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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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Environmental Adaptations for Improved Behavior

Environmental adaptations are an important yet underutilized way of helping individuals with behavioral, developmental, and sensory modulation challenges. While environmental adaptations are often included in positive behavioral support and relaxation programs, they are not given sufficient attention. A third of children with significant sensory modulation differences were found to have major psychiatric diagnoses http://www.fyiliving.com/wp-content/uploads/2010/09/re-examiningsensoryregulation.pdf Individualizing and teaching clients to use sensory environmental adaptations can significantly improve their behavior and decrease stress at school, work and home.

Environmental adaptations can provide structure and offer coping strategies that significantly reduce anxiety and improve behavior. Environmental adaptations include both the generalized and specific use of adaptive equipment and techniques. Generalized adaptive equipment and techniques such as assigned seats, reduced noise levels, posted rules and coping strategy bulletin boards provide structure for improved behavior.

WallPushBulBrdClassRules

An important guideline is to increase environmental structure before increasing behavioral demands, such as beginning more academically challenging learning activities. Likewise, reducing behavioral demands can be helpful in less structured environments. When clients first begin showing anxiety or behavioral difficulties, assess if the environmental supports match the demands being made and adjust environmental adaptations accordingly.

Some clients with significant behavioral, developmental, and sensory processing challenges benefit from individualized adaptive equipment and techniques such as study carols, noise canceling head phones, and being directed to do one activity for a minimum of five minutes before cleaning up and selecting another task. Research shows that adaptive equipment helps all children feel more comfortable in stressful environments, but the effects were significantly greater for children with developmental disabilities http://www.aamse.us/sites/default/files/Influence_Adapted.pdf

Adaptive Equipmentcropped-coping.jpgCopingCardChairleg Theraband

Specific environmental adaptations are most effective when they are individualized to meet the client’s behavioral goals and sensory needs. It is helpful to introduce environmental adaptations one at a time for a two-week period after practicing their use for goal achievement.

A Sensory Functional Behavioral Analysis, FAB Trigger & Coping forms, Sensory Profile, and goal-related base line data can be useful for finding the most effective environmental adaptations and tracking their effectiveness.

FABTriggerCopingFormsMasterpgno3FABTriggerCopingFormsMasterPg4FABTriggerCopingFormsMasterpgno5         It is important to clearly explain the rules for continued access to environmental adaptations before introducing them (e.g., gum chewing will be allowed only if students consistently throw their gum in the garbage when they are finished with it). Specifically considering and teaching clients to use environmental adaptations significantly improves their effectiveness for individuals with behavioral, sensory processing and developmental challenges.

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Assessing Sensory & Behavior Challenges

Many clients have interrelated sensory processing and behavior challenges that interfere with their functioning. Sensory processing disorders are distinct from behavior disorders (e.g., Oppositional Defiant, Post Traumatic Stress, Autism Spectrum, and Bipolar Disorder) but clients who have these mental health diagnoses are significantly more likely to have sensory processing challenges as well.

It is important that clients who have both sensory processing and behavior challenges affecting their functioning receive an evaluation that addresses both difficulties. Regardless if the evaluation is done by an occupational and/or mental health therapist (psychologist, social worker, licensed professional counselor, behaviorist) it is important to assess both sensory processing and behavioral functioning. Coordinated assessment by both an occupational and mental health therapist can be extremely helpful.

It is helpful if the sensory processing and behavior assessment include observations and a norm-referenced, reliable and valid measurement tool. The sensory processing clinical observations can describe whether the client becomes overly excited during movement activities, is able to pay attention in loud environments, touches people and objects more frequently than others his age, is easily distracted, and the length of attention span for both preferred and adult directed activities. Standardized assessments include the Short Sensory Profile sensoryprofile.com and Sensory Processing Measure http://www.wpspublish.com/store/p/2991/sensory-processing-measure-spm

Behavior observations can include the frequency of inappropriate behaviors (e.g., yelling, screaming, swearing, hitting, biting, spitting) as well as the most common setting events, antecedents, and consequences related to them. Standardized behavior assessments include the Devereux Behavior Rating Scale-School Form and the Ages and Stages Questionnaire: Social Emotional.

