Addressing Aggressive Behaviors in Children

Aggressive behavior is something that parents of children with autism or emotional disabilities are often confronted with on a regular basis. It can be a challenging, frustrating and emotionally draining experience. Through the support of a professional behavior analyst and consistent practices, parents, teachers, and caregivers can address aggressive behaviors in children and adolescents so that they can live productive and independent lives.

Many times when caregivers are faced with aggressive behavior, their impulse is to want to stop the behavior, and they may view the child as misbehaving. However, it’s important to understand that aggressive behavior is sending us a message. Every behavior serves a function— such as making a request, avoiding something, escaping a task or seeking attention. The same is true of aggression. For individuals with limited communication skills, aggressive behaviors can become inadvertently shaped by caretakers and others in their environment.

For example, a child throws a tantrum to gain access to candy. The parent gives the child candy to stop the tantrum. If this interaction repeats itself, the behaviors become reinforced and the child learns that tantruming is rewarded with access to the desired food. Next time, the parent may decide they are not going to give the child candy and so the child tantrums even louder and harder. If the parent gives the child candy, the parent has inadvertently reinforced the behavior. As parents, we all do this in very subtle ways regardless of whether our child has special needs or not, often without realizing that we are shaping our children’s behavior and strengthening the behaviors that are unwanted.

When children are small, it can be less of an issue for parents to manage aggression, or they may think that their child will grow out of it. It is easier to restrain young kids to combat and control outbursts, but if these are the only methods we use, we are not setting our teenagers up for success. It is important to understand why our kids are acting out and what they are trying to communicate. Once we know the “what” and the “why”, we can teach more appropriate means of communication to replace the need for aggression (such as making a verbal request and teaching the child to tolerate “no” when the answer is “no”). If the aggressive behaviors are not replaced by more appropriate functional behaviors, then we run the risk of shaping adolescent aggression which can include physical violence that is more serious and tougher to overcome.

If your child is demonstrating aggression, the best place to start is an assessment of his behavior to understand why the behaviors are occurring. A good assessment will tell you what the function of the behavior is, meaning— why he is acting out and what he is trying to communicate. Then a plan can be put in place to teach new methods for communicating effectively as well as reducing and eliminating the aggression using behavioral strategies.

Here are a few strategies you can use before aggressive episodes start:

  1. Give up some control over the environment or routines by offering choices; it does not matter if he brushes his teeth before changing clothes, but if having control over that routine helps keep your child’s aggression down, give up that control and let him choose. Providing choice also teaches independent thinking and problem solving which are critical skills for adult life.
  2. Prime your child by giving them a verbal “heads up” of what is coming: describe to your child when and what the expectations are for that setting.
  3. Use visual support like a picture board or a photo to help provide clear expectations for each activity or different parts of the day.
  4. Prompt and model the behavior you want to see instead of the aggressive behavior.
  5. Praise that behavior when you do see it so that it will continue to be a part of their repertoire. Remember if you like something you need to let your child know. In other words, catch them being good and if you like a behavior, reinforce it!

In the moment of the aggressive behavior, safety is most important! Do your best to keep yourself and your child safe. If you can redirect your child onto something else or an activity, that might be necessary.

Some parents of adolescents who display aggressive behaviors worry that it is too late for their child to have a fulfilling and independent life. On the contrary, it is never too late to start planning on a future for your child and working towards attainable goals. Think about what you want your child to be doing in a year from now and start working towards that today. If you want your child to ask for the desired item or preferred activity instead of tantruming to get it, start taking small steps now. If you are hoping they will have more friends in a year, start exposing your child to those opportunities and teaching the socially appropriate skills that will afford those opportunities. If you want them to have fewer aggressive behaviors, do not wait a year to start working to improve that behavior. It is never too late or too early to start working towards next year. The results will support your child in having their needs met and experiencing greater success at each stage of development. The ultimate goal is setting your child up for success and helping him achieve as much independence as possible.

-Richie Ploesch, M.A., BCBA, and Ronit Molko, Ph.D., BCBA-D

The Benefits of ABA in Dual Environments

When a child is diagnosed with autism, parents become charged with finding quality treatment – and the evidence-based recommendation is to seek out Applied Behavior Analysis (ABA).  Choosing the specific ABA program that is right for a child can feel daunting, especially if ABA is new territory for a family.  In this article, we look at the benefits of a program incorporating both in-home and center-based programs.

