure to develop the in-built mechanism, apparent in most children, of communication in general and verbal language results in an inability to function as well as others. It may present itself as a complete failure to learn to speak or use gestures or alternatively as an acquisition of words or gestures/signs but not used in a communicative way. For some children this can lead to displays of what others may see as challenging behaviour (Clements and Zarkowska 2000).
Although some children with ASD are non-verbal, this does not mean they are non-communicative. Communication for a child with autism may present itself in many different ways. Many attempts to communicate may be construed as behavioural problems and may not always be socially acceptable and what they are attempting to communicate may prove difficult to determine.
“If a child in the classroom pulls his neighbours hair, he is almost certainly communicating something: it may be that he is bored agitated or distressed; that he is ill or in pain; that he dislikes the child involved; that the work he has been given is too difficult; that he has been bullied in the playground; that his morning routine has been upset before he left for school; that his parents are always fighting, or that his father has just left home.” (Howlin 1998) p.107
By using the schedule developed by Schuler and her colleagues (1989) (cited Howlin 1998) to obtain a profile of a child‟s communicative attempts, an indicator of what could be termed challenging behaviour may indicate important communication functions involving verbal and non-verbal responses. The completed schedule shows a range of communicative means and functions.
The introduction of the Picture Exchange Communication System (PECS) or the Treatment and Education of Autistic and related Communication Handicapped Children (TEACCH) programme for a non-verbal or verbal child with an ASD can assist communication and help alleviate some of the possible frustrations associated with challenging behaviour (Clements and Zarkowska 2000, Cumine at al 2000, Jordan and Jones1999, Jordan and Powell 1998, Powell and Jordan 1997,). PECS provides a tool for early communication by offering an opportunity to quickly develop „real spontaneous communication‟ (Cumine et al 2000, Jordan and Jones 1999). TEACCH helps to introduce routine and stability to what can be, for many children with an ASD with hyper sense sensitivity, a very confusing and over stimulating classroom situation (Cumine et al 2000). It sets out to provide visual information, structure and predictability.
“—teaching non-verbal individuals appropriate ways of conveying communicative intent is effective in reducing problem behaviours. --appropriate behaviours that meet the same communicative need (functionally, equivalent responses) can be taught to replace the undesired behaviour.” (Koegel and Koegel 1998) p.18
Input from a Speech Therapist to develop receptive and expressive language and thus aid communication is also discussed (Waterhouse 2000). Without intervention some children with an ASD may only infrequently use language and may never learn the variety of functions of utterances necessary for communicative competence (Koegel and Koegel 1998).
For many children, working in a relaxed and secure 1 to 1 situation using play and music therapy to learn useful words and be able to express himself more clearly is advantageous. Unfortunately this is not always the case and unless a planned therapeutic programme taking account of the needs of the child— auditory problems, literalness, processing difficulties etc. is undertaken, the situation can be stressful and produce its own challenging behaviour (Waterhouse 2000). Correctly formulated speech and language programmes can be helpful for improving comprehension, increasing the complexity of speech, enhancing social communication skills or correcting problems of intonation or articulation (Howlin 1998).
The child I have chosen for this study is called Mark. He is eight years old and has a twelve-year-old sister. He comes from a middleclass family, his father is employed and his mother has recently returned to work. They live in a fairly large village and Mark attends the local Primary school that his sister attended before moving to the local Secondary school.
From a very early age, Mark‟s mother was very concerned about his development and noted particular behavioural characteristics. Consequently she consulted her G.P. who referred her to the Child Development Centre (CDC). By the time Mark was admitted to the Nursery, his mother was very concerned about his behaviour particularly his interaction with other children and his outbursts and tantrums which seemed to be occurring for no apparent reason. She had also noted his inability to accept changes to his routine or his environment.
With all the information from parents and other professionals at CDC, Mark was diagnosed with having an Autistic Spectrum Disorder, which was eventually defined as Asperger Syndrome on his Statement of Special Educational Needs.
