Understanding and Managing the Challenging Behavior of People with Autistic Spectrum Disorders - Literature review Example

Understanding and managing the challenging behaviour of people with autistic spectrum disorders: Why might someone with autism demonstrate challenging behaviour and what could we do about it? Autistic spectrum disorders (ASD) affect childrens verbal and non-verbal communication, their social behaviour and understanding and their sensory perception (Teachernet, 2009). Often children with an autistic spectrum disorder demonstrate challenging behaviour, especially in an educational setting and this will be the focus of the essay. The key questions to be addressed are how do we define challenging behaviour, why do children with ASD resort to this type of behaviour and how can we manage and prevent it? To begin, defining challenging behaviour is problematic because it is a subjective term; what one person believes is challenging behaviour may not be considered to be so by somebody else. Therefore there are a range of factors which contribute to creating a definition of challenging behaviour and these are important to consider (Clements & Zarkowska, 2000, pp. 32-33). Firstly, there is the issue of personal tolerance. One person may be able to “block out” something like continual screaming, whereas another person may find this unbearable. In addition, personal tolerance levels might be affected by a persons mood, physical health or stress. Secondly, our personal standards of what constitutes acceptable behaviour will impact on a definition a challenging behaviour. It is also important to remember that it is not unique to children or people with ASD, anybody can exhibit challenging behaviour (Clements & Zarkowska, 2000, pp. 32-33, 45, 47). There have been many different definitions of challenging behaviour offered by academics. One way to define it is as “behaviour that challenges – whether it is to our understanding, our own well-being or our childs, or else our responsibilities as parents or professionals” (Whittaker, 2001, p. 4). The general consensus among academics is that challenging behaviour impacts on the health and safety on the individual and the people around them. It also impacts on the quality of life of both the individual and those around them. Challenging behaviour generally includes elements of “violence, self-injury, destruction, disruption” and “excessive self-stimulation” (Hanbury, 2007, pp. 4-5). Now that we have a definition, the question is why do children or adults with ASD sometimes manifest challenging behaviour? Whitaker argues that ASD “increases the vulnerability to developing behaviour” that can challenge parents, carers or teachers. First of all, one of the main symptoms of ASD is social impairment; sufferers tend to have difficulty in “instinctively sensing, understanding and caring about” the feelings and intentions of other people. This “mindblindedness” can therefore easily create tension, conflict or misunderstanding of a particular person or social situation (Whitaker, 2001, pp. 5-6). Communication problems are also a main feature of ASD and, as with social impairment, can create a whole host of problems for the sufferer. Although the range and severity of problems varies from person to person, verbal and non-verbal communicative problems are generally present. This is commonly manifested when an ASD sufferer tries to communicate a need or desire, or in making conversation with a non-sufferer. It is also quite common for a person with ASD to have trouble understanding the use of a figure of speech or grasping the true meaning of another persons sentences (Whitaker, 2001, pp. 7-8). Another area, which can potentially create challenging behaviour, is an ASD sufferers need for routine or “sameness”. The reasoning behind this behaviour is still unclear but could be linked to problems of communication and social interaction. When a person with ASD is unable to predict what is about to happen, anxiety can appear and thus their “rituals and routines” are their way of reducing this feeling and coping with the presence of others around them (Whitaker, 2001, pp. 9-10). It has been estimated that between one half and two-thirds of people with autistic spectrum disorders have learning difficulties. As discussed earlier, social and communicative problems and the need for structure, repetition and routine can potentially create challenging behaviour. In addition, children with ASD tend to have an unusually high sensitivity to sound, sight and textures. This can lead to fascination in a particular object or sound and can negative impact on their ability to pay attention and stay focused in a classroom. It can also create a fear towards a particular object or sound and can have a “dramatic” effect on their behaviour (Whitaker, 2001, pp. 10-11). When these various issues are combined, it is easy to understand why children or adults with ASD can develop or exhibit challenging behaviour. Regardless of ASD, all behaviour is “needs-driven” and understanding the need behind challenging behaviour is crucial to understanding the root cause. Behaviour can be classified into four different areas of need; attention, tangible, escape and sensory. Any one of these needs can create challenging behaviour, from screaming and disruption to grabbing other peoples food or running away (Hanbury, 2007, pp. 14-15). Using these four areas of needs, the Motivation and Assessment Scale, devised by Durand and Cummins (1992), can be used to assess challenging behaviour in ASD sufferers. This scale can be completed by one person or a group who support the behaviour of an individual with ASD. The “respondents are asked to rate sixteen items by selecting from seven possible descriptions of how often the individual would engage in the identified behaviour in a given situation”. After this has been completed, the responses are categorised around the four areas of need, a mean score is then created and the four areas ranked in order. This allows the carer or teacher to see how influential each particular need is and then strategies can be developed to prevent challenging behaviour. The advantage of this scale is the use of objectivity in the needs and behaviour analysis (Hanbury, 2007, pp. 17-18). Another approach which can be used to assess the challenging behaviour of someone with ASD is a subjective one, which involves listening and talking to the “opinions and