Many proponents of ABA like to state, “ABA can be done anywhere.” It is true – but we shouldn’t overlook another important point: the environment itself is a critical component of therapy.  Controlling the environment to some degree is frequently part of the teaching process.  Selecting a teaching environment is a decision that impacts the rest of the teaching strategy and so also has an effect on progress.

Common teaching environments for young children with autism include center-based ABA therapy, private or public school, a childcare environment, and home programs.   While there is not enough research to prescribe a particular environment or model generally for children with autism, many parents and professionals are finding that a multi-site model of a controlled environment (such as a center-based program) and a natural environment (home, childcare, school) provides the best of both worlds.

Benefit #1 – Social skills can be targeted consistently and with children in the child’s community.

It is necessary for peers to be available regularly for consistent teaching; in this respect, a clinic setting is ideal for having regular access to other children to practice target skills.  Ultimately, the goal is for the child to interact with the other children in their community, their siblings, classmates, and neighbors.  Having a regular home component allows the therapist to work on target skills with the people who will be important in their normal daily life, even if these opportunities aren’t as regular as those in a clinic setting.

Benefit #2 – Controlled Environment vs. Natural Environment: Best of both worlds

A multi-site model allows technicians to address the most challenging skills in a distraction-free environment, but still have access to the home or school setting, with all of its naturally-occurring distractions, to make sure that those learned skills are being put to use.

Benefit #3 – Consistency of the Behavior Plan

When a challenging behavior is treated differently across settings, it is more likely to persist; this set-up can even make the behavior worse in the long-run.  The best treatment involves the same plan being followed across the day.  Having professionals use a consistent plan in both the home and center environments also supports family members to do the same.

Benefit #4 – Assessment of Generalization

All programs must address the issue of generalization, but a multi-site model is tailor-made for this.  Generalization can be specifically addressed right from the beginning, either by teaching in both environments, or by teaching in one place and testing generalization in the other.

Benefit #5 – Ease of Group Work Vs. Ease of Parent Training – You Get Both!

One of the most important aspects of the teaching environment is the people present.  In a center-based program, other children are close at hand for social interactions, peer modeling, and working on group instruction, so these parts of therapy can happen regularly.  When ABA sessions are at home, it can be more convenient for parents to make themselves available for training.  In a multi-site model, the child benefits from both of these types of teaching opportunities.

Whichever provider a family selects, they should be sure to work closely with their team to personalize the child’s program to best meet their needs and the goals for their family.

– Richie Ploesch, M.A., BCBA & Katherine Johnson, BCBA

Prevalence of Autism Spectrum Disorder – What you should know

On April 27, 2018, the Centers for Disease Control and Prevention (CDC) released a new report on the prevalence of autism spectrum disorder (ASD) in the United States. The prevalence estimates show an increase from 1 in 68 children from the previous report in 2016 (Christensen, Baio, Van Naarden, Braun, et al., 2016) to 1 in 59 children in the current report.  The CDC established the Autism and Developmental Disabilities Monitoring Network (ADDM) in 2000 to provide prevalence estimates of children diagnosed with ASD.  ADDM releases surveillance data every two years.  The data for the current surveillance were collected at sites in 11 different states using health and educational records of children 8 years of age.

The results of the ADDM report suggest the increase in prevalence of ASD may be due, in part, to the identification of ASD in children from diverse racial and ethnic backgrounds.  Previous ADDM reports noted a disparity in the prevalence of ASD with more Caucasian children identified with ASD than black or Hispanic children. The racial, ethnic, and socioeconomic disparities in children diagnosed with ASD has been highlighted in numerous empirical studies (e.g., Durkin, Maenner, Christensen, Daniels, Fitzgerald, Imm, Lee,…Yeargin-Allsopp, 2017; Mandell, Wiggin, Carpenter, Daniels, DiGuiseppi, Durkin,…Kirby, 2009; Tek & Landa, 2012).  Later identification of ASD results in a delay to accessing effective treatment.  Empirical research over the years consistently finds early intervention to be effective at increasing a variety of adaptive skills. It is important to remember that the American Academy of Pediatrics recommends that all children in the U.S. be screened for ASD at 18 and 24 months.