Whilst in the Nursery, Mark received extra help from a Speech Therapist and an Early Years Specialist teacher (EYS). The Speech Therapist provided
programmes of work to help with his receptive and expressive language skills. 11
His Early Years Specialist teacher provided programmes of work to help him integrate into the Nursery school environment. Mark also had a Teaching
Assistant assigned to him to ensure other children were „safe‟ from his sudden outburst, to ensure he was accessing some of the Nursery curriculum and to help deliver the programmes of work set out by the Speech Therapist and EYS teacher.
When Mark moved through into the Reception class in the main school, he was allocated fulltime teaching assistant (TA) support so that not only class time was monitored but also playtime and dinnertime. Both play time and
dinnertime proved to be very problematic as Mark did not understand the „rules‟ of playing. He did not understand why hitting and kicking were not acceptable and often felt persecuted by other children‟s actions towards him no matter how harmless they may have been. Mark became more isolated at playtime as the other children refused to include him in their games because they did not know how to deal with his challenging behaviour. His poor communication skills limit his understanding of what is expected of him in play situations. Mark had, on many occasions, to be withdrawn from the playground to „play‟ with his TA on a time out basis.
Whilst Mark was in Year 2 TEACCH had been used to structure his day. The TEACCH programme was discontinued when Mark moved classes at the beginning of this school year. It was felt that as he was moving from Infants to Juniors TEACCH was no longer appropriate. Also his Year 3 teacher had had no training how to use TEACCH and was not comfortable about delivering it successfully. 12
Mark is able to hold a conversation with adults and his peers but he does not necessarily take notice of what the other person is saying. As a result of his interest/obsession with road signs, he guides the conversation on to this topic regardless of what the main topic may be.
Mark is able to read and is learning to spell by looking at the whole word. He finds writing difficult but if in a good mood will attempt one sentence with help. He can count and writes all the digits correctly but expresses a fear of numbers, which is hindering his progress in Mathematics.
Mark‟s parents are still very concerned with his temper tantrums and his obvious frustrations when other people cannot understand what he is thinking and don‟t react in a way he sees as appropriate to meeting his needs. In the last year they consulted a specialist to find out if his diet could be altered to help his condition. After a trial period of 6 months when he tried a gluten free diet and various other food abstentions it was decided that food restriction had made no significant difference to Mark. The parents were told he was „just a naughty boy who knew how to manipulate a situation to suit his own needs‟. Subsequently, Mark is now back on a normal diet.
For this assignment, I will observe the challenging behaviour displayed by Mark to find out when it occurs, how often it occurs, if communication problems are involved, what the possible triggers may be and what the outcome is. With
the help of staff in school involved with Mark we will consider possible strategies to help accommodate his frustrations and resulting challenging behaviour and hopefully to enhance his learning.
“If the behaviour is constructing a barrier to learning then we must adopt a rigorous approach to removing the barrier, so that the teacher can focus upon the learning need, rather than the behaviour difficulty.” (0‟Brien 1998). P.75
“ Each person is different and each behaviour needs to be considered in its own right. In addition the reasons behind one behaviour may not be the same as the reasons behind another behaviour which the person shows. A person may shout because this makes others do as he asks. He may hit because this makes others leave him alone. There is therefore a need to build a detailed understanding of why a particular person is engaging in a particular behaviour and why he is likely to engage in that behaviour more under some circumstances than under others.” (Clement and Zarkowska 2000) p.38 To begin to try and understand the reasons behind Mark‟s outbursts and temper tantrums, I decided to adopt the STAR approach to record his behaviour.
The STAR approach
(Zarkowska and Clements 1994) is a means of
observation and recording behaviour under four headings: S representing Settings T representing Triggers A representing Actions R representing Results
Settings—This part is for recording where and when a particular behaviour occurs. Information about the general environment, the room, the
people/children involved, the child‟s well being or mood at the time, whether the action/setting was part of the normal routine and even what the temperature in the room or the weather outside was like immediately prior to the incident (the sound of thunder or rain may be of great significance).
Triggers—In this part, a note of what appears to trigger the particular behaviour is recorded, whether it be sensory overload, a communication
misunderstanding, a particular movement by someone or something or an invasion of personal space.
