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FAB Trigger & Coping Forms

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The FAB Trigger & Coping Forms are an assessment that can be included in occupational, physical, and speech/language therapy assessments to help students identify their most problematic triggers and most affective coping strategies. The FAB Trigger & Coping Forms are helpful in developing student’s awareness of their triggers for misbehavior, and used in developing affective coping strategies. Students are asked to identify three pictures from each page depicting their biggest environmental triggers, body triggers, and coping strategies for preventing misbehavior.

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The FAB Trigger & Coping Forms are particularly useful for motivating students with complex behavioral problems by building on their existing understanding of the triggers and coping strategies related to their problematic behavior. I have been using them as a component of my occupational therapy evaluation for the past fifteen years and found this assessment motivates students and improves their self-control. Students with complex behavioral challenges can be uncooperative during therapy assessments because they are skeptical that anything can help them. The FAB Trigger & Coping Forms enable therapists to introduce students to new, fun coping strategies at the beginning of the assessment, motivating them to participate in the assessment and therapy. It is made clear that everyone is an individual, and it is up to the student to choose the coping strategies they enjoy and find most useful.

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Role of school OT’s, PT’s, SLP’s in Behavior Intervention

School Occupational, Physical and Speech Therapists play a significant role in improving student behavior. While traditionally viewed exclusively as the role of school social workers, psychologists, and behaviorists the complex problems of students with interrelated behavioral and developmental challenges can be helped by the contribution of school therapists.  The relationship between behavioral problems, the occupation of students, communication/language abilities, and gross motor skills supports the role of school occupational, speech/language and physical therapists as members of school teams helping students with behavioral and developmental challenges.

By teaming with occupational, speech/language and physical therapists, teachers and school mental health specialists can enhance their school positive behavioral support programs with expanded use of visual supports, mindfulness, music, exercise, and sensory-motor activities (Patten et al., 2013; Schaaf et al., 2014).  There is emerging evidence that cardiovascular and resistance exercise enhances body awareness, attention, as well as functional strength and endurance for improved participation in school learning tasks http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3208137/pdf/nihms297861.pdf

School therapists can utilize evidence based mindfulness strategies as movement breaks that improve attention, and integrate behavioral strategies into their school therapy to enhance student’s school behavior.  Behavior for Therapists Slides The picture below describes the FAB Strategies adaptation of the PATHS PBS Turtle Technique to help students with special needs learn to calm down and avoid aggression.

FABModifiedTurtleTech

The AOTA supports the role of school occupational therapy in helping to improve student’s behavior (Cahill & Pagano, 2015).  The following Occupational Therapy article describes clinical school occupational therapy strategies that can be used to reduce student aggression  (Click on highlighted, then double click on lower heading) SchoolOTRedAgg

References

Cahill, S. M. & Pagano, J. L. (2015). Reducing restraint and seclusion: The benefit and role of occupational therapy. AOTA School Mental Health Toolkit. http://www.aota.org/-/media/Corporate/Files/Practice/Children/SchoolMHToolkit/Reducing-Restraint-and-Seclusion.pdf

Flook, L., Smalley, S., Kitil, M., Galla, B., Kaiser-Greenland, S., Locke, J., Ishijima, E., Kasari, C. (2010). Effects of mindful awareness practices on executive functions in elementary school children. Journal of Applied School Psychology, 26(1), 70-95. http://skolenforoverskud.dk/Artikler%20-%20mindfulness/Flook-Effects-of-Mindful-Awareness-Practices-on-Executive-Function-1.pdf

Kazdin, A. E. (2008). The Kazdin Method for parenting the Defiant Child. NY, NY: Mariner Books.

Laugeson, E. A. (2014). The PEERS curriculum for school-based professionals: Social skills training for adolescents with autism spectrum disorder. Routledge.

Mahammadzaheri, F., Koegel, L. K., Rezaee, M., Rafiee, S. M. (2014). A randomized clinical trial comparison between pivotal response treatment (PRT) and structured applied behavioral analysis (ABA) intervention for children with autism. Journal of autism and developmental disorders, 44(11), 2769-2777.

