FamilyConnect

By Carla A. Brooks

Introduction

The first three articles in this behavior series introduced the idea that you are the behavioral expert in your child’s life. You know more about your child than anyone else. While you celebrate new skills, you may also be concerned about behaviors that emerge during the toddler years. They are expected because they are common occurrences in children who are two or three years old and might be labelled as “problem behaviors.” They may be frustrating for you and your child who is blind or visually impaired, but they can change and improve over time. Understanding the different stages of skill development will help you recognize the possible causes of the behavior and learn ways to support them in a positive way. You might call this behavioral intervention approach “developmental.”

In contrast to these developmental behaviors, you may observe more intense and repeated behaviors that can occur at any age. These behaviors might be labelled as “challenging behaviors.” They are unexpected, worrisome, and confusing. Using a developmental approach may be some help, but it might not be enough. You may find that you need a detailed and structured assessment and an individualized and more complex intervention program to support your child, teach new skills, and decrease the behaviors. 

In the past, behavioral approaches were focused on eliminating unwanted behaviors, often using punishment of those behaviors and rewarding more appropriate behavior.  Use of these approaches with adults with significant developmental deficits as well as in special education programs in the schools began to be questioned in the mid 1980s. Research into person-centered planning, least restricted environments, and functions of behavior resulted in the study of new approaches.

As changes in these educational and adult care settings emerged, so did recommendations for parenting and childcare. More positive and non-punitive approaches were developed. What might be called a “classic” disciplinary approach was found to reduce self-esteem and to result in only short-term changes in a child’s behavior. 

New Behavioral Theories and Approaches

Behavioral theories help us to understand our child’s behavior. But the primary benefit of an accurate theory is the development of a successful intervention approach. In the past, behaviors were managed with the goal of eliminating the behaviors, often using punishment, and rewarding new behaviors. It was more of a “disciplinary approach.” More recent approaches focus on positive ways to intervene, starting with truly understanding the reason for the behaviors. Viewing all “behavior as communication” has become the standard for these newer approaches. There has also been increased attention to other reasons for behavioral differences. These include risk factors such as the child’s medical or neurological condition, any sensory impairment, and their social/emotional and attachment history. There is also consideration of environmental or contextual elements (places and people) that might serve as “triggers” for the behavior. 

The following are four of the approaches or methods currently being used in educational settings.

1. Positive Behavior Support (PBS) is an approach that offers a process for describing the behavior, understanding the functions or factors that contribute to the behaviors, and continuing and developing a plan to help in a proactive way.

2. A Functional Behavioral Assessment (FBA) is a method used to gather as much information as possible about your child’s behavior and the reasons it may be occurring. 

3. The outcome of an FBA is a Behavior Intervention Plan (BIP).

4. Positive Behavior Interventions and Support (PBIS) systems are now found school-wide from preschool through high school. 

Key features of a positive behavioral approach include the following: 

• Promotes social/emotional development
• Supports appropriate behavior by teaching new skills 
• Modifies the environment to prevent the behavior
• Puts prevention strategies in place before new behaviors occur

The use of positive behavioral approaches is now required by federal law (IDEA). Information can also be found on your state’s, county’s, or school district’s education sites. 

Parenting and child care guidelines also focus on a more positive way of supporting behavior skills at home and in daycare. Websites, books, and courses are available to learn more about using this approach. PBS (Public Broadcasting Service) has excellent articles that you might find helpful.

As the parent of a child with a visual impairment, your goals are to support your child through difficult developmental stages and to help him modify his behavior if needed. There is information everywhere you look once you know the key concepts, but talking to your child’s team is a great place to start.

Discipline: The Shift from Negative to Positive

It is important for a family to have rules and expectations about behavior. All parents want their child to be well-behaved, kind, and respectful. It is not unusual to feel that there need to be consequences for different behavior. In some families, behavior may be labelled as “good” or “bad.” There may also be a belief that “the child is the problem” rather than seeing that the “the child has a problem.” Even if these are not your beliefs, when you are frustrated, and everything you’ve tried has not changed the behavior, it might feel like your child is being willful or non-compliant. When you feel that way, you might react to the behavior rather than take a step back and support your child in positive ways.