There is no cure for ASD. However, interventions based on the principles of applied behavior analysis (ABA) have been shown to have a beneficial impact on individuals with ASD.  Decades of research indicate that ABA-based interventions can increase communication and adaptive skills and decrease challenging behavior.  Although early intervention is critical, adolescents and adults benefit from ABA-based interventions.  The key is to identify a qualified professional (i.e., Board Certified Behavior Analyst or BCBA) with training and experience working with individuals ASD to work with your family.  A qualified BCBA will be able to develop a well-rounded program to meet the needs of your child and your family.

To access the 2018 ADDM report visit the website https://www.cdc.gov/ncbddd/autism/addm-community-report/index.html

To learn more about the Autism and Developmental Disabilities Monitoring (ADDM) Network visit the website https://www.cdc.gov/ncbddd/autism/addm.html

Reliable resources:

– Dr. Hanna Rue

 

Christensen DL, Baio J, Van Naarden Braun K, et al. Prevalence and characteristics of autism spectrum disorder among children aged 8 years—Autism and Developmental Disabilities Monitoring Network, 11 sites, United States, 2012. MMWR Surveill Summ 2016;65(No. SS-3): 1 -23.

Durkin, M.S., Maenner, M.J., Christensen, D., Daniels, J., Fitzgerald, R., Imm, P., Lee, L.C.,…Yeargin-Allsopp, M. (2017). Autism spectrum disorder among US children (2002-2010): Socioeconomic, racial, and ethnic disparities. American Journal of Public Health, 107, 1818-1826.

Mandell, D.S., Wiggin, L.D., Carpenter, L.A., Daniels J., DiGuiseppi, C., Durkin, M.S., …Kirby, R.S. (2009). Racial/Ethnic disparities in the identification of children with autism spectrum disorders.  American Journal of Public Health, 99, 493-498

Tek, S. & Landa, R.J. (2012) Differences in autism symptoms between minority and non-minority toddlers. Journal of Autism and Developmental Disorders, 42, 1967-1973.

 

What is it About CalABA?

I’ve been thinking about what has my team all abuzz every year leading up to the excitement of going to CalABA.  It always seems to bring about a renewed energy and vigor for seeing clients and finishing those last couple reports.  The idea of taking a break from our typical week to learn more about our science is invigorating for us clinicians.  And the opportunity to see some of the greats in our field share excellent insight and new research, has some of us giddy about soaking up as much as we can.  The likes of Dr. Daniels, Dr. Malott, Dr. LeBlanc, and Dr. Dixon create the SHORT list of invited speakers, and it sparks the enthusiasm we all felt in grad school.  While we won’t buy backstage passes, or wait in line for three days to get their autographs, these names are definitely some of the rock stars of ABA.  The opportunity to see them in person brings a thrill for even the most conservative among us.

But there is more to it than just the fan frenzy.  Yes, getting those CEU’s is always important, but you can get easily get one online these days.  We go to CalABA because we get something more. Community.  It’s that feeling of satisfaction that comes from attending one of the sponsored events and purchasing a glass of wine with your ticket that seem to be worth more than gold.  Its the thousands of pieces of luggage being stored in the lobby because we all checked out at the same time on Saturday to save one extra night’s hotel fee. Its not minding that your flight got delayed (again) because it allows you one more drink with friends I haven’t seen since last year.

CONNECTEDNESS!  I think that is what we get at CalABA that is truly special. The chance to see colleagues and coworkers that have become friends.  The chance to connect with those you haven’t seen in two years because last year you had a baby, or to show those new BCBAs how to scan in and out of each session.  The chance to share stories and laughs with those that truly understand what we all go through and how much we care.

Our field can be isolating at times.  We spend so much time with our clients that it is possible to go long stretches without seeing coworkers.   But something about being at CalABA, just seems to put us all at ease – even when the line at Starbucks is taking forever –  and I’m going to be late to Dr. Bailey’s talk – and I might still need 2 Ethics CEU’s… but I really need a double shot right about now.  There is something about the safety of being surrounded by people that just get my daily struggles and triumphs, and who understand why I might be over the moon excited because a client initiated play with a sibling without a prompt.

I’m looking forward to being connected to everyone yet again.  And while I’m always excited to learn from some of my idols and mentors, I’m equally as excited to hear how your week went.  See you there!

Richie Ploesch