012 664 8871 dsat@downs.org.za

Challenging Behaviour

Ancella Ramjas

Specific Outcome:

Understand what is meant by challenging behaviour and how to implement useful strategies in preventing disruptive and challenging behaviour.

Terms used to describe persons with Down Syndrome:

  • People with Down Syndrome are “Special”
  • People with Down Syndrome are “Gods Angels”
  • People with Down Syndrome are always “Happy”

The terms we use to label our children often dictates the way we treat them.

There is a perception that you cannot discipline a person with Down Syndrome because they don’t understand what you are saying or trying to teach them.

“If a child doesn’t know how to read, we teach”
“if a child doesn’t know how to swim, we teach”
“If a child doesn’t know how to multiply, we teach”
“If a child doesn’t know how to drive, we teach”
“If a child doesn’t know how to behave, we
……….teach?        ……….punish?

“Why can’t we finish the last sentence as automatically as we do the others?”

What is challenging Behaviour

Challenging behaviour is defined as that which results in “self-injury or injury to others, causes damage to the physical environment, interferes with the acquisition of new skills, and/or socially isolates the learner.”

One of the characteristics long associated with individuals with Down Syndrome is their tendency to be stubborn.

Challenging behaviour take on many forms such as:

  • Non – Compliance
  • Compulsions – rearranging objects and repeating certain actions
  • Social withdrawal
  • Self-talk
  • Attention problems
  • Aggression
  • Tantrums
  • Inappropriate oral sounds
  • Laughing/giggling
  • Swearing, screaming and yelling
  • Biting and pulling of hair
  • Mishandling objects- throwing, tearing
  • Close physical contact- hugging kissing and touching
  • Self-injury, injury to others

What motivates challenging behaviour:

  • To obtain (Socially motivated) Attention from parent
  • Access to snacks, treats and toys
  • Access to certain activities such as trips, plays

Socially motivated behaviour involves those in which the child seeks to obtain/escape something from another individual in their environment. Behaviours serving a social function in children with developmental disabilities are often related to impairments in communication skills.

Examples of this behaviour:

  • Tantrums
  • Approaching a forbidden area
  • Grabbing of the forbidden snack or toy
  • Biting, screaming and yelling

To avoid – escape (Non-socially motivated)
Interaction with other children
To avoid certain foods
To avoid certain activities

Non-Social motivated behaviours involve those in which the child seeks to escape or avoid situations in which they are not comfortable with. These non- social motivated behaviours are often referred to as “self-stimulatory” behaviour.

What is Self-stimulatory behaviour?

Self-stimulatory behaviour is when an individual engages in the behaviour because it either feels good i.e. he/she is obtaining some type of pleasure from the act or trying to escape an internal stimuli i.e. a young child trying to escape the pain of an ear infection.

Examples of this behaviour:

  • Disruptive tantrum behaviours (throws and breaks objects)
  • Charming and cute behaviours (comes and give you a hug)
  • Task avoidance behaviour (doesn’t like the task given or is unsure of what is expected from them)

Additional factors that can have an impact on behaviour:

Biological Factors

A higher incidence of illnesses may significantly increase the likelihood of challenging behaviour.

  • Upper respiratory infections are very common in children with Down Syndrome due to their low immune system.
  • Otitis Media – can lead to hearing loss (collection of fluid in the ears).
  • Sleep apnea (stop breathing during sleep)
    This can result in the child feeling very Lethargic, tired and irritable.
  • Poor eyesight
  • Medications

Social factors

Poor speech can lead to high levels of frustration as it isolates individuals from peer interaction. Cognitive differences between the child with Down Syndrome and their peers become wider as they get older. Remember that their receptive language is better than their expressive language.

Family

Divorce, death of a loved one or relocating to a new area.

Environment

  • Large crowds and loud music. This can lead to high levels of anxiety, stress, depression and withdrawal and can also increase with age.
  • Too hot or cold (known to take off all their clothes)
  • Sensitive to light

Changing Routine

Most individuals with Down Syndrome struggle to adapt to new situations.
They display different behaviour within a structured home environment and can act completely different in an unstructured environment e.g. to the malls, playground and new places.

Boundaries

They struggle with recognizing their physical boundaries therefore it is very easy for them to wander away as they are easily distracted by more “interesting events” taking place elsewhere. Boundaries need to be visually and physically defined.

Self – Talk

Talking to themselves or an imaginary friend. They resort to self-talk when they find themselves in stressful situations. They also tend to this when they want to sequence the days events.

Remember mis-behaviour is part of normal development. One needs to make the distinction between normal mis-behaviour of early childhood and behaviours that are becoming disruptive and destructive.