Adaptive EquipmentPartSentBigFeelin

Whenever clients present with interrelated sensory processing and behavioral concerns related to their functioning both issues need to be comprehensively addressed. The assessment needs to include functional base lines data, prioritize functional goals, and recommend needed intervention. Comprehensively assessing the client’s interrelated sensory processing and behavior concerns guides affective intervention for both problems.

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Individualizing Coping Strategies to Improve Behavior

The use of coping strategies is an evidence-based intervention that improves behavior.  It is commonly used in school positive behavioral support programs and mental health interventions to improve functional skills.  Coping strategies enable individuals to manage their strong feelings of sadness, anger, or anxiety with out violence or other functional difficulties.  Coping strategies are a proven component of school Positive Behavioral Support programs (Second Step, PATHS, DECA), Dialectic Behavior Therapy (DBT) and CBT (Cognitive Behavior Therapy).

Learning to use coping strategies to manage depression, anxiety, and aggression can be particularly challenging for individuals with behavioral, mental health, developmental, trauma history, and/or sensory processing challenges.   Learning to consistently implement coping strategies is a long process that can be facilitated by teachers, family members, as well as occupational, speech/language, physical, and mental health therapists.  It is important when evaluating coping strategies with clients to assess their efficacy in facilitating short-term and long-term frustration tolerance and functioning.  For example, some client attempts to cope with strong feelings provide short-term relief (e.g., self-injurious behaviors, risky sex, drug and alcohol abuse) but worsen long-term coping and functioning.  It is often necessary to exert considerable effort to help clients find the best fit of coping strategies to improve their functioning across settings.

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Careful consideration of client’s interests, developmental level, sensory processing, as well as success and challenges in implementing coping strategies is a good place to start.  Coping strategies involving physical movement are usually most successful when teaching new coping strategies to clients.  Inclusion of physical exercise, music, sensory equipment and adaptive techniques, mindfulness strategies, yoga, and touch strategies can be particularly helpful for individuals with special needs.

CopingMindfulClock2

A helpful tool is having clients select 3 items from each page of triggers and coping strategies on the FABTriggerCopingForms

An understanding of the client’s unique environmental triggers (situations such as “being told no”) and body triggers (e.g., “breathing fast; crying”) that precede disabling anxiety or aggression are helpful in teaching coping strategies.  When evaluating the effectiveness of coping strategies those that show the greatest effectiveness with slight environmental and body triggers can be expanded on.  Repeatedly practice and reinforce clients for successfully using coping strategies in controlled settings, while gradually increasing their stress levels.  Once strong feelings can be consistently managed with coping strategies in controlled settings, begin practicing and reinforcing them in supported naturalistic settings.  While coping strategies are difficult to learn they are worth the effort, as they are extremely helpful in increasing client’s functioning.

References:

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

Kovacs, M. & Lopez-Duran, N. (2012).  Contextual emotion regulation therapy: A developmentally-based intervention for pediatric depression.  Child and adolescent psychiatric clinics of North America, 21(2), 327.

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Strategies to Improve Body Awareness & Mental Health

Intervention strategies promoting body awareness can improve behavior in children and adolescents with sensory processing, trauma history, developmental, and mental health challenges.  Improving youngster’s body awareness is particularly important for children and adolescents because it impacts development and provides the foundation for functional motor planning skills.  Many children with internalizing behavioral challenges including depression and repeated complaints of pain can be helped through enhancing their body and emotional awareness skills.

Although body and emotional awareness difficulties are commonly described in children and adolescents with trauma histories and psychiatric disorders, limited attention is given to body scheme and emotional awareness by mental health therapists. The sensory integration, massage, mindfulness, and yoga frames of reference offer effective body awareness assessment and intervention strategies. FAB Sensory Modulation Strategies that promote body awareness include: Touch vibration on the Back and Arms, FAB Pressure Touch, arm traction, Back X, Spine crawl, Wall pushups, Nose breathe, Mindful clock, Bird, Tense & relax, Focus on feet, Focus on palms, and the Body scan.

