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Monday, August 10, 2009

Ask Amanda ... a student who is under three and displaying aggressive behaviour

Amanda, I have a new student who is two and a half. He is extremely impulsive, he cannot have anyone near him that he is not being aggressive to them, to the point where if I am near and pick him up, touch him or in any way try to talk to or remove him from the situation (hitting repeatedly, punching, pushing etc.) he will with one hand try to stop me while continue to strike out at the child. I think he has some form of spectrum disorder, his other behaviors are what appears to the other adults including his parents to make him 'gifted' his speech is very articulate overly complex sentencing (he is 2) but he repeats everything (very clearly) which I think is echolalia (sp?) not cognitive language use.what can I do to help him stop hurting others.

I am meeting with the parents and right now I will just ask them how he is at home types of questions. I have only had this child for 2 weeks and want to set up a good relationships with them. I have learned to approach with caution when this type of issue arises. Thanks Beth


First I just want to apologise for taking so long to answer this very tricky question. The world has been spinning very fast lately.

But now I have time to sit, think and answer your question.

I can’t suggest a quick fix

This difficulty is not something that can be addressed easily. It will take time and some investment of energy. However, I may be able to suggest some practical things you can do to help improve things over time.

I will also shy away from suggesting a diagnosis etc. That is up to the psychologist, paediatrician or other medical professional.

Step one: Formal Observation

The first thing you may need to do is take a step back and really observe what is happening. It may even be worth getting a third party in, for example another staff member who works in your centre, to watch what is happening.

The purpose of this is to get a better picture of what is going on. It will help unlock some clues to why he may be behaving this way.

Observational tools:
The observations should be written down. This written account should be factual rather than an interpretation of what is happening.

There are many forms of written observations. But you may find a couple of these useful.
Firstly, the simple anecdotal observation (click here or here for more info). That is, the observer watches for a certain time period and records everything that is happening. Not just what the child is doing, but what others around him did and in what setting it occurred.

The second example is an ABC observation.

A= Antecedent: Write down everything that happened before the child began to display the inappropriate behaviour. This includes anything that other children did, what setting they are in, what was said etc.

B= behaviour. Record exactly what the child did.

C= consequences. Record the responses of those around him. That includes the response of the other children, as well as the response of the staff.


What might be the function of his behaviour?

Read this previous post for more information on funcational behaviour assessment. However, the description of the behaviour you have given suggests to me a couple of purposes the child’s behaviour might have. However, these are only guesses as they are not based on full observations as described above.

1. A reaction to proximity
He may have sensory integration issues and subsequently have difficulty sharing space and equipment. He may not be able to endure the proximity of others, and his behaviour is his way of communicating this.

I did read somewhere else that when reprimanded he says he won’t do it again. But if it is due to sensory integration issues, and he has difficulty with social communication, he may not be able to change this behaviour without consistent and explicit support. He will continue to react impulsively in order to protect himself from the intrusion of others.

If this is the reason for his behaviour, removing him from play may seem very unfair to him as he will feel he is being punished for his anxieties or for what other children are doing. And it is unlikely that he will be able to articulate this in any other way than trying to continue lashing out whilst being removed.

What can you do in this instance?
- Set up a safe space that he can retreat to without fear of intrusion. This can be done using a mat, book shelves, cushions or a chair and table. All children should be told that this is a quiet space and only one person can be there at a time. In this space place a couple of the child’s favourite games. But this is only a starting point as you don’t want to always isolate the child from other children.
- Have a routine session every day based on a turn-taking game. This needs to be a quiet, highly structured game where only one child has a turn at a time. Start with just one or two other peers, and sit between them and the child. Let the child pick the children he wants to play with in this session. As the child gets used to this routine you may find that you can start introducing more children and less structured games. But it may take some months before your intervention is not needed.
- Use the child’s echolalic language skills to teach appropriate communication alternatives to his aggression. For example, teach him to say, “Move, please!” using an appropriate hand gesture when children get too close.

This is not a comprehensive list, but it may be a start.

2. A desire for interaction but limited social skills
I have worked with a number of children who have an intense desire to interact with others and play the same games but end up ostracising their peers because they don’t know how to get involved without aggression. There was a boy who wanted to play tips, but kept being isolated by staff because he was running around punching children. It turned out this was his invitation or his request to play tips. When he was taught how to play, and taught specific language to ask others to play, he ended up with a nice little bunch of playmates.

So if this is the case it is again not surprising that the behaviour isn’t changing. He may not be able to identify why it is wrong, or exactly what behaviour you want him to stop. He may also have a sense that is it “not fair” that he is being isolated when other children are playing together - even if he couldn't articulate this.