Actions—Here a recording of the resulting behaviour is made. Considering the nature of the behaviour being observed, this could include such incidences as hitting, pinching, pushing, unnecessary shouting, tears of frustration or anger, agitation, stamping of feet and self harming.
Results—In this part a recording of the actual outcome of the incident is made. This could include total withdrawal from the situation, a time out period, a calming activity or a visit to the head teacher depending on the severity of the incident.
Example of STAR recording format SETTING Hot day, hot in classroom. Class or 30 children. Numeracy hour. TRIGGER Another ACTION child Verbal RESULT to
abuse Removed at
picked up the aimed pencil Mark and children.
TA quiet area to other work 1 to 1.
Carpet time then move to wanted group tables. Question session. Equipment table. in centre of and answer
Throwing offered pencil
As I was not with him every day I enlisted the help of his teaching assistants and class teacher. I also kept his parents informed of what we were intending to do and enlisted their help in keeping a home/school diary whereby they could inform us of any changes that may occur at home that could have a bearing on Mark‟s behaviour in school. They were encouraged to include any observations they noted at home which preceded any tantrums. For Mark‟s benefit, as he liked to know what was being written in his home/school book, as many positive points (if possible) as negative were included.
The TA‟s observed Mark throughout the day in various settings including playtime, dinnertime, free choice activities, assembly time, carpet time, Numeracy and Literacy lessons and the beginning and end of the school day. His class teacher took particular note of any incidence of what she considered to be challenging behaviour during class time.
This observational period was for two weeks although previous incidence of challenging behaviour had been noted and were included if there was enough background information concerning the incident for it to be analysed as part of the overall picture.
Everyone was encouraged to be specific about recording resulting actions, stating exactly what had happened—i.e. not simply to put „had a tantrum‟ but to state Mark‟s precise actions—i.e. stamped his foot, hit another child, flayed his arms around etc.
As this assignment is considering the possible interaction of autism, communication and challenging behaviour, I also asked the TA‟s to try and take particular note of any communication difficulties that may or may not have been apparent at any of the various stages. I was interested to see if any particular words or phrases were significant or if literal interpretation had any bearing on what was happening to trigger behavioural patterns. I was also conscious that Mark‟s receptive, expressive and cognitive skills might have had some bearing on his behaviour. As well as communication skills, other factors that could have had an influence on his behaviour patterns included his general well being, including health and his obsessions, changes to his environment, home/school and possible sensitivities, sensory overload, motivation, level of personal competence and how others respond to him.
“Observation provides us with an insight into the child, the teacher, the learning environment and the intricate and complex interaction between all three.” (O‟Brien 1998) p.76 On completion of the two-week observation period Mark‟s teacher, TA‟s and myself met to analysis our results. Mark‟s parents were also invited to attend the meeting to present any additional information they had noted in Mark‟s behaviour patterns at home.
Firstly we looked at the challenging behaviour that Mark had displayed over the two-week period. This included verbal abuse directed at his TA‟s and He also directed some verbal abuse
individual children in close proximity.
towards himself, calling himself „stupid‟ when being directed to reattempt an incorrect question, Inappropriate shouting and unnecessary moving about including crawling under tables for deliberately dropped pencils was also noted. Pushing children and attempting to interfere with or hurt those who appeared to invade his space was also evident, carpet time and dinnertime being particularly problematic. Mark‟s parents expressed concern about his
behaviour at home when they wanted to go out anywhere. They were also concerned about their inability to reason with him to dilute a stressful situation when Mark‟s challenging behaviour to them included tears, shouting, feet stamping and self harm (biting hand) and an apparent stubborn refusal to accept what they were saying.
Next we looked at the particular triggers that seemed responsible for the resulting behaviours. The most common trigger involving other children
appeared to be with regards to their proximity to him, carpet time, assembly time and dinnertime being of particular note. Changes to normal school routines and his classroom environment were also significant.
Shouting out was usually preceded by Mark not being picked to answer a question. Verbal abuse initially appeared to have no set triggers but after
discussion a variety of triggers were highlighted mostly concerning some aspect of communication breakdown. It seemed Mark was not interpreting that instructions directed at the class included him, but was picking up on words such as „free choice‟ (when work was completed) or „drawing a picture‟ (reward for good work) to mean that was the prime objective of the lesson and to be done first. The verbal abuse invariably occurred when the actual work was presented for him to complete.