ideas” of the people closely involved with the individual. This provides an “invaluable resources” for understanding challenging behaviour because it utilises the experiences of those directly involved with the children or adult. However, caution should be used to prevent ideas and opinions about prevention which have no grounding in fact or are ill-informed (Hanbury, 2007, p. 19). Another tool for assessment is the Autism Behaviour Checklist, or ABC. This was designed and published in 1980 as part of the broader tool, the Autism Screening Instrument for Educational Planning. The ABC is designed to be completed by an individual, such as a parent or teacher, and is then returned to a “trained professional for scoring and interpretation.” The ABC has a total of 57 questions split into five categories; sensory, relating, body and object use, language, and social and self-help. It has been used with children as young as three years old (Clinical Practice Guideline, 2005). Now that some of the assessments have been discussed, what strategies can be used to limit and prevent challenging behaviour? There are many possible strategies which could be used with ASD and the essay will now outline and assess several of them. Dodd has outlined some basic principles which, she argues, must underpin a behaviour support program to maximise its effectiveness in ASD. The program must have a clear message, be consistent, encourage participation and provide clear messages. It must also use visual supports, provide positive reinforcements, plan for success, and choose priorities. Dodd also stresses the importance of identifying the underlying causes in episodes of challenging behaviour. When a good understanding of causation has been achieved, parents, carers or teachers will be able to “see a pattern that helps identify common elements (Dodd, 2005, pp. 199-200). Whitaker has designed the Eight Step Plan to promote positive behaviour in sufferers of ASD. It is based on what is usually termed the “behavioural approach” to challenging behaviour. The plan also has similarities to the STAR program, which will now discussed. (Whitaker, 2001, p. 17). This plan is a “comprehensive behavioural program” designed for children with autism. (STAR Autism Support). The STAR model aims to understand the Setting, Triggers, Actions and Results of challenging behaviour. With “careful thought and observation” the STAR plan can “change and control” challenging behaviour (Whitaker, 2001, p. 15). At the centre of this approach is the importance of “gathering factual information.” It also allows the parent or carer to consider other factors which influence the behaviour of a child with ASD (Plimley & Bowen, 2007, p. 36). Whitakers Eight Step Plan incorporates the four principles of the STAR program but adds four additional ones. It is based on the principle of “organising thoughts and observations systematically”, to understand and make sense of the childs behaviour in terms of what it achieves for them. In addition, it focuses on prevention and develops an action plan based on the thoughts and experiences of the parent or teacher (Whitaker, 2001, p. 15). Whitaker emphasises that preventing challenging behaviour relies on the parent or carer having a clear idea of acceptable, good behaviour. A child with ASD often has difficulty in understanding what is expected of them and so the way the message is communicated is extremely important (Whitaker, 2001, pp. 15-16). Plimley and Bowen remind us that challenging behaviour is “not simple or speedy to change,” and that reactions which only address the behaviour should be short-term (2007, p. 37). As Dickinson and Hannah point out, patience is vital as a behaviour programme could take up to six weeks to show visible results (1998, p. 7). Understanding the underlying reasons for challenging behaviour is central and could be something as simple as illness, diet or poor sleeping pattern. Another important tool is to teach children or adults with ASD ways to effectively calm themselves down, such as counting to 10 or using stress balls (Plimley & Bowen, 2007, pp. 37-38). To conclude, this essay began with the complexities of defining the subjective term challenging behaviour. It has also emphasised the importance of understanding all behaviour as needs-driven, and how the symptoms of ASD, such as communication problems and social impairment, have created tension and anxiety for the sufferer. It has also looked at some of the different methods to assess a sufferers challenging behaviour, such as the ABC, which uses the experiences and observations of parents, carers or teachers. Finally, this essay has considered different strategies in controlling episodes of challenging behaviour, such as the STAR model and the Eight Point Plan. This has shown that patience and understanding are crucial to any ASD behaviour program. Finally, it is only by understanding the needs of ASD sufferers that challenging behaviour can be limited and that consistency and patience are the key. References Bowen, Maggie., & Plimley, Lynne. 2007. Social Skills and Autistic Spectrum Disorders. London: SAGE Publications. Clements, John. & Zarkowska, Ewa. 2000. Behavioural Concerns and Autistic Spectrum Disorders: Explanations and Strategies for Change. London: Jessica Kingsley Publishers. Clinical Practice Guideline. 2005. Autism/Pervasive Developmental Disorders: Assessment and Intervention for Young Children (Age 0-3 years). Department of Health, New York State. http://www.health.state.ny.us/community/infants_children/early_intervention/disorders/autism/index.htm#Table_of_Contents, Accessed 9th April 2010. Dickinson, Paul. & Hannah, Liz. 1998. It Can Get Better: Dealing With Common Behaivour Problems In Young Autistic Children: A Guide For Parents and Carers. London: National Autistic Society. Dodd, Susan. 2005. Understanding Autism. Marrickville: Elsevier. Hanbury, Martin. 2007. Positive Behaviour Strategies to Support Children and Young People with Autism. London: Sage Publications. STAR Autism Support. 2008. STAR Program Research. http://www.starautismprogram.com/research-0, Accessed 9th April 2010. Teachernet. 2009. Autistic Spectrum Disorders. Department for Children, Schools and Families. http://www.teachernet.gov.uk/wholeschool/sen/asds/, accessed 9th April 2010. Whitaker, Philip. 2001. Challenging Behaviour and Autism. Making Sense – Making Progress. London: National Autistic Society. Read More