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    Managing challenging behaviour

    Challenging behaviour is behaviour that causes problems for people around the person

    No Fighting, No Biting, No Screaming – Bo Hejlskov Elvén

    Probably not unfamiliar for families of children with or without additional needs, in fact Sebastian occasionally shows frustration by throwing his toys around the room. Challenging behaviour for us has manifested in many ways, while we can use many of the usual techniques with S so far very few of the standard methods (distraction, calm redirection, talking it through) really work for A.

    Right now our current method involves using two cards, one with a red block of colour and a sad face and another card with a green block of colour with a happy face. What we are looking to achieve is firstly understanding of feelings that one behaviour causes another to feel sad and secondly the start of self regulation – can we get A to stop and think about her actions and how they impact someone else. So far it has been incorporated reasonable well, A seems to understand one thing can make her or someone else feel red or green, we never modelled the cards as ourselves but she has taken the abstract thought and applied it to us rather than just her behaviour. For example If S is feeling sad she might say “S is red” and this has allowed us to further enhance with other words, S is sad, S is feeling angry, S is feeling happy.

    It’s very simple but has allowed us to cross a barrier in communication, due to A’s incredible visual memory she took to the cards within a day which is much quicker than we or nursery had planned. At first it was treated like a game and I wondered if we had made a mistake, she wanted to see the cards all the time but slowly the novelty has worn off and we are even adding a “I can calm myself down” card too. Both us and nursery are using the same technique, which is incredibly important to enable children to generalise. It hasn’t stopped all of the challenging behaviour but it’s a start to understanding and learning, which I think applied in the right way – visually and logically A quickly can apply to social situations.

    One of our biggest barriers is cognitive rigidity, that is simple that once you know this is the way we do things it’s hard if you have cognitive rigidity to then change that way up. Having worked in Information Tech I know how reluctant the general population are to move away from what is comfortable, the know is easier and fosters a resistant to change, this was one of the biggest considerations when changing any system. The known is safe, expected and thus anxiety is kept to a minimum in A’s case. So I thought about it and what would I do in a business context to navigate change? Well I would normally talk to a person and explain what I’d like to happen, what I’m expecting of them and how discuss through any concerns or questions they have. When it comes to children with complex social communication challenges that is not something that is easy or even really possible to do always. The red and the green card along side a visual timeline of events allows us to try and navigate that in a way that can be understood, reducing anxiety, reducing surprises and hopefully reducing challenging behaviour longer term by giving A the tools she needs to start paving down expectations.

    Changing your outlook

    People who can behave, will.

    Bo Hejlskov Elvén

    Let me take you back to a situation that arose a few weeks ago, we had a hospital visit planned which would wipe of the whole days schedule for A. Taking both children to the hospital anyway is quite an event, A really doesn’t like hospital much anyway – who does! Although things have improved a lot (with the help of visuals and staff understanding her needs). The day before I tried to prepare A that she would not be going to nursery that day, that morning I arranged her visual timeline to show that we would be going to hospital, I explained again that she would not see her 1:1 today. All was going reasonably well and just as we were about to leave, our new cleaners arrived – I had intended to leave to avoid this as I knew seeing new people would be a risk. A coped reasonably well and other than yelling “HELLLOOOOOO” and “BYE, BYE” on a loop (she was waiting for them to say bye back in the way she likes) we headed out the door without any stress.

    The morning other than a few surprises was going reasonably well, certainly better than I had anticipated. At the hospital we managed to park nearby, which was again great, part of the challenge can often be waiting in the car while I try to find somewhere to park which I can lift A out of the car. We arrived into outpatients and I went to check A in for her appointment. No appointment in the system, at about this point I realised something was not quite right but meanwhile A wandered off down to play with the toys, this being a very well known outpatients for her she initiated her usual routine. I spoke with a member of staff who kindly told me that the appointment had been rearranged until the following week.