Schaaf, R. C., Benevides, T., Mailloux, Z., Faller, P., Hunt, J., van Hooydonk, E., … & Sendecki, J. (2014). An intervention for sensory difficulties in children with Autism: A randomized trial. Journal of autism and developmental disorders, 44(7), 1493-1506.

Warner, E., Spinazzola, J., Westcott, A., Gunn, C. & Hodon, H. (2014). The body can change the score. Journal of Child & Adolescent Trauma, 7(4), 237-246.

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Sensory Strategies Improve Learning

Classroom environmental adaptations can enhance behavior and learning.  However, effectively using adaptive equipment and techniques involves more than handing out adaptive equipment.  To improve learning and avoid causing additional classroom management problems it is important to specifically consider how sensory strategies can improve an individual student’s behavior for enhanced learning.SensoryRoom

Sensory Integration and Positive Behavioral Support strategies can be combined to develop effective coping strategies.  The first step is to choose one specific goal involving adaptive equipment and techniques that improves the student’s behavior, learning and future.  Select a goal that is most important for improving behavior and is attainable within six months.  The goal is worded positively and is incompatible with the inappropriate behavior that interferes with learning.

For students who have multiple needs research suggests prioritizing goals that can reduce future school aggression such as: safe hands (no hitting), polite voice (no yelling), as well as increased attention and seated attention.  After the goal is chosen collect base line data on how often the desired behavior occurs.  Use the base line data to refine the goal before choosing adaptive equipment.

Next consideration is given to the student’s specific need for sensory input.  The Sensory Profile and an activity analysis are useful tools for finding effective adaptive equipment and techniques.  The Sensory Profile is a reliable, valid assessment that identifies significantly different sensory behaviors.  If a student’s scores show a definite difference in Sensory Seeking/Low Registration (e.g. a significant difference found in only 2 out of 100 students their age) this provides clues about the sensory input needed.  Sensory processing disorders are complicated, and each student’s individual sensory needs must be addressed.

Next an activity analysis is done to explore the sensory input the student may be getting through the inappropriate behavior, sensory strategies that have helped him in the past, and his favorite activities.  Begin the activity analysis by considering the sensory input the student receives from the problematic behavior (e.g. wiggling his fingers in front of his eyes so frequently that it interferes with learning).  Determine if he is doing this for attention, sensory input, or both.  If he is doing the behavior for sensory input, go where no one will see you and imitate the student’s behavior to determine the sensory input it provides (e.g., finger movement, visual stimulation, or both).

Further assessment for developing coping strategies can be gathered using the FABTriggerCopingForms filled out by the student or parent, who choose on each page the three most frequent situations and body reactions that precede the inappropriate behavior and the most helpful coping strategies for avoiding inappropriate behavior.  This provides greater information regarding the role served by the behavior and possible alternative activities that provide the needed input. INSERT  Choose the adaptive equipment or techniques that will help achieve the student’s goal using information from the SensoryProfile, activity analysis, and FAB Trigger & Coping forms.

 

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Once adaptive equipment or techniques are chosen introduce them in a way that maximizes success.  Given current school inclusion practices many classrooms include students with diverse developmental levels.  It is helpful for teachers and therapists to initially explain to the class that they have different needs and abilities, and will be treated fairly but not equally.  Students will be given different rules, equipment and expectations based on their individual needs.  Adaptive equipment is then tried with individual students “for the day as an experiment that will be continued only if used appropriately to help reach their goal”

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Specifying rules for continued use of adaptive equipment or techniques before introducing them avoids potential problems.  Many teachers forbid adaptive strategies because they interfere with classroom management (e.g., forbid gum chewing because gum is stuck on seats; don’t allow fidget toys because students throw or make loud noises with them).  Setting clear limits that adaptive equipment will no longer be used if students break the rules or don’t progress toward their goal make teachers and parents more willing to try them.

It is also important and challenging to be sure parents/guardians approve of adaptive equipment before it is used.  The best way to do this is by discussing it at a parent conference.  When this is not possible write a note describing the goal and reason for the adaptations.  Then ask the parent to sign permission for the goal and specific adaptive equipment to be tried on the bottom of the form.

