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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.

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Sensory Strategies in Adolescent Psychiatry

The FAB Sensory Match Strategy uses individualized sensory coping strategies and reinforcement to reduce self-injurious behaviors in adolescents with psychiatric challenges.  Effective treatment approaches for self-injurious behavior such as DBT, CBT, and ARC teach adolescents to use generalized coping strategies to replace self-injurious behaviors.  However, research reports that adolescent self-injurers have significantly increased sensory modulation difficulties and physiological reactivity to stress.  Research suggests their problem is not ignorance about coping strategies but the inability to use selective coping strategies to reduce self-injurious behavior.

Research shows that the function of self-injurious behaviors is automatic negative reinforcement (e.g., pain as an escape from negative thoughts and feelings) and automatic positive reinforcement (e.g., to feel something even if it’s pain when numb).The FAB Sensory Match Strategy combines sensory processing and behavioral intervention to develop individualized sensory coping strategies that adolescents can use as an alternative to self-injurious behaviors, and reinforces them for reducing their incidences of self-injury.  Assessment includes the Adolescent Sensory Profile, a functional behavioral analysis with base line data, and use of the FABTriggerCopingForms

Following assessment several sensory coping strategies are done with the adolescent and they select the strategies they find most helpful in reducing self-injurious behavior.  The most effective strategies are listed along with the Sensory Match Strategy on the FABSTRATEGIES TO PROMOTE SELF-CONTROL form.  Reinforcement is provided when the child uses coping strategies to reduce self-injurious behavior.  The most commonly helpful sensory coping strategies used in the FAB Sensory Match Strategy include: fidgets, comfort box (a box of fidgets and sensory toys), theraplast hand exercises,  craft kits, vibrating bath brush, surgical scrub brushing, massage on request, theraband arm exercises, therapy ball use, and mindfulness activities.

References:

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

Nock, M.K. & Mendes, W.B. (2008).Physiological arousal, stress tolerance, and social problem-solving deficits among adolescent self-injurers.  Journal of Counseling and Clinical Psychology, 76(1), 28-38.

Nock, M.K., Prinstein, MJ., Sterba, S.K. (2009).  Revealing the form and function of self-injurious thoughts and behaviors: a real-time ecological assessment study among adolescents and young adults.  Journal of Abnormal Psychology, 118(4), 816-827.

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.