    When I explained that we were not seeing the doctor and in fact we were going back home, A took it better than I expected. I suppose in hindsight she probably wasn’t too keen to see a doctor anyway, but I had a problem. I couldn’t just go home because I had expected our clean to be done while we were out that day, A really dislikes vacuum cleaners. It was raining and I thought while driving, I’d brave going to a supermarket. This was the very worst choice I could have made, it turned out that A was not over the fact that she did not get to see the doctor. I offered her ice cream to go inside but she thought we were getting ice cream from a very specific store locally which sell the ice cream in a tub with a flake on top. To her great displeasure upon reaching the back of the store, which she had repeatedly said ice cream over and over to get to it was not the kind she wanted and she became distressed.

    Remaining as calm as I could possibly manage I told A that we would need to go home if she wanted a different kind of ice cream, it was at this point that she said “Next is doctor”. I realised she had something very different going on in her mind than that I had, she had not let go of the fact that she was expecting to go to the hospital and instead we had a delayed reaction. After this point while trying to get her to leave she had a very public melt down, which involved biting, hitting me in the face, kicking and hitting S. All while S is throwing his snack everywhere in the pram yelling in distress, I felt very sorry for A because in her mind she was going to the hospital, she had spent that morning worrying about going to the hospital only to get all the way to the hospital and not go. This alongside the fact that she also wasn’t attending nursery that day due to the hospital appointment it tipped her over into chaos. It was that day that I decided we definitely need an extra pair of hands!

    In hindsight I should never have taken her into a supermarket, which to date we very rarely go into with A unless I am in desperate need. I should have realised that she would eventually need to vent her frustration at the change in routine and ultimately I needed to manage and adjust my expectations to enable A to achieve success that day. There is always a trigger and a reason for a meltdown and I have found it much easier to divert before we tip over the edge to avoid a meltdown than managing the cleanup situation afterwards. I see similar tantrums with S but he is much easier to distract and he is able to communicate his desires so it’s easier to avoid, also he does not have the same limitations in his environment and is not as triggered by sound, touch/texture, social interactions and routine. It means it’s less frequent and less restricting overall.

    Methods?

    I’ve had to really change up the way that I look at parenting with A, no matter how many times I say “use gentle hands” and yet, we still have very non gentle hands. Ditch out all the things traditionally we are taught from my own upbringing. My parents would probably have used persuasion or bribes for example “If you hit you won’t get X” or “Don’t hit, nice people don’t hit” neither of these work on A and I would encourage you instead to look at why they are doing it. What is triggering that behaviour, what are they getting from it? What are they trying to communicate?

    Simple techniques to avoid tipping over

    I have learnt that there is a very small window of opportunity before the behaviour switches over into aggression and a fight or flight response emerges, just before this I try:

    • Talking calmly to understand what is causing the challenging behaviour
    • Use the red and green visual cards discussed above to communicate that the behaviour is not appropriate, offering a chance to learn
    • Lowering down to A’s level and making sure I am to her side rather than directly in front of her, if she takes a step back I try and distance myself also
    • Avoid too much eye contact while still appearing interested
    • Using simple phrases and makaton
    • If I need to touch A I will limit this to the shoulder area
    • If it is obvious to me I will try to stop whatever is triggering the behaviour or guide A out of the situation
    • If we are at home A’s bedroom has lots of sensory calming lights which really help, but this is not always practical.
    • Compromising, A really loves ice cream and if all else fails I will compromise with something to transition. Before researching and reading this is one of the things I was reluctant to do in case it increased the challenging behaviour for reward, if you are concerned about this I encourage you to read the book I’ve listed below.

    If the above do not work then it is a matter of damage limitation, making everyone sa

    For me always there is a reason, whether it be lack of structure, changing in routine, poor sleep, pain, difficulties in understanding cause and effect, mental overload, sensory input (sound, touch, vision), too many or too little demands in life, relationship conflicts (siblings, parents, friends) or just an effect of the mood of others around A. When we first started this journey and I was asked “Are there any warning signs” I said no, but now I can see that there are many warning signs indeed. I think these are unique to the individual and I’ve found it very helpful to read around the subject.

    For more in-depth reading I can recommend “No fighting, no biting, no screaming” by Bo Hejlskov Elvén.

    It’s a work in progress for us, behaviour continues to be a real challenge but I feel equipped with the tools and understanding, which on the days when we are on our sixth meltdown and I’ve been bitten several times and with more unsuccessful attempts than I can count. I can reflect and know why it happened, learn and try to adjust for tomorrow.

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