FAB STRATEGIES FORM

Finally, additional reinforcement with a sticker chart or other reward is given to the student for making progress towards their goal.  By keeping track of goal progress from the base line, it is easy to show that the plan is working or modify it if it is ineffective.  While this process of combining sensory and behavioral strategies is criticized because it does not show whether the plan worked for sensory or behavioral reasons, it affectively improves student behavior and learning.

References:

Dunn, W. (2007).  Supporting children to participate successfully in everyday life by using sensory processing knowledge.  Infants & Young Children, 20(2), 84-101.  www.sensoryprofile.com

Seifert, K. (2011).  CARE-2 Assessment: Chronic Violent Behavior and Treatment Needs.  Boston, MA: Acanthus Publishing.  www.drkathyseifert.com

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Activities Teaching Feelings Improve Behavior

Helping students understand and express feelings improves their behavior.  This behavioral improvement appears related to the neuropsychological processes of self-control (from the frontal cortex) and communicating feelings (between the brain hemispheres).  Positive behavioral support activities promote self-control through the Turtle technique, Simon Says, Freeze dance, and similar strategies that teach and reward movement self-control.

Communicating feelings is taught with pictures of feelings, feeling wheels, environmental and body triggers, coping strategies, distinguishing feelings from behaviors, and anger meters.  These strategies help regular and special education students understand and express their feelings in developmentally appropriate ways through art activities.

Angercartoon  ComicCoping Triggers MadvsKick

AngerMeter

The FAB Switch hands toss strategies provides movement activities that involve self-control and the verbal expression of feelings for children and adolescents with behavioral, developmental, sensory processing, and/or trauma challenges.  The FAB Switch hands toss strategies combine passing a beanbag with the verbal expression of preferences, feelings, values, and choices.  Building on Positive Behavioral Support activities that teach emotions and express feelings, It involves fun movement that can be done individually with students and in groups.  Both the beanbag pass progression and expression of feeling can be developmentally individualized to promote developmental, social, and verbal skills.

The FAB switch hands toss strategies let kids who don’t like being still actively practice emotional awareness and expressing feelings in a fun way.  They can be easily graded by selecting the specific strategies at the client or groups level.  FAB switch hands toss strategies can address the verbal expression of: favorites (e.g., color, team, quality in a friend), best coping strategy, guessing the feeling or degree of feeling expressed by the therapist or peers, right now I feel _____, and I messages (e.g., when you yell at me, I feel sad, so please speak to me politely). The FAB switch hands toss strategies are a fun addition to Positive Behavioral Support activities to improve emotional awareness and the verbal expression of feeliings.

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.

Lieberman, M.D. (2009).  The brain’s braking system (and how to ‘use your words’ to tap into it).  Neuroleadership Journal, 2, 9-14.

Miller, A.L., Rathus, J.H., & Linehan, M.M. (2007).  Dialectical behavior therapy with suicidal adolescents.  NY, NY: The Guilford Press.

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.

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.

Suveg, C., Southam-Gerow, M. A., Goodman, K. L. & Kendall, P. C. (2007).  The role of emotion theory and research in child therapy development.  Clinical Psychology: Science and   Practice, 14(4), 358-371.

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Movement Enhances Learning Behaviors

Appropriate behavior for learning is enhanced by engaging sensory activities that teach rule based inhibitory movement control.  Behavioral problems frequently involve inadequate inhibitory control of movement involving the arms (e.g., punching, slapping, scratching), legs (kicking) or mouth (e.g., spitting, biting, threatening, screaming, swearing).  Teachers can collaborate with occupational, physical, speech/language, and mental health therapists to enhance self-control using developmentally appropriate movement activities with children and adolescents who have behavioral, mental health, sensory processing, and/or developmental challenges. 

A major obstacle in teaching youngsters with behavioral challenges is motivating them to participate in challenging activities to enhance their development.  Children and adolescents find movement activities engaging and fun.  Involving students in brief developmentally appropriate movement brake activities enhances academic transitions, self-control and learning. Helpful activities include: playground tasks, parachute games, Simon says, red light, giant steps freeze dance, freeze shake, play plan, play review, obstacle courses, and movement to music (10 little hotdogs, Hokey-pokey, If your happy and you know it, Hot cross buns, We all need somebody to lean on).

