4

Special Needs Behavior Plans

Students with complex behavioral problems including cognitive limitations need to be taught to behave appropriately so they can learn in school. An individualized understanding of the student’s developmental level, trauma history, sensory modulation, and effective coping strategies are helpful in developing a behavior plan. It is helpful to develop a trauma informed behavior plan that addresses the student’s feelings and developmental challenges.

Often “big” feelings need to be managed to prevent problematic behaviors. Visual supports help students become aware of their problematic big feelings. Emotional learning follows a developmental sequence with the first feelings learned being sad, mad, glad, tense and relaxed. Once these are learned more complex and combined emotions can be taught. Emphasis is given to current feelings that lead to problematic behavior. Ask student to use different colors to draw all the feelings “in my head”.

FeelingsinmyHead

Next, feelings which are always O. K. things to feel need to be distinguished from problematic behaviors like hitting, which are not O. K. in school. Particularly with cognitively impaired students desired results are emphasized not morality. It is also helpful to use a trauma informed approach that repeatedly emphasizes “I will like you no matter what. Some behaviors will be rewarded that will make you successful, while other behaviors will be punished so you don’t have a bad life”. A rainbow goal is a useful art activity is used to help the student plan behavior goals.

RainbowGoal

For cognitively impaired students goal planning emphasizes what they want to do “Be safe” rather than what they won’t do “hit”. Each rainbow beneath the top pot of gold goal is a related step. The student can dictate or write, chooses the color, and draws. Participation is encouraged, rather than just scribbling and saying “done”.

Finally a safety plan is visually depicted with objectively specified behaviors for reaching their rainbow goal. The students favorite sensory coping strategy options for replacing the inappropriate behavior are included. Coping strategies are “non-contingent reinforcement (NCR)”, always immediately available options that do not need to be earned. This transdisciplinary behavior plan was developed by the student’s occupational therapist, social worker, and speech/language pathologist.

Visual Safety Plan

The objective behaviors include a definition of “Be safe” that the student and all teachers and therapists understand clearly “No hitting, threatening, or throwing objects”. A baseline is taken and specific point chart or rewards are given for progress toward the goal. Visual supports and art activities can help students with complex behavioral challenges improve their behavior for learning.

0

Sensory-Motor Strategies to Improve Self-Control

Sensory-motor strategies are often motivating for children and adolescents, providing therapists with a useful modality for improving self-control.  DBT www.linehaninstitute.org and CBT intervention http://apt.rcpsych.org/content/7/3/224.full can improve self-control in children and adolescents, but are often ineffective for youngsters who have significant cognitive deficits and/or a very limited attention span. Sensory-motor strategies offer a motivating and effective component of comprehensive mental health treatment to improve self-control in young people with complex behavioral, developmental, and sensory processing challenges.   

Inappropriate behavior involves a lack of functional inhibitory motor control.  Behavioral problems result from inadequate inhibitory control of arm movements (e.g., punching, slapping, scratching) or mouth movements (e.g., spitting, biting, threatening, screaming, swearing). Actively helping children learn motor self-control is an effective intervention for aggressive youngsters with behavior, developmental, and sensory processing challenges. Sensory-motor strategies promote the development of overall inhibitory control, behavior, and social skills. Since inappropriate behavior involves movement, graded activities requiring increasing levels of inhibitory control can be reinforced to improve self-control.  These activities include: Simon says, red light, giant steps freeze dance, freeze shake, play plan, play review, and turn taking during sensory-motor games. www.fabstrategies.com  www.challengingbehavior.org

Self-control can also be facilitated through new learning of developmentally sequenced bilateral movements.  Research suggests that learning new bilateral sequential skills (e.g., drumming and piano) promotes neurological connectivity (e.g., between cortical and midbrain emotional centers as well as across the corpus callosum coordinating the brain hemispheres) involved in self-control skills.  Neurological connectivity impacting self-control can be significantly compromised in youngsters with Pervasive Developmental Disorders and/or an early trauma history.  For this reason sensory-motor activities involving sequential bilateral movement appear clinically useful in promoting inhibitory control and communicating feelings.

Sequential bilateral activities include: ball bouncing activities, bean bag pass, obstacle courses, and mindfulness movement. Sequential bilateral activities can be integrated with the verbal expression of feelings and coping strategies using a game format.  Sequential bilateral movement activities are clinically useful to promote learning and social development in students with behavioral, developmental and sensory processing challenges. www.braingym.org www.movementbasedlearning.com

In addition, clinical experience utilizing the sensory processing frame of reference suggests that slow sequential movement activities involving deep pressure input through the joints help calm children and adolescents with behavioral, developmental, and sensory processing challenges.  While some therapists question the efficacy of sensory-motor intervention the benefits of exercise on the development of physical and mental health has been repeatedly demonstrated.  Further, exercise clearly has less potential contraindications when compared to the alternative of prescription medications to reduce hyperactivity and anxiety.

Sensory-motor activities can be embedded in regular classroom activities through movement brakes, music activities, brakes to get a drink at the water fountain, and school jobs (e.g., moving desks, moving mats, passing out books, delivering supplies around the school).  Children and adolescents can be taught to independently use tasks combining slow linear movement with deep pressure coping strategies (wall pushups, isometric exercises, therapy ball activities, theraband arm exercises, theraplast hand exercises) to maintain a quiet alert state when they initially notice they are becoming anxious.  In addition, children can participate in after school activities involving aerobic exercise (e.g., walks, biking, scooter, swimming, basketball, soccer, dancing and structured playground activities).  Sensory-motor strategies offer an effective component of a comprehensive intervention program to improve self-control and functional behavior.

References:

Bengtsson, S.L., Nagy, Z., Skare, S., Forsman, L., Forssberg, H., Ullen, F. (2005).  Extensive piano practicing has regionally specific effects on white matter development.  Nature Neuroscience, 8, 1148-1150.

Hillman, C. H., Pontifex, M. B., Raine, L. B., Castelli, D. M., Hall, E. E., Kramer, A. F. (2009).  The effect of acute treadmill walking on cognitive control and academic achievement in preadolescent children.  Neuroscience, 159(3), 1044-1054.

Riggs, N.R., Greenberg, M.T., Kusche, C.A., Pentz, M.A. (2006).  The mediational role of neurocognition in the behavioral outcomes of a social-emotional prevention program in elementary school students: Effects of the PATHS curriculum.   Prevention Science, 7(1), 91-102.

Smith, S.A., Press, B., Koenig, K.P., Kinnealey, M. (2005).  Effects of sensory integration intervention on self-stimulating and self-injurious behaviours.  American Journal of Occupational Therapy, 59, 418-425.

Sun, F.T., Miller, L.M., Rao,  A.A., Esposito, M.D. (2007).  Functional connectivity of cortical networks involved in bimanual motor sequence learning.  Cerebral Cortex, 17(5), 1227-1234.