So when do we intervene? When behaviour takes control over all aspects of your life.

Family – marriage, neglect of the other children.
Work – continuously called to remove child from place of care. Socially – when you can no longer go out to eat, to shop or on trips.

Feelings of parents

“I am so frustrated by these behaviours, some days I feel so incompetent, sometimes I cry not because he is hurting me but because I don’t know what to do with him.”

To understand such behaviour is to gain an understanding of the function that the behaviour serves for a particular child.

So how do we prevent challenging behaviour from entering the repertoire of individuals
with Down Syndrome.

Three steps to positive behavioural support to ensure successful intervention

We apply the ABC model:

  • Antecedent – What triggered the event?
  • Behaviour -What is the child’s response after the event?
  • Consequence – What action was taken after the event occurred

How can this be done?

  1. Data collection: interviews, observations, surveys & checklists identify: the behaviour of concern, factors triggering the behaviour, with whom, what activity and frequency.
  2. Assessment and analysing of behaviour: recording of behavior through a behaviour chart
  3. Support strategies: Preventative strategies, skills building strategies and motivation and reinforcement strategies.

Behaviour management is a skill we need to learn and only acquire over a period of time. Behaviour management needs to be based on “common sense”, consistency, courage and a sense of fairness. We also need to be willing to learn from our mistakes.

Behaviour Support Chart

Date What triggered it How did child respond How did you respond Setting event Strategies used

Time

Asked to do something

Refused

Demanded he do it

Tired

Choices

Changed to another activity

Refused to change over

Became angry
Shouted at him

Confused

Allow enough time

Removed an object

Bit, screamed, kicked

Time out

Unexpected loss

Teach him to ask

Playing alone

Pushed his way in

Removed him/her

Lonliness

Social attention

Wanted my attention

Throwing objects

Ignored

Illness

Reassure

Difficult task

Cried, stubborness

Insisted he complete

Afraid of failure

Make it easier

Circle time

Did not want to paticipate

Allowed him not to

Too loud

Bring him in at a later stage

Brushing teeth

Refused

Brushed his/her teeth

Water too
hot/cold

Visual pictures

Switched off the TV

Threw you with something
kicked the TV

Punished

Bored

Play fun activities

Consequences: must fit the crime must follow through
keep it small and simple

Give them responsibilities
It gives them a sense of being
valued.

Repetition, Repetition

To help to transition from one activity to another

Children with Down Syndrome are strong visual learners

  • Provide him/her with a picture schedule to help him understand the transition
  • Use a timer to help him/her prepare for the transition
  • Use clear simple language to warn that transition is about to happen
  • Include times on the schedule when he/she can do the things they like to do
  • Write a story about what he should do during transitions and read it to him each day
  • Role play with practicing the transition time but do it when the person is not upset
  • Praise their efforts
  • Offer choices
  • Join in the activity
  • Teach request behaviour

Provide emotional support

  • Are being listened to
  • Acknowledge their feelings
  • Feel encouraged
  • Feel liked and loved
  • Feel respected
  • Have rules and limits
  • Have routine and structure
  • Are forgiven
  • Are disciplined
  • Feel secure and accepted

Accessing early intervention from an early age is critical for the optimal
development of children with Down Syndrome.

Create high quality environments

  • Safe and free from hazards
  • Clean and free of clutter
  • Inviting, interesting, colourful
  • Comfortable spaces for movement
  • Reading books and sensory exploration materials should be at a level where children can reach them

Children with Down Syndrome love to copy cat other children so place them into stimulating and positive environments so playgroups and nursery schools is an ideal place to learn positive social skills

Age appropriate skills strategies:

Age: 3 – 5 (Social Skills)

  • Facilitate friendships
  • Please, Thank you
  • Greetings
  • Turn taking, sharing

Age: 6 – 10 (Strive to be like their peers)

  • Place child next to someone who’s behaviour is appropriate
  • When you want the child with Down Syndrome do something praise the child next to him/her

Teach young children
about the different states of emotions

In the Zone

Red

Extremely angry Out of control Need help

Yellow

Not so angry
Between the red and green
Need some help

Green

Able to handle my feelings
I can manage
I’m okay

Nursery Song

“If you happy and you know it clap your hands”
“If you angry and you know it stomp your feet”
“If you need help and you know it raise your hands”

In conclusion:

“Interactions between children, parents, caregivers, interventionists and teachers are all critical in promoting children’s social- emotional development, young children develop their self-image and understanding of the world based on these interactions”.

Good Role Models

Children who have positive relationships, self-confidence and social skills are less likely to engage in challenging behaviour.

Thank You