What can you do in this instance?
It will be about teaching specific social and language skills. Your observations will be able to tell you which skills are most relevant, but here are some ideas.
Language (teach a gesture or makaton sign language to go with this):
- Can I play?
- Can I have a turn?
- That’s mine. You can have it later.
- Can you move, please.
Social skills:
- looking at facial expressions and identifying when others are sad.
- Turn taking
- Sharing space and equipment

How could you teach these?

Social stories:
My book, Dave is Brave, is like a social story. It demonstrates a sequence of events that occur in consequence of aggressive behaviour, with pictures to illustrate facial expressions and emotions of others. It also has key phrases like, “Can I play?” demonstrated as an alternative to aggressive behaviour. (Sorry if this sounds like advertising, but I wrote the book for children with these sorts of issues so you may find it useful)

You could use this, or you could work with the student to design your own short picture sequence. You could do this by taking photos (with parent permission) of a short role play. Two photo sequences could be:
1) photo of him watching others playing
2) photo of him role playing pushing another person
3) photo of another person being sad
4) photo of him sitting by himself, not able to play with others
Second sequence
1) photo of him watching others playing
2) photo of him asking, “Can I play?” with a smile and appropriate gesture
3) photo of another person smiling back
4) photo of him sitting with others, playing together.

You could also look into using PECS such as Boardmaker and those seen on the do2learn website. This will help make language more meaningful for him if he learns well through visuals.


Responding to aggressive incidents

While he is learning these new skills, you will still need to have a way of managing or responding to aggressive incidents.

If you think that his behaviour might be due to sensory integration issues, or a difficulty with the physical proximity of others, you might want to do the following:
- Manoeuvre yourself in between him and the child he is lashing out at.
- Firmly but calmly and gently say, “Stop” with a stop hand sign
- If he doesn’t stop after 2 or 3 requests, point to his quiet space and ask him to take his toy to that space, re-assuring him that he can come back to this play space when he is ready to be settled (choose a word he can understand and use that same word all the time, you may even have a picture of the quiet space and being “settled” to help him understand what you are saying)

As much as possible, avoid physical contact. Try and shepherd him to the quiet space rather than physically move him if possible. You may also find that taking his toy to the quiet space will mean he comes with you.

If you think his behaviour is due to poor social and language skills, follow the same process. But instead of just saying, “Stop” get him to repeat a key phrase such as, “That’s mine.” with appropriate gestures so other children can understand him.


Conclusion:

The bottom line is that anything you do will take time and energy. You and anyone else working with the child will need to be consistent, repeating exactly the same process and exactly the same words every time an aggressive incident occurs. Remaining calm will be very important.

And if one thing doesn’t work after you have given it a good go (eg one month), do another observation and analyse whether you might need to think about the behaviour having a different purpose behind it.

5 comments:

Barbara Winthrop,  August 10, 2009 at 10:42 PM  

Thanks Amanda for posting this response. I am have a special needs daughter who has begun displaying some aggressive tendencies. So I really appreciate information on the subject. She isn't aggressive towards peers as much as toward adults when she is tired or ill. These behaviors seem be escalating and I am looking for methods of changing this behavior before they become ingrained habits. So again thanks for your input.

Amanda August 10, 2009 at 10:46 PM  

Not a problem. I hope you find some good strategies that work for her.

Michael Leventhal August 11, 2009 at 6:08 AM  

I think your explanation of what Beth is facing with her new student is exactly what she and thousands other teachers need right now; a simple, comprehensive, straightforward description. Unfortunately for them, they have more questions than people like you to answer them. Beth will need more information and a lot of support by her school. Administration should sign off on a behavior plan that should provide for some form of professional evaluation and intervention. This is not solely the teacher's responsibility, but the teacher-parent-ervice provider team.

I recommend 2 additions to your commentary:
1. Parents MUST be involved in the process. Education does not stop at the front door.
2. Videotape the classroom for a few days as a baseline, not only to document behaviors to be addressed but as a snapshot of how life is running in this little part of the world. (Get signed permission from parents!)

Love your posting. I'm now a fan

Amanda August 11, 2009 at 11:36 AM  

Thanks, Michael. And I totally agree with your additions....

•´.¸¸.•¨¯`♥.Trish.♥´¯¨•.¸¸.´• August 17, 2009 at 9:00 PM  

Some great ideas here.
The question was a tough one. Very thorough answer.
I have three year twin boys who are starting to get agreesive with each other. I have picked up a few tips here to help them play more nicely.

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