ParachutePlayground

Additionally, basic yoga and mindfulness activities provide sensory movement that is useful as a pre-correction technique (e.g., activity used before problematic situations like school assemblies or lunch time).  Pre-school and elementary classes benefit from mindfulness and basic yoga tasks such as the: wall pressing, tensing then relaxing their muscles, mindful clock, body scan, feel your feet, feel your palms, stretching activities, and isometric exercises.

MindfulClock1MindfulClock2

Children with behavioral and sensory processing problems often show improved behavior following movement activities involving slow linear movement and deep pressure (e.g., pushups, wall pushups, desk pressing, rocking onto their hands on their stomachs over a therapy ball).  Helpful activities for students with behavioral and sensory processing challenges who are integrated into a regular education program include: setting the table, moving mats, moving tables, moving chairs, passing out books, and delivering notes or packages to teachers through out the school.

WallPushupProneTherapyballfar

Finally, special accommodations can sometimes be made for children who are academically bright but have difficulty maintaining a sustained seated position.  Sitting on therapy balls, sitting on disk-o-sit cushions, standing in a masking taped area, or using a sensory area in the back of the class where they can do there work without disturbing or being disturbed by others.  Rolling to read and rolling to math are useful activities for children who can’t remain seated but are capable of academically advanced work.  During resource room, occupational and speech/language therapy, and home work sessions they roll across the floor then read a chapter in a book or complete several math flash cards.  After completing the reading or math they are reinforced then roll again and do the next chapter or flash cards.

Particularly for preschool, kindergarten, and all students who have behavioral, psychiatric, developmental, sensory processing, and/or trauma history challenges it helps to include movement activities in the classroom.  Students are initially taught the cardinal rules for movement tasks: “Don’t touch any body or anything with out permission, and resume good learning after so we can do this activity tomorrow (if not we will skip this activity tomorrow then try it again the next day and I’m sure you will do much better”).  Teachers and principles understand that students benefit from movement engaging the bodily-kinesthetic, interpersonal, and musical intelligences.  While the teachers I work with and I am accused of “coddling students” and “wasting time” by using movement activities in the class room, no one can dispute our data showing this method results in increased academic goal achievement and decreased behavioral problems.

References:

Dunn, W. (2007).  Supporting children to participate successfully in everyday life by using sensory processing knowledge.  Infants & Young Children, 20(2), 84-101.

Flook, L., Smalley, S., Kitil, M., Galla, B., Kaiser-Greenland, S., Locke, J., Ishijima, E., Kasari, C. (2010).  Effects of mindful awareness practices on executive functions in elementary school children.  Journal of Applied School Psychology, 26, 70-95.

Koester, C. (2012).  Movement based learning for children of all abilities.  Reno, NV: Movement Based Learning Inc.

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.

Warner, E., Koomar, J., Lary, B . & Cook, A. (2013).  Can the body change the score?  Application of sensory modulation principles in the treatment of traumatized adolescents in residential treatment settings.  Journal of Family Violence, 28(7), 729-738.

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Planning Strategies Improve Behavior

The FAB List, Picture schedule, Praxis comic, 3-Comic, Schedule story, and Coping card strategies describe planning with visual supports to improve self-control.  These FAB planning strategies improve behavior in children and adolescents with sensory processing, developmental, trauma history, and mental health challenges.  Learning routines, rules, and structure enhance self-control.

The FAB List strategy helps organize children and adolescents who move rapidly throughout the class or therapy room making a mess and getting more disorganized. The therapist or teacher keeps all materials locked up then has the child make a sequential list of up to six activities they want to do that day.  They are then given access to the first activity, and must clean up and check it off the list before beginning the second task.

A similar strategy for students who learn best through visual prompts is the FAB Picture schedule strategy.

VisSchedSelfCont

This FAB Picture schedule strategy was individually developed by this student’s speech-language pathologist and occupational therapist using board maker.  The child’s individualized picture schedule helps the student identify when he is angry and/or mad (the feelings that most often precede his aggressive behavior), then choose one of his three most effective coping strategies to stay in control.  The picture schedule also designates that the student will be rewarded with an extra fifteen minutes long session with John (his occupational therapist) if he uses coping strategies.