With regards to the behaviour Mark‟s parents were concerned about at home, the triggers appeared to relate to some form of communication problem. Getting into the car, other than first thing Monday to Friday when he knew he was going to school, without a visual or verbal itinerary of what was happening, where he was going and when the trip out would end seemed to be the main problem with going out.
The trigger for his self harm, tears, foot stamping and shouting when they tried to reason with him appeared to be their inability to accept that Mark would not „conform to the norm‟ and did not perceive things in the same way as the vast majority of the population. They still find this very difficult to understand and
expect Mark to „grow out of it‟. The removal of or the restriction of his obsession (road signs) also worked as a trigger for his „tantrums‟.
We then considered the settings, the environment and people/children involved prior to the triggers and resulting actions. Carpet time, dinnertime,
Mathematics and assembly time dominated the incidents of challenging behaviour. The beginning and end of the school day appeared to be incident free as a set routine was already established with Mum and Mark being met by TA in the morning, home/school book exchanged and the opposite happening at the end of the day with TA and Mark being met by Mum.
Finally we considered the results of the incidents of challenging behaviour. The result in the vast number of cases was for Mark to be withdrawn to work 1 to 1 with his TA, usually within a designated part of the classroom for the duration of the lesson. Mark normally worked quite well 1 to 1 enjoying the undivided attention of his TA. When Mark was being particularly loud or
physical and disrupting the entire class with his behaviour, he was taken into the library to work.
Mark‟s parents stated that at home they tried various methods to defuse the incidence of challenging behaviour either by sending Mark to his bedroom to calm down or refusing to acknowledge him when he shouted and stamped about when they realised reasoning techniques were not working. If out
shopping, they tended to buy him what he wanted to „shut him up‟ because of the embarrassment of having other people looking at him and them and not understanding what was happening. 21
We also looked at the frequency and timing of the incidents of challenging behaviour over the two week period. There appeared to be no set pattern and that they could happen at any time. No particular single day of the week stood out above the rest as being most problematic.
“Joint planning between parents, teaching and support staff and other involved practitioners is important in tackling behavioural challenges.” (Cumine et al 2000) p.90 To begin to set up suitable strategies to deal with Mark‟s challenging behaviour, we realised we would need to prioritise what we considered to be the most important factor from our observations to address first.
A lot of the incidents of challenging behaviour appeared to be occurring at carpet time, i.e. a time when all the children in the class sat together, in close proximity, on the floor, near the teacher. We decided this would be our starting point. As Mark seemed to be displaying some characteristics of Tactile
Defence Syndrome (TDS), an inability to tolerate the closeness of others, our first priority was to establish a recognised position for Mark to sit that he and the rest of the class were aware of. In his previous class Mark had used a carpet square as his marker. We decided to reintroduce this.
Our next objective was to ensure that Mark did not interfere with those closest to him; therefore we needed to keep his hands occupied. We also needed to address the problem of him shouting out inappropriate, unrelated answers to questions and the behaviours he displayed when he was not picked to answer a question. Plus we wanted him to be more focused to what the teacher was saying.
To do this we provided all the children with a white board.
They were all
encouraged to write down answers to questions (irrespective of spelling errors)
so that even if he was not picked Mark could still share his answer with class teacher or TA.
For carpet times involving the reading of stories or relating of information, Mark was given a list of up to 6 words/pictures (pre-arranged between teacher and TA) to listen for and mark off when heard. In an attempt to make this more meaningful for Mark, Social Stories using words and pictures outlining what was expected of him at carpet time were introduced prior to the onset of the white board and key word strategy and revisited at least once per week as a reminder.
To address the occurrences of challenging behaviour at non specific times during the course of lessons when Mark would attempt to interfere with other children and to give focus and structure to his lessons, we decided to reintroduce TEACCH. We felt Mark needed to have a visual timetable of events for each lesson, a beginning and more importantly an ending with opportunity for a reward system involving his „road signs‟. An area of the classroom was set out as Mark‟s working area to work 1 to 1 with TA or specialist teacher when not working within a group.
