Using a skill-based treatment approach to address problem behaviours in the early years
Updated: Dec 29, 2020
“There comes a point where we need to stop just pulling people out of the river. We need to go upstream and find out why they’re falling in.” - Desmond Tutu
I have a 'bee in my bonnet'! If you're living in a part of the world where that makes no sense at all, then I will explain. It means I am obsessed with something and can't stop thinking about it. What is your 'bee' you ask? I'll tell you.
My 'bee' is the concern I have about the increasing prevalence of suspensions of young children in Australian schools. A recent news article claimed that 1067 prep children in Queensland schools were given suspensions in 2017 (Baker, 2019). The report raised concerns about children being sent home because of problem behaviours that may be caused by undiagnosed conditions such as Autism or ADHD. Whether a child is diagnosed or undiagnosed with a disability, this shouldn't be occurring at such high rates. Why are suspensions happening in such large numbers among children who are 4 or 5 years of age? Look, to be honest, I have several bees flying under my bonnet about this topic and, that is the first one!
I wish I could provide a simple answer to the question about the suspensions, but I can't. There are far too many variables beyond the school setting that are impacting on the ever-increasing rates of problem behaviour in the early years. I won't be addressing those issues within this blog, because often they are out of the control of schools. My concern is with what schools may be able to control and the practices that could effectively lessen the likelihood of a child engaging in problem behaviours in the early years' settings. That is my second bee!
'At risk' is a term often used within the education sector. Students recognised as having a higher probability of failing or dropping out of school are considered 'at risk'. A variety of external factors can contribute to a child being 'at risk' such as poverty, unemployment, homelessness, family breakdowns or domestic violence. These factors, among many others, can often result in a student engaging in problem behaviour and can also be an indication of particular skill deficits. Understanding why a student engages in problem behaviours is key to ensuring they receive an effective individualised intervention in the school context. Is the task too difficult for them? What is the child getting from engaging in challenging behaviour? Is it to gain attention from adults or peers? Is it to get out of doing a hard task or the need to gain access to a preferred item or activity?
If a child does not have the skills to tolerate having to wait or being told "no", can't follow a simple instruction or can't attend to their name then it is unlikely they can learn effectively. Tolerating changes to routines; an inability to respond to teacher instructions in a variety of different learning environments or working cooperatively with others can result in an increased likelihood that a student may engage in problem behaviours. For example, if I don't have the necessary skill to ask for something I want appropriately, ask for a break or some adult attention, I might throw myself on the floor and scream. The adults in the room will come running and often hand over what I wanted to stop the screaming. I have now learnt an effective way of having my needs met. It's not appropriate behaviour and, it's quite tiring but, it gets me what I want. Boy, if only there were another way to ask for something I want that requires a little less energy. Yes, there is! Currently, several effective programs and curriculums are using the principles of Applied Behaviour Analysis to address issues of problem behaviour. I will be discussing several of these programs over a series of blogs.
A few weeks ago, I was fortunate to attend a 2-day workshop over in the US presented by Dr Greg Hanley. To give you an indication of the amount of work Dr Hanley has done in addressing challenging behaviour; his CV is an impressive 60 pages long. Ongoing research carried out by Dr Hanley, and his colleagues have focussed on the assessment and treatment of problem behaviours often associated with Autism or other developmental disabilities. Dr Hanley describes problem behaviour as "an accident of learning" - if I have learned that throwing myself on the floor will get me out of school work AND that it will also gain the teacher's attention, then that's what I'll do!
The Practical Functional Assessment and Skill-Based Treatment process is an effective response to both the assessment and treatment of severe problem behaviour. Several appealing aspects drew me to this approach. This first is on ensuring the safety and dignity of the child. The second is the importance of developing a strong rapport with the learner and establishing a positive learning environment. The third super appealing aspect was that I didn't need to arm myself with materials such as stickers, edibles, token boards or timers!
Firstly, to gain more insight into the functions that may be maintaining the challenging behaviours, a Practical Functional Assessment (PFA) is completed with someone close to the child. An open-ended interview can provide vital information about the problem behaviour. The information gathered via the PFA is then used to inform a quick and safe functional analysis to identify what contingencies are reinforcing the problem behaviour. Once a relationship has been defined between the problem behaviour and the suspected reinforcement contingency, it's time to progress to setting up conditions where we can teach skills.
A skill-based approach (SBT) teaches and supports the child to acquire the necessary skills to effectively communicate their wants and needs in a more socially appropriate manner. Hanley (2019) describes the skill-based treatment as a method of providing a child with functional communication skills to build and develop their social repertoire. A simple example of this is teaching a child to appropriately ask for something they want rather than engaging in maladaptive behaviours such as tantrums and aggression. A process known as 'shaping' moves the learner from a simple to a more socially acceptable response rather than engaging in problem behaviour. Once the learner begins to initiate the responses independently, the process moves to teach tolerating delay and denial of reinforcers. The process then continues into slowly introducing the learning of contextually appropriate behaviours such as looking up, handing over an item or pausing an activity; then gradually moving towards more complex instructions. The child must meet specific criteria before moving onto each step in the chain. The contextually appropriate behaviours should suit the needs of each child to ensure they can eventually transition successfully to learning in the classroom. A chain of contextually appropriate behaviours may be instructing the child to stop the activity they are doing, move to their desk, sit down, hands-on desk, ready to learn across multiple activities.
