Addressing Challenging Behavior in Toddlers and Preschoolers with Visual Impairments and Blindness

Introduction

Watching your child who is blind or visually impaired grow up can be exciting and wondrous. Each new skill will be noticed and celebrated. You may wonder how your infant, who needed your help with everything, suddenly became a fairly independent little person. Growing up can also feel like a roller coaster of emotions and struggles as your child strives to become her own person. Common labels used to describe the behaviors that may occur in your child’s early years are “problem behaviors” or “challenging behaviors.”

In this series of behavior articles, the term “problem behaviors” is used to describe developmentally expected behaviors. “Challenging behavior” is used to describe more significant behaviors that don’t respond to typical developmental management approaches. These challenging behaviors may be observed during the toddler/preschool years, but they often become increasingly concerning in the elementary years and, without appropriate intervention, may continue to adulthood.

Challenging Behaviors and Children with Visual Impairments

Challenging behaviors share some characteristics with developmentally expected behaviors. They are physical in nature and may also take the form of sounds or words. The behaviors occur with greater intensity and frequency, cause more disruption, and may result in harm to others or to the child herself. As a result, they can be very stressful for your child and your family, and you will likely find that your child’s support team will be concerned as well.

These challenging behaviors can be categorized in the following ways:

Physical aggression: hitting, head butting, pinching, biting, scratching, spitting, punching, kicking, slapping; can be directed towards others or the child herself.
Vocal and verbal: yelling, screaming, speaking loudly, using profanity or aggressive words
Destruction: pushing, kicking, or throwing materials or furniture or objects
Other physical movement: dropping to the floor or leaving the area
Signs of emotional distress: crying or changes in facial or body language

These behaviors are difficult to observe, to manage, and to change. Interventions such as modeling a more appropriate behavior or trying to use logic or reasoning does not work. Limited vision is not a primary reason for such behaviors. No matter how much expertise you have as a parent observer, you need help finding answers. Why is this happening, and how do I help?

The Link Between Missing Skills and Challenging Behavior in Children with Visual Impairments

As toddlers and preschoolers, children demonstrate behaviors that are primarily linked to new skills. Their effort to become independent, to have more control, to resist independence, and to cope with changing emotions usually results in behaviors that are problematic. But it is fairly easy to understand how to support your child during this transition. You can let her know that you understand that she seems frustrated and that you are going to be there to help her through these times. If new skills are needed, you can model new ways to communicate and to adapt to these changes. Your child may have delays in language development or motor skills, or her vision impairment may affect her learning during this developmental period, but new skills in these areas will help support behavioral changes.

Children who are demonstrating “challenging behaviors” have learned to use certain behaviors to get what they need or want. The child learns that the behavior has worked before, and so, it is repeated. But the behavior is unexpected, unconventional, or inappropriate. The child may be missing skills or may not be able to use them when they are anxious, confused, stressed, or even excited.

Skills that might be missing or need to be supported include:

Language and speech skills: associating concepts with language, understanding or expressing language as a baby who is blind, accumulating vocabulary as a toddler who is visually impaired, advanced listening skills, using single words or word combinations that are spoken clearly
Social communication skills: communicating needs/wants nonverbally or verbally and communicating assertively—communicative intentions include requesting and protesting or rejecting
Self- or mutual-regulation skills: using appropriate behaviors that calm, self-sooth, or self-stimulate
Social skills: playing with other children, building friendships, participating in pretend play, and relating to and empathizing with peers, siblings, and adults

It is important to understand that these behaviors typically are not signs of disobedience, defiance, or other non-compliance. There is a reason for the behavior, and the behavior is an unexpected and atypical means of communicating a message to you or her teachers.

What Your Child with a Visual Impairment May Be Communicating with Challenging Behavior

Behavior management approaches have changed over the years, but current research strongly supports the concept that all behavior serves a function or purpose. A key concept is that a child is having a difficult time using expected nonverbal or verbal forms to communicate. One way to think about this is that she is “acting out” her needs or feelings rather than communicating in a more conventional way. While challenging behaviors are confusing, discovering what your child is trying to tell you can be a step towards finding clarity and being able to support positive changes.

Most researchers have identified three primary functions of challenging behaviors:

To gain attention or other desired events (wants and needs)
To escape or avoid undesired events or activities
As a response to a physical or sensory experience (pain, discomfort, or to feel good)

The following are some possible communication intentions or functions that your child who is blind or visually impaired is attempting to communicate:

What she wants or doesn’t want
What she wants to do or not do
How she is feeling or that she is having difficulty coping with her feelings
That she doesn’t understand what you are telling her or asking her
That she needs more time to finish something
That it is hard to wait for something
That she has physical needs like hunger, being too hot or cold, or being in pain or physical discomfort
That she is having difficulty regulating sensory experiences (she is overwhelmed, or she is seeking sensory input)

Finding Help: Your Child’s IFSP/IEP Team

If you are ready to share your concerns and seek help, it is possible to request a meeting of your child’s Individualized Family Service Plan (IFSP) /Individualized Education Program (IEP) team. An informal behavioral assessment might be recommended before requesting a Functional Behavior Assessment, which is the standard comprehensive method of gathering information about your child’s behavior and determining the best intervention plan. Depending upon the guidelines of your program, the process might include steps such as the following:

Describe your child’s behavior (see list of possible behaviors above).
Describe what may have happened before the behavior occurred and after the behavior occurred.
Consider where and when the behavior typically occurs and who was involved with your child during that time.
Create a hypothesis or “guess” about what your child was trying to communicate (see list of possible functions above).
Discuss what to do to support new skills and to reduce the occurrence of the behavior, such as teaching a new skill that can replace the challenging behavior, supporting current skills that support positive behavior, changing or modifying the environment, or supporting coping and tolerance skills.
New IEP or IFSP goals might be established as part of the plan.
Once the plan is developed, your child’s behavior will be monitored to see how changes occur with the development of new skills and modifications in her program.

The IFSP/IEP team may recommend the more formal and detailed Functional Behavior Assessment (FBA). The process gathers the same information described above and additionally changes what happens before and after a behavior to see what is causing the behavior. The result of an FBA is typically a Behavior Intervention Plan (BIP). This process can take several months because of the time it takes to gather information, create a hypothesis about the function of the behavior, test the theory, and finally, develop a comprehensive and individualized plan.

Both “problem behaviors” and “challenging behaviors” affect your relationship with your child, and often it affects your family’s life as well. You are the “parent expert,” and with experience, you are becoming the “behavior expert.” Always know that your team is there to help you. You are the best advocate your child can have.