As Mark is aware of his feelings and often very remorseful after incidents of challenging behaviour, a system of „Time-out‟ was introduced involving picture cards of facial expressions. If Mark felt he was becoming too stressed by a situation he could give his teacher a „stressed face‟ card and take two minutes time out on his own to calm down and then return to his work. If he felt
pressured he could present an „upset face‟, if feeling anger towards another 24
child or his TA an „angry face‟ was used. Alternatively his TA or teacher could give him the card to take „time out‟. So as not to abuse the system a limit was set on the number of time outs Mark could opt to take in a day. To ensure there was meaning to the „time out‟ strategy, Mark‟s TA talked through the incidents with him as soon as he had calmed down and if appropriate, particularly with „anger‟ situations provided Social Stories to help Mark with the situations if they occurred again.
We also needed to address the language we were using to ensure we were not giving crossed messages to Mark. To deal with any out of seat behaviour , verbal abuse and shouting, the word „stop‟ plus a hand gesture would be used followed by specific positive instructions. We made a conscientious attempt to ensure we used Mark‟s name when giving instructions and did not use language that could be taken too literally.
In order to address the problems Mark‟s parents were experiencing with regards to going out, it was suggested they used a visual itinerary of the impending journey ensuring discussion could take place before Mark was asked to get into the car. They were also encouraged to use Mark‟s road sign obsession when out in the car.
Finally we considered the outcome of all the displays of challenging behaviour and how we could best address Mark‟s needs by not always punishing him but „listen‟ to what his behaviour was trying to convey. Everyone agreed that if Mark‟s challenging behaviour threatened to be harmful to other children he should be withdrawn to his designated area in class or if really bad removed to 25
the library to work 1 to 1. We did not want Mark to see this as a reward for his behaviour; therefore as soon as he calmed down he would be returned to the classroom. Also we did not want the onus of dealing with his behaviour to fall to his TA.
Our aim was to keep Mark focussed in class, to be less distracted and hopefully spend more time in class with his peers rather than withdrawn to work 1 to 1.
Evaluation of Strategies
After approximately six weeks the class teacher, TA‟s parents and I met to discuss the effectiveness of the strategies we had been working on with Mark. As we had decided at the onset to look at the „whole‟ child and not just one specific behaviour, the strategies needed to have worked together to begin to produce the results we were hoping for—i.e. a reduction in all types of challenging behaviour.
The strategies we implemented for carpet time produced some improvements in Mark‟s behaviour. As he has a designated carpet square that other children know they must leave a space round, he has had less opportunity to interfere with them. Unfortunately, he finds the carpet square interesting and has taken to rolling up the corner when he does not have the white board or list of key words to listen for. Using the white board has not lessened his shouting out so far but his shouting has been to let the class teacher know he has written something down, usually an appropriate answer to the question particularly in Mathematics. The list of key words to listen for is requiring lots of prompting from his TA and so far we are not achieving our aim of him being more focussed to class teacher.
The re-introduction of TEACCH showed an immediate improvement in Mark‟s behaviour over the course of a lesson. The number of incidents of verbal and physical abuse directed at TA‟s and children lessened with the use of a visual timetable, verbal input specifically directed at Mark and having a designated area identified for Mark to work 1 to1 in class with all the equipment he needed
at his work station. The problems reoccur when integration into his group takes place, as he still likes to have control of the equipment on the table.
Dinnertime has shown an improvement. Being able to sit at the same table every day is obviously important to Mark. The problems with regards to
integrating with other children during the playtimes have still to be addressed.
Social Stories and the Time-out strategies have been particularly important in dealing with Mark‟s challenging behaviour. During the first week of
implementing the strategies, class teacher, myself and the TA‟s in particular gave extra time to talking through Social Stories with Mark for carpet time, dinner time, play time, lesson time, Time-out strategy and also listening to his responses. We involved Mark in writing some of his own Social Stories with words and pictures and encouraged him to talk about stressful situations in class and how to deal with them. The Time-out strategy helped Mark to begin to think about how he felt. Through facial expression pictures he could indicate to us how angry or stressed he felt and how his mood changed as he calmed down.
