Saturday, April 29, 2017

Ever Had a Crisis Kind of Day?

Contributed By: Melissa Dubie, Educational Consultant
Let’s presume that you have already completed a functional behavioral assessment (FBA) and are implementing a behavior support plan because a student on the autism spectrum has continually displayed problematic behavior. Yet as you put the plan into place, the student’s behavior still rises to the crisis level. This article will describe behavior stages that any student in a crisis mode will escalate through when displaying extreme emotions. The stages may include: anxiety, refusal, release, and building rapport toward a resolution. In addition, helpful hints and proactive strategies in each of the phases will be described particularly when working with students on the autism spectrum.
When any student is in a crisis mode, his/her emotional state is high while his/her quality of judgment is very low. It is also important to note for some students’, behavior starts with anxiety and escalates through phases while others may come into your classroom already in the crisis mode. As a result, it is imperative that the one primary person that is trying to calm the student with ASD knows him/her well in order to understand all of the characteristics of their personality. In all circumstances, the goal is to recover from the crisis, work toward a safe resolution, and ultimately teach self-management.

Anxiety Stage

Students on the autism spectrum may feel anxiety about social situations, changes in routines, overload of senses, and environment stressors. A warning sign may be that he or she does things that are atypical. An example may be that the student is trying to calm him/herself by doing repetitive movements faster (e.g., rocking, hand flapping, pacing) or counting and repeating words. As staff members, our job is to be supportive. This means acknowledging the change in behavior and offering the student with ASD assistance using positive behavioral support strategies. Some of the ways may be to:
  • Allow more time to process information (e.g., may need 30 seconds to ten minutes). Make sure everyone is clear about the time needed for the student to process receptive information. Try giving one direction; then waiting the designated time before restating the information. If the time needed is long, try walking away from the student to help another child in class. Be patient. Then watch to see if the student follows the direction given.
  • Model ways to express the need for a break (e.g., visual supports, sign language signal to signal break time). Many students with autism need to have periodic breaks within the structure of their day to calm themselves. This time is essential and should not be thought of as a “reward time.”
  • Adjust the way the curriculum is presented to meet the student’s low frustration level and allow for adaptations on how the student shows mastery of the skill.
  • Identify sensory needs or movement differences that exist. Then with the occupational therapist, plan strategies to accommodate the student in the stated areas.
  • Possibly review the daily schedule by using photographs, symbols or words when the student first arrives at school to relieve the student’s anxiety.
  • Offer the student choices (e.g., first we’ll do this, then we’ll do that or show me which math papers you want to do first).
  • Consider any antecedents that the student with ASD may not have control over (e.g., changes in medication, weather, lack of sleep, poor nourishment).

Refusal Stage

When positive behavioral supports fail, the behavior may start to escalate. This will look like refusal to do the task or follow through the directions given. The student with ASD may walk or run out of the classroom, hide under a desk, sit with arms folded or refuse to talk. The staff needs to respond calmly by setting limits. Staff members need to make sure the limits are:
  • Clear and simple – Many students with ASD learn best by being given short phrases that are concrete (e.g., the bell to start class just rang, sit down at your desk). Don’t keep rephrasing a direction in many different ways in a short amount of time. Are you using too many words or trying to use a long explanation to reason with the student? Often the difficulty lies in our need to express a lot of information. Other students work better with choices or options. Always state the positive choice last so that if the student with ASD perseverates it will be on the positive option.
  • Reasonable – Remember that all behavior communicates a need and serves a purpose from the student’s point of view. Make sure the limitation that is stated is within the individual’s capabilities. The limit that is set may need to be flexible. For example, staff requests the student to return to a specific location after running out of the room. The student may move closer to the designated location but need additional space. Ask the student if you can approach him/her. If he/she says “No,” respect their wishes by allowing some space. Then try again after a period of time based on their processing time when agitated. Try to write a note in order to use less verbal requests. This process may take some time. It is important to wait. Listening to the student’s needs is an important part of setting reasonable limits.
  • Enforceable – When setting a limit, make sure that staff can follow through with the expectations. Do not overreact by grabbing or running after the student. The appropriate response by staff should only include verbal or visual redirection.