The FAB Praxis comic strategy guides children and adolescents in understanding and sequentially following multiple step activities.  Below is the 4-part FAB Praxis comic created and used by a small occupational therapy group.  Group members are guided to describe, draw, and color 4 comic strips depicting the sequential components of every group. 

GroupComic

The students dictate and write the captions of the group sequence, (with the sensory purpose of the activities described here in parenthesis): 1. Move the chairs (e.g., specifically involving slow linear movement combined with deep pressure through the joints to facilitate self-regulation) 2. Throw the ball underhand (a sequential movement task that is combined with the verbal expression of feelings). 3. Sit (a calming activity during which students construct a feeling wheel or coping card, given the environmental structure of a seated position) 4.Play Frisbee ending the group (e.g., the final routine regularly done as a transition before moving the chairs back to end the group). Another FAB Praxis Comic is presented that is used in groups and individual sessions with adolescents learning to cook.

PraxComCook

For these students hand washing before cooking and sitting to plan the cooking were major steps they needed to remember.  For other students I stress other steps of cooking like a reminder to shut off the stove when done cooking.

The FAB 3 Comic is used to help children understand the trigger and consequences of their problematic behavior.  3 comic strips are constructed using drawings and captions.  The child begins by drawing comic 2 depicting the problematic behavior, draws comic 1 next showing the antecedent trigger, and finally comic 3 illustrating the consequences.

3 Comic Chain

It can be done with the child when they are calm following the problematic behavior, and be reviewed repeatedly.

The FAB Schedule story helps children understand and follow structure, and is particularly useful for promoting self-control during transitions and situations with little external structure.  The first example was done to assist a girl I worked with Autism Spectrum Disorder to leave the class for her speech language and occupational therapy sessions.

ScdlStry

The second schedule story was constructed with a small group who had difficulty independently selecting and carrying out free time activities.  INSERT  The children dictated the captions and drew the picture of their favorite free time activities.  For example, the teacher posted the Build Model picture on top of the cabinet where the models were kept.  When it was free time the student who liked model building would get the schedule story, select the picture Build Models, match the picture to the same picture on the cabinet where the models were kept, and play with the models.

SchedStryFreetime

The FAB Coping card strategy concisely integrates on a laminated index card the child’s preferred interest, behavioral goal (selected to be incompatible with aggression), coping strategies and equipment, and reinforcement schedule.

Copingcard

For example, a student who frequently bit his own hand when peers teased him helped construct a coping card with a drawing of his preferred interest Sponge Bob, coping pictures of his chewy, weighted blanket, and listening to music (colored, cut out, and pasted on an index card from the FAB Trigger & Coping forms), with the written caption: “Keep safe hands don’t hurt myself when I get upset”.  On the reverse side of the coping card was his reinforcement plan: “Safe hands for one 10 minute activity earns one sticker (five stickers= 1 toy car)”. The coping card is worn or posted on the desk to remind the child and all staff of the child’s behavioral goal, preferred interest, coping strategies, and reinforcement schedule.

The FAB List, Picture schedule, Praxis comic, 3 Comic, Schedule story, and Coping card strategies assist planning with visual supports to improve self-control.  These FAB strategies involve students in developing organizational strategies that improve their behavior.  These FAB  planning strategies can be individualized to best meet each child’s needs and integrated into their daily routines.

References:

Diamond, A. & Lee, K. (2011).  Interventions shown to aid executive function development in children 4-12 years old.  Science, 33(6045), 959-964.

Gray, C. A., & Atkins, T. (2010).  The new social story book. Arlington, TX: Future Horizons.

Miller, A.L., Rathus, J.H., & Linehan, M.M. (2007).  Dialectical behavior therapy with suicidal adolescents.  NY, NY: The Guilford Press.

Spencer, V., Simpson, C., Day, M., Buster, E. (2008).  Using the power card strategy to teach social skills to a child with Autism.  Teaching Exceptional Children Plus, 5(1), 1-10.