Mark does attempt to abuse the system of Time-outs, wanting to opt out of lessons he finds difficult. He is being restricted to a maximum of three time outs of his own choosing in the morning and three in the afternoon. A reward system has been introduced for good behaviour when Mark has worked through a lesson without having to take more than one Time-out. As we are still in the early stages of implementing the strategy and his challenging behaviours are still very much in evidence, this is at times difficult to maintain. 28
Mark‟s parents have been using a visual/verbal itinerary for taking him out in the car. They admit they have not always found time to do this but on the occasions when they have Mark has at least started the journey calmly.
The main problem I have had with implementing these strategies is that it has been started in the Summer term when lots of alterations to the school timetable have taken place—sports practice, sports day, trips out. Also I have only been able to implement the strategies for 6 weeks. To gain any insight into their viability and to make any alterations or modifications, the strategies need to be continued and monitored for much longer.
I would use the STAR approach again and in the case of this child ensure TEACCH, Social Stories and input on receptive and expressive language be incorporated into his timetable.
I feel that communication and challenging behaviour are very closely linked and without our having taken time to talk to Mark and listen to his responses verbal and non-verbal we would not have been able to begin to address his challenging behaviours.
“Most behaviours, whether identified by others as problematic or not, are meaningful. They are about meeting needs and wants.” (Clements and Zarkowska 2000) p.36
A child with an ASD sees the world in a different way to the rest of society, but they have similar needs and wants as others. As a result of their brain function they are not always able to convey these needs and wants in what society would term a conventional way, by direct verbal communication. That does not mean they do not communicate.
To communicate is not simply to talk in complete grammatically correct sentences. We use our whole body to communicate, to covey meaning. Our facial expressions, voice intonation, hand and arm gestures, and the way we stand or position our body makes a statement that the vast majority of the population can understand. To most children with an ASD all this is lost, it is not seen, unless it is taught, consequently they often do not know how to communicate or interact with others.
If the attempts a child with an ASD makes to communicate are not recognised because of their unconventional way to communicate, then they are likely to become disheartened and may stop trying to communicate and resort to a more successful way to get their own way.
To some children with an ASD the simplest way to convey their wants or needs is to scream or shout, hit out at others, throw things, bite themselves or others
etc. to get attention. This „challenging behaviour‟ invariably results in them achieving their needs—i.e. being withdrawn from a situation they cannot understand or being given the item they want.
“Even practitioners and researchers who do not speculate on primary causes often refer to the direct correlation between communication and language difficulties and other inappropriate behaviours, such as aggression, self-stimulation, and self injury. This emphasizes the importance of communication intervention as a primary goal in the habilitation process and suggests that many untreated aberrant behaviours are likely to show concomitant positive changes as communication improves.” (Koegel and Koegel 1998) p.17
In all the publications I have read for this assignment, there is evidence presented that emphasises the connection between „challenging behaviour‟ communication and autism. Clement and Zarkowska (2000) in particular
express the importance of an understanding by all adults dealing with a child with an ASD of knowing how to interpret a child‟s needs by the challenging behaviour they display, through constant observations of the individual in order to interpret what they are attempting to communicate.
“Communication is a two way thing “(Waterman 2000). Responsibility is also levelled on the parents, teachers, TA‟s and other professionals dealing with a child with an ASD to use a common „language‟, whatever media form this may take—speech, signing, symbols, using pictures, writing using a keyboard, using other electronic aids—when working or playing with the child and to have specific strategies to deal with the challenging behaviour. Unless the strategies are agreed on and implemented by all they are not viable and the challenging behaviour will not begin to diminish.
The child I chose for my case study has begun to respond to the behavioural strategies put in place. As changes to behaviour is usually a long term
prospect, a half termly review will continue throughout the remaining time in his present Primary school and modifications made as necessary. Language
strategies and improved communication, I feel, have begun to address this child‟s „challenging behaviour‟ and has improved his learning and interaction with other children in his peer group.
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