MindfulClock2MindfulClock1 MaryMassage

Light touch to reduce somatic pain and improve body awareness can be provided using the FAB Back X and Spine crawl strategies in the BackX & SpineCrawlGame

 References:

Beider, S., & Moyer, C. (2007).  Randomized controlled trials of pediatric massage: A review.  Evidence-based Complementary and Alternative Medicine, 4(1), 23-34.

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.

Intervention strategies promoting body awareness can improve behavior in children and adolescents with sensory processing, trauma history, developmental, and mental health challenges.  Improving youngster’s body awareness is particularly important for children and adolescents because it impacts development and provides the foundation for functional motor planning skills.  Many children with internalizing behavioral challenges including depression and repeated complaints of pain can be helped through enhancing their body and emotional awareness skills.

Although body and emotional awareness difficulties are commonly described in children and adolescents with trauma histories and psychiatric disorders, limited attention is given to body scheme and emotional awareness by mental health therapists. The sensory integration, massage, mindfulness, and yoga frames of reference offer effective body awareness assessment and intervention strategies. FAB Sensory Modulation Strategies that promote body awareness include: Touch vibration on the Back and Arms, FAB Pressure Touch, Back X, Spine crawl, Wall pushups, Nose breathe, Mindful clock, Bird, Tense & relax, Focus on feet, Focus on palms, and the Body scan.  Light touch to reduce somatic pain and improve body awareness can be provided using the FAB Back X and Spine crawl strategies in the Back X & Spine Crawl Game.

 

References:

Beider, S., & Moyer, C. (2007).  Randomized controlled trials of pediatric massage: A review.  Evidence-based Complementary and Alternative Medicine, 4(1), 23-34.

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.

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FAB Rainbow Goal Strategy

The FAB Rainbow goal strategy is useful for helping children and families develop goals and plans for goal achievement.  The child or family begins by drawing a star at the top of the rainbow by brain storming what they would choose if they could earn anything in the world.   Next, they draw five separately colored rainbows beneath the star that describe the steps needed to earn their goal.  The rainbows describe the specific steps they need to take to achieve their goal, described positively as what they need to do rather than what they need to avoid doing.  The final rainbow is what they need to do immediately, and is paired with a sticker system and tangible reinforcers.

Rainbow Goal

The rainbow goal shown in the link above was done by a child in middle school with Pervasive Developmental Disorder and Oppositional Defiant Disorder, who demonstrated aggressive behavior.  He was initially unable to list any goals he had for the future and I could find no affective reinforcers for changing his behavior.  This child reported that his goal was to stay at home, rather than again being sent to another group home or juvenile detention facility.  The FAB Rainbow Goal Strategy enabled him to use a fun activity to develop a visual representation of his goal and the steps for achieving it.

His sequential rainbow steps were: “I can talk to Mom when upset, Stay in control , and Do what Mom asks”.  His final rainbow step was that he would now go back and “Today work hard in school”.  I learned from his mother that he loved toy cars, and developed a car sticker system that I paired with his step “Today work hard in school”.

He received one car sticker when I visited his class each time I observed that he was working hard in school.  If he was not working hard (or initially if he was acting aggressively), I pointed to his rainbow goal step and explained I still liked him but could not award him a sticker because he was not working hard in class.  I usually visited his class six times daily, and gave him the opportunity to cash in his stickers for prizes at the end of each day.  One sticker earned a racing car card and stick of gum, six stickers bought a toy race car.

The FAB Rainbow Goal Strategy is useful for motivating children and families to set goals, an action plan, and develop a reinforcement schedule to improve behavior.  It also promotes goal directed behavior, which research significantly correlates with decreased aggression.  The FAB Rainbow Goal Strategy empowers parents, teachers, and therapists to help children and families develop and visually represent their goals, so they are motivated to achieve them.  It is often helpful to pair the immediate goal with a tangible reinforcer.

References:

Kazdin, A. E. (2008).  The Kazdin Method for parenting the Defiant Child.  NY, NY: Mariner Books. http://childconductclinic.yale.edu/

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