Addressing Challenging Behaviors During Intervention
Categories: Increase Your Effectiveness - Tips for SLPs
I don’t know about all of you, but I came out of my master’s program in speech pathology with ZERO skills to address challenging behaviors. I don’t remember having a single classroom discussion about challenging behaviors. Maybe I was lucky that the clients I saw at the university clinic were all well-behaved so it just never came up.
So when I hit the scene as a clinical fellow at the Kennedy Krieger Institute in Baltimore in 1997, I was in for a rude awakening. I remember walking out of one evaluation with my head hanging low, just waiting for my supervisor to pull me into her office. I was waiting to hear, “What the heck was that?” Martina Rao, my CF supervisor, however, was far more diplomatic than that. She kindly walked me through some steps to more successfully support children with limited attention and challenging behaviors in future sessions.
Since then, I’ve gradually added tricks to manage challenging behaviors in therapy, and I continue to build my skills. I am still in awe of those in our field who take on the children with the most challenging behaviors. Patricia Villarreal Ybarra, who worked with us at Bilinguistics before moving to San Antonio, was one of those. She had an amazing skill set that could turn trantrums into tranquility. She shared many of her approaches in Life Skills Speech and Language Enrichment Activities.
Recently, I presented at a conference in El Paso and had the good fortune to sit next to Sheryl Wilcox at lunch. Sheryl was also a presenter at the conference. Unfortunately, we presented at the same time so I did not get to hear her speak. BUT, I got to sit next to her at lunch and learn about what she does. Sheryl works in the Socorro Independent School District in west Texas, which serves approximately 48,000 students. Sheryl Wilcox, like Patricia Villarreal Ybarra, found a calling in addressing significant behavior challenges in children who receive speech therapy services. She has become her district’s go-to person for all things behavior.
When we met in El Paso, I asked Sheryl if she would be willing to contribute to a blog post on addressing challenging behaviors in speech therapy. She happily agreed. I asked the following questions:
Sheryl, what are your top three tools for addressing challenging behaviors in speech therapy?
First I always start with understanding what behavior is and isn’t! Behavior is a VERB! Not an adjective or a person’s identity. Ever hear, “Here comes Mr. Talks A Lot or Ms. Attitude or The Runner or the Biter” etc…? You get the picture and so do they. They hear you label based on the behavior and from then on they never fail at showing you they can live up to their label.
When we take the time to view behavior as a verb, an action that is about to occur or has passed we can separate our feelings and focus on how to replace or change that verb. How do you do that, Ms. Sheryl? Well… it starts with you and your positive attitude. Asking proactive questions like “What is their purpose? Is it to gainor avoid? What are they communicating to me in that moment?” Change in mindset questions: “What social skills are they missing? What emotional skills are they lacking? What can I teach them to do before or right after?” When you can see the behavior as a verb and can categorize it into gaining or avoiding then decide what their needs are, you can move forward with a simple plan.
Second, I set my expectations by focusing on what I want rather than what I don’t want. Expectations are the opposite of RULES. Rules are authoritative and meant to be broken, whereas Expectations are positive, simply stated and directly address what you want from your kiddos. Take your RULES and ask yourself, if I don’t want them to hit then what do I want them to do? What should they be doing with their hands? If I don’t want them to run then what should they be doing instead? Sitting? Well let’s start there!
Third, I always work on one social or appropriate behavioral skill at a time. I start with safety first, like sitting to reduce running or wandering. Every time we enter that room or start that task, we sit in a chair with our feet touching the ground or on a box to establish stability and give that person the kinesthetic feedback they need that they are actually sitting. Sitting in a chair is formal and helps to maintain attention. What do we do with our hands, our back, and our heads? There are so many steps to just sitting that we can focus on and teach explicitly! I focus on how to keep hands to themselves to reduce hitting or fidgeting. I utilize social stories, video modeling, peer modeling and quick positive reinforcements when they are keeping their hands to themselves to increase self-awareness. These are just examples of how I teach what I want by working on one to two behaviors until mastered or nearly mastered. Start with the foundation tasks that we assume everyone has like sitting or keeping hands to yourself and stay there in those moments with them until they grasp that skill.
What do you do when you have students who consistently disrupt speech therapy groups and make you feel like you are not able to address the needs of the others in the group?
We first set our Expectation to “We will wait our turn during speech.” Then I role play the expectation with all students and practice. As soon as the child waits their turns or listens quietly I quickly reinforce with positive statements. “I like how you are waiting for your turn and listening quietly.” I bring it to their attention when they are on task with listening. When they need the re-direction I always state “Someone is speaking right now. What should you be doing?” When they respond with the correct expectation of waiting for their turn then I state “Show me.” If you have set up your expectations, role played and practiced then re-teaching through re-directions will come naturally. If they are not able to respond with the correct expectation then we take that time to review, role play and practice. I use every opportunity to teach and re-teach what I want. You may think this is time consuming but I can guarantee that you will spend the same amount time begging them to be quiet, sit and listen and quit interrupting as you do in actually teaching them. Stay positive, stay in the moment and teach it!
How do you collaborate with other educators to provide positive behavior intervention support for your students?
I advocate for all professionals to focus on what they want instead of what they don’t want. Do you see a pattern here? Well, it’s something I feel needs repeating and reminding for all involved. I offer classroom lessons in behavior management through listening skills, social stories and role playing. I work with others on Behavior plans and help to gather data to address the behaviors. I support teachers and other Speech Therapists by observing the behaviors occurring and then directly modeling interventions in that moment. I stay in the environment in which the undesired behavior is occurring. This is important because once you remove the student they have difficulty learning how to act in that area.
How do you get parents involved in the process of addressing challenging behaviors that are happening at school?
I offer parent trainings to my parents and do the same with them as I do the professionals. I introduce the basics of what behavior is and if it is being used to gain or avoid. I help them decide which one or two behaviors they want to reduce or replace. I show them hands-on how to teach the social skill and/or behavioral skill needed and then have them practice with me there to help guide both parent and child. I give them strategies that suit their abilities and schedules.
Have you ever felt like there was a student you just couldn’t handle? If so, what did you do?
Always! So many behaviors and so little time! I remind myself to take a step back and not take it personally. Once I remove my emotions and my needs then I step back in with a new mind set, a more positive one. I observe more often if I need to and collaborate with the rest of the team. There is always a team! I ask my positive questions regarding the verb! What do I want instead of this? How can I teach that new skill? I give myself permission to work on one or two skills at a time. I tell myself I am only a small part of their journey and I always celebrate the smallest of victories through verbal positive reinforcements!
One final note, change that long-winded discussion of what you don’t want to positive lessons focused on what you do want. Have you ever been given general directions from your boss and suddenly you screw it up and are then told how you should have done it? Your first thought “If you just tell me exactly what you want the first time then that’s how I would have done it!” Well Bingo! You just experienced every day in the life a child with behavior difficulties. Tell them, show them and expect what you want! Sheryl L Wilcox, M.S. CCC-SLP
Thank you to SLPs like Sheryl and Martina who support our growing needs as SLPs to effectively support our students and clients. For additional information, ASHA also provides information on supporting the diverse behavioral needs of those we support.
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Thank you for addressing this issue. I’m still working on it. After an early disastrous session in grad school, a friend who was a counselor with the school’s special ed dept. gave me some helpful tips. She told me that my session begins not in the therapy room, but when I fetch the child from the classroom. The task of setting and teaching my positive expectations begins at that moment.
It’s great to have colleagues with helpful tips! And it is so true that every moment counts.