No matter what your initial reactions are to “problem” or “challenging” behaviors, it is important to understand that discipline that focuses on eliminating these behaviors (while rewarding acceptable behavior) without exploring their functions usually results only in temporarily stopping the behavior. The other option is to do some problem-solving: think about what might be causing the behavior and how to change things that seem to cause the behavior in the first place. 

Classic disciplinary models are no longer considered an effective way to change behavior for any child, whether visually impaired or fully sighted. Discipline is sometimes seen as a control-based approach—with the adult in charge. The move to positive behavioral approaches is seen as responsive, respectful, individualized, preventative, and supportive of a child’s social and emotional development and offers long-term changes in behavior. The approach helps you focus on what your child needs and not on your need to keep things under control. Following this type of approach can help you raise a child who is positive, respectful, kind, and compassionate. It can also help your child build new skills and cope with any challenges presented by their differences in learning abilities or their visual impairment.  

The Role of Development in Positive Behavioral Approaches

One of the core concepts of positive behavioral approaches is that all behavior is an attempt to communicate needs or wants. Another core concept is that there are positive, supportive ways to respond to a behavior that help a child reduce the less desirable behaviors while developing new appropriate skills.  Understanding behaviors from a developmental perspective can help us understand both the reason for the behavior and how to help change the behavior. 

Behavior as a Response to Developing Skills: A Developmental Approach

During the toddler and preschool years, children are developing new skills at a steady and sometimes rapid rate. Even if your child has identified developmental delays, these changes are occurring. There are changes in motor, language, social, emotional, and thinking (cognitive) skills. For example:

• Toddlers are beginning to understand that they are different people, separate from their parents, and they are trying out ways to experience that. They want to be independent as their confidence increases. They want to do it themselves. 
• They want to have some control over their lives.  They want to make their own choices, and they also have a hard time waiting for you to get them what they asked for. 
• And they are sometimes confused by their emotions.  There can be wild swings from one emotion to another.  And the emotions just feel big to these two- and three-year-olds. 
• Toddlers also have new skills they are practicing and using, and sometimes, they aren’t skilled enough to do things without help. This causes them to be frustrated and to feel upset if you try to help them when they do not want help or to feel frustrated if you encourage their independent effort when they want help. 

Recognizing these developmental changes can help you understand the frustrating behaviors that occur during this period of time. Changes in behavior due to developmental changes can occur throughout childhood and into the teen years, so it is not just toddlers that experience frustration. The approach to helping your child get through these experiences is to let them know you understand it is frustrating and to help them cope with the emotions. You are actually teaching them new skills as you model ways to do that.

Behavior as a Response to Missing Skills: A Functional Behavioral Approach

As noted above, 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 developmentally appropriate forms of communication. Physical or vocal/verbal behaviors are used in place of what we would expect a child to use. Discovering what your child is trying to say with these behaviors can be a first step towards finding clarity and being able to support positive 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

Using the Functional Behavioral Assessment model, answering the following questions can help you and your child’s team gather the information that is needed to create a plan to help change challenging behaviors.

• What are the behaviors? Observe and describe or label the behaviors.
• Where do the behaviors occur? Describe the settings or environments where they occur.
• Who might be involved when the behaviors occur? Name the people who are in the environment before, during, or after they occur.
• When do the behaviors occur? Identify times when the behaviors tend to occur.
• Why do the behaviors occur? Create hypotheses about the functions or causes of the behavior.
• Determine what might happen before and after the behavior occurs
• Consider different functions of the behavior. Most researchers have identified three primary functions of challenging behaviors: 1) To gain attention or other desired events (wants and needs); 2) To escape or avoid undesired events or activities; 3) As a response to a physical or sensory experience (pain, discomfort or to feel good).
• How often do appropriate behaviors occur? Ask all the above questions about these behaviors.
• What happens when replacement behaviors are taught, the environment is changed, or triggers are removed?

In summary, both “problem behaviors” and “challenging behaviors” affect your relationship with your child who is blind or visually impaired, and they often affect 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 and that there are positive ways to support your child at home, in the community, and in school. You are the best advocate your child can have. Recent changes in behavioral theories have led to intervention strategies that respect your child and help build skills that will make a difference in his or her and your family’s life.