This process was a complete game-changer for me in terms of dealing with problem behaviours as they occur. Dr Hanley stresses the importance of always ensuring the child is in a happy, relaxed and engaged (HRE) state both before and when you are working with them. It is a critical element in the success of this process. Along with the priorities of safety and rapport, Dr Hanley also shared a new but useful and valid word I had not heard before - "televisability". What he was referring to here is an important issue we often face when we are dealing with challenging behaviours - is the treatment we are providing to the child valid enough to be televised on the nightly news? A relevant word to focus on each time we engage with a child who has challenging behaviour.
Teachers, teacher aides and parents can be trained to implement each step of the skill-based treatment and, due to their relationships with the child, it is a preferable option. This process can be applied within the school environment but would require initial sessions to implemented in an area outside the classroom. The final goal of this process is for a child to live free of problem behaviour and achieve socially significant outcomes in all areas of their lives (Hanley, 2019).
One drawback of this process is the lack of staff with behaviour analytic knowledge and skills in Australian schools. The Practical Functional Assessment and Skill-Based Treatment process do require a Board Certified Behaviour Analyst (BCBA) to oversee all procedures to ensure the integrity of its implementation. Schools must begin to recruit knowledgeable and skilled professionals to work in the area of behaviour. Staff who have a sound understanding of the scientific principles of behaviour are one of the key elements to reducing suspensions due to problem behaviours. You can find information about the credentials for Registered Behaviour Technicians (RBT), a Board Certified Assistant Behaviour Analyst (BCaBA), Board Certified Behaviour Analyst (BCBA) and Board Certified Behaviour Analyst-Doctoral (BCBA-D) through the Behaviour Analyst Certification Board. Monash University offers a Masters of Education in Applied Behaviour Analysis and, as of this year, Griffith University will be offering both a Graduate Certificate and Masters in Applied Behaviour Analysis. In 2018, Victoria introduced a BCBA Pilot program to support students with challenging behaviours in schools. Applied Behaviour Analysis is a growing field in Australia, and currently, there are not enough of us. In a perfect world, I would like to hope that one day, in the not too distant future, there will be at least one BCBA in every school region in Queensland (and every other state) at a minimum.
I believe we can do better when addressing the problem of challenging behaviours in the school environment. It also begins with capacity building at a school level by providing teachers and school staff with support in effective research-based practices around behaviour management. Change in mindset within the education system is the key to reduce the rate of suspensions effectively. Inclusion is not a 'one size fits all' approach and is not about sitting a child at a desk, with the expectation they will conform. It is about acknowledging a child's learning strengths and differences. And, we need to change our focus from purely academic success to social and emotional success as well. It's equally important that students are achieving positive, socially significant outcomes in our schools.
So, my final bee is the frustration of why can't we can do better about this issue? We can! I know the external variables I mentioned earlier can have a significant impact on a child's success at school. However, educators can influence and guide a child to achieve success using practical and useful tools that can assist with the identification and support of students, enabling them to become socially successful and independent learners within the school environment.
In response to the quote at the beginning of my blog - we can't just keep pulling young children out of the river without the acknowledgement of and attention to the skill deficits they may have. Let's address these skill deficits, so they don't keep falling in. It is possible to do much better than we are currently doing for 'at risk' students in the classroom. #dobetter
Baker, J. (2019, November 15). 'It doesn't make sense': More than 600 kindy kids suspended last year. The Sydney Morning Herald. Retrieved from: https://www.smh.com.au/national/nsw/it-doesn-t-make-sense-more-than-600-kindy-kids-suspended-last-year-20191115-p53b42.html
Ghaemmaghami, M., Hanley, G., Jessel, J., & Landa, R. (2018). Shaping complex functional communication responses. Journal Of Applied Behavior Analysis, 51(3), 502-520. doi: 10.1002/jaba.468
Hanley, G., Jin, C., Vanselow, N., & Hanratty, L. (2014). Producing meaningful improvements in problem behavior of children with autism via synthesized analyses and treatments. Journal Of Applied Behavior Analysis, 47(1), 16-36. doi: 10.1002/jaba.106
Practical Functional Assessment. (2020). Retrieved 2 February 2020, from https://practicalfunctionalassessment.com/
Santiago, J., Hanley, G., Moore, K., & Jin, C. (2015). The Generality of Interview-Informed Functional Analyses: Systematic Replications in School and Home. Journal Of Autism And Developmental Disorders, 46(3), 797-811. doi: 10.1007/s10803-015-2617-0