Release Stage

If time is not allowed or a solution has not been discovered for the student to calm down, then the behavior may escalate to releasing their anger by becoming self-injurious (e.g., head banging, biting, slapping themselves, yelling, crying, stomping feet, throwing objects). The student may also be aggressive or intimidate others. It is critical to realize that our behaviors may further escalate the situation. Below are some reactions to avoid:
  • Do not start setting firm limits after the student is calm.
  • Do not bring up past incidents that may have occurred on another day.
  • Do not judge the student or compare him/her to other students in class.
  • Do not lecture the student.
  • Do not make up consequences as the crisis escalates. State clearly the boundary or rule that the student needs to learn from the crisis experience. If a consequence must be applied, make sure it matches the function of the original behavior. The consequence needs to be immediate, relevant, and natural if possible.
Instead, solutions when students with ASD are at the release stage need to include:
  • Calming the student. Use a soft voice and talk slowly.
  • Getting other students in the classroom out of the area. Have another staff member take the class to an alternative setting (e.g., library, another classroom) or stay with the class if the student runs out of the room.
  • Having an administrator involved in all levels of the crisis.
  • Making sure that everyone in the situation is safe. Students that are apt to harm themselves when they are frustrated or scared will continue this behavior until they are taught another solution, and/or until the environment is altered correctly for their needs.
  • Being aware of how you handle crisis. Ask yourself: Am I overreacting? Under reacting? There are some interventions that should be done cautiously. Make sure you:
    • DO NOT physically intervene unless the student is being aggressive towards others in an uncontrolled manner. This has to be used only as a last resort. Remember some students with ASD crave deep pressure. As a result, physically holding a student who needs deep pressure will reinforce the inappropriate behavior.
    • DO NOT use any type of physical intervention (i.e. especially restraining a student) unless staff has been trained with specific instructions in these techniques. Also, consider the size and age of the student. The student should never be taller or stronger than the staff member. If physical intervention is essential, make sure that there are more than two people in the area helping the staff member.
    • DO NOT physically restrain a student unless the person who is the leader (one who is only talking) has considered whether the behavior can only be controlled if he/she is restrained. Remember that usually when a student is held, the behavior will escalate before the person calms down.
    • Ultimately the focus should still be on the student regaining control of their behavior. Be sure to set realistic expectations for the specific individual with ASD.

Building Rapport Stage

When rebuilding focus, the student should be calm. He/she may feel embarrassed, show no emotion, or laugh inappropriately. Often students with ASD show inappropriate emotions in uncomfortable situations. The student may not know how they feel and be unaware of how the staff is feeling during or after the crisis. The focus should be on re-establishing rapport with the student by:
  • Evaluating if the student is able to reason through the situation? It is important to know the student’s capabilities and respect how they process information even if it is different from the needs of the staff members.
  • Giving your undivided attention to the student by completely listening to the real message (e.g., using reflective listening, visuals).
  • Returning the student to a familiar setting. The student may need reassurance from a specific staff member before returning back to class.
  • Processing as a team after school or the next morning. The team of teachers who worked through this crisis need to individually write down what happened from their point of view. Then everyone needs to talk about the situation from his/her report. This will allow everyone time to express concerns, provide feedback to one another, and become more aware of the student’s needs. A plan will need to be developed (if not done already) and shared with the student and his/her parents so that everyone can work together to prevent crisis situations from occurring again.
  • Revising the original FBA and behavior support plan to re-identify the function of the behavior and the antecedents. An observation by an independent person (e.g., someone not involved daily) may be helpful to give more insights to the behavior. Often when the original plan is created, it will need to be tweaked as more information is discovered.
Effective interventions for students with ASD must include the recognition that all behavior has a function and communicates a message. The staff must learn to interpret these behaviors and attempt to teach alternative strategies involving the individual’s language processing time, learning style, sensory needs, social capabilities, and cognitive ability. Any person working with individuals with ASD will need to communicate with a group of people to constantly investigate different patterns, antecedents (triggers), and messages of the students’ behavior. Here are some general rules to keep in mind:
  • Students who engage in behavior that warrants a crisis approach, must have a behavioral support plan that is consistently followed.
  • Minimize your verbalizations in a crisis situation. Do not lecture the student.
  • If you continue to spend the majority of your efforts with a student in a crisis mode, then redo the FBA and reexamine the behavior support plan.
  • Crisis management is a short-term intervention that has no long-term or educational outcomes.
  • The outcome of a good behavior support plan is not that others can control the students in a crisis situation, but that the student can learn to self-manage or self-control.
  • Remember as professionals that the way we frame our responses to the student impacts their behavior and attitudes, and may add to the problem situation. Challenge yourself and your team members to be more proactive and positive. Follow the lead of the student by listening, watching, and waiting for the student with ASD to “show” their needs and address these before the crisis arises again.

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