Reduce Maladaptive Behavior in Children with Disabilities

Extinguishing a behavior in a child, normally with a disability, is done only when the behavior puts the child or others at risk of injury, or the behavior is so maladaptive that it will severely impact the child's life in a negative manner if left unchecked. Like all behavior modification, it is done with great care, with a well thought out plan with input from all adult participants in the child's life.

Understanding
Before making a move, it is crucial to understand what purpose the maladaptive behavior serves. This way, you can decide whether or not it should be discouraged, and what coping mechanisms you could provide as replacements.
 * 1) Figure out why the disabled child acts maladaptively. Determine what happens before each incident, and how that makes the child feel. You cannot help a child with maladaptive behavior until you understand how it works. [[Image:Extinguish Maladaptive Behavior in Children with Disabilities Step 13.jpg|center|550px]]
 * 2) *If possible, ask the child directly why they do that. During or after the episode, ask the child what went wrong and why they acted the way they did. Usually they have specific needs that are not being met.
 * 3) *Checklists exist for helping determine the reason behind maladaptive behaviors.
 * 4) Sometimes, the best solution is not to train the child, but to remove the stressor. For example, if a girl only hits her head when seeing her therapist and being told "quiet hands," then she is trying to communicate that she is being mistreated. Find her a respectful therapist and the maladaptive behavior will cease. [[Image:Girl Cries as People Talk.png|center|550px]]
 * 5) Ask yourself why you want to change the behavior. Is it causing direct harm (such as self-injury or screaming loudly around other people) or is it merely strange (e.g. flapping arms)? Take a day or two to ponder this question. [[Image:Convince Your Dad to Let You Buy Ringtones Step 1.jpg|center|550px]]
 * 6) *If the behavior doesn't cause real harm, then getting rid of it will probably cause more harm than good. Forcing people to appear "normal" is a waste of time that will ultimately diminish their self-esteem and tire them out.
 * 7) Consult the disabled community to find out what purpose the behavior serves, and if it is harmful or not to get rid of it. [[Image:Autism Discussion Space.png|center|550px]]
 * 8) *Sometimes, well-intentioned people will extinguish a behavior, only to find out that their actions are robbing the disabled person of an important coping mechanism. This can be abusive and traumatic to the disabled person.
 * 9) *For example, if you want to understand an autistic boy, then ask autistic people, because they experience the feelings and urges themselves.

Talking to the Disabled Child
Older and/or more mature disabled children may need only emotional support in order to quit a maladaptive behavior. No matter the child's maturity, talking with them is an important step in helping them recognize that you're going to help them cope better.
 * 1) Take the disabled child aside and explain your position. Tell them that you see them doing a maladaptive behavior, that it upsets you to see them so upset, and that you'd like to help them find a way to cope better. [[Image:Convince Your Parents to Let You Buy Something Expensive in a Short Amount of Time Step 10.jpg|center|550px]]
 * 2) *Chances are, the child does not enjoy maladaptive behavior. For example, a boy who scratches his arms probably doesn't like the pain and injury that follows; he does it because he doesn't know how else to cope. He may be very pleased to learn that he can scratch his sweatpants or thin sleeves to get the same sensation on his body without leaving marks.
 * 3) Work together with the child to brainstorm potential solutions. Pull out a piece of paper and create a list of alternative behaviors. Encourage your child to come up with ideas. This will help them feel ownership over their treatment, and it makes them more likely to remember and implement the strategies. Consider... [[Image:Child Anger Management Strategies.png|center|550px]]
 * 4) *Ways to minimize triggers (e.g. bringing earplugs or headphones, taking breaks from stressful situations)
 * 5) *Alternative actions (e.g. shaking the head instead of hitting it, fidgeting with a stim toy instead of ripping all the paper in the house)
 * 6) *Creating an action plan (e.g. coming up with a hand signal that means "get me out of here" when the child notices stress building up, so she can calm down somewhere quiet instead of pushing herself to the point of explosion)
 * 7) When you see the child engaging in the maladaptive behavior, ask them to use the replacement behavior instead. For example, if your son screams when upset, calmly ask him to take deep breaths and tell you what's wrong, just like you brainstormed together. [[Image:Man Helps Unhappy Child.png|center|550px]]
 * 8) *Be gentle with the child. Maladaptive behavior often emerges during stress, so (s)he may not be thinking clearly, and may need extra reminders.
 * 9) *Remind the child why the replacement behavior is good. For example, "It's hard for me to help you when you scream. If you talk to me and tell me what's wrong, then I'll understand why you're upset, and I can help you fix the problem."
 * 10) Encourage the child when they begin to use the replacement behavior. Praise their efforts and tell them how proud you are of their skills.[[Image:Extinguish Maladaptive Behavior in Children with Disabilities Step 11.jpg|center|550px]]
 * 11) *For example, "I noticed that you were getting mad, and that you started to take deep breaths and walked away. I'm really proud of how strong and mature you were. Good job!"
 * 12) *Emphasize why they did a good thing. This helps them learn the distinction between people-pleasing and constructively taking advice. Never pressure the child or teach them to comply for compliance's sake, as this will hamper their social skills as an adult.
 * 13) Younger children may benefit from a reward system. For example, each time a girl successfully uses breathing techniques to calm herself, she gets a gold sticker to place on her chart. When she fills the chart, you bring home a treat from the grocery store or let her pick out a small toy.
 * 14) *Avoid overusing reward systems, because the child may become too dependent on approval. Reward systems should be phased out as a child gets older. The child/teen should learn how to set boundaries and say no, so they can be safe.
 * 15) Keep clear communication between yourself and the child. Treat the child's communication (verbal and nonverbal) with respect, and always presume competence. Talk regularly to the child so they know what's going on and what's in your mind. That way, the child will trust you and talk to you if a problem arises. [[Image:Convince Your Dad to Let You Buy Ringtones Step 5.jpg|center|550px]]

Outside Intervention
Serious maladaptive behavior may require a coordinated effort and a reward-based plan. Only use an intervention plan for severe maladaptive issues, because this level of intervention can unravel a child's agency and self-esteem if used often.
 * 1) Call a meeting of caregivers. Bring every person (parents, therapists, teachers, older siblings) who will be involved in replacing the maladaptive behavior. It is best if everyone meets at the same time and place so that no misunderstandings can exist.  [[Image:Extinguish Maladaptive Behavior in Children with Disabilities Step 1.jpg|center|550px]]
 * 2) *One team member should take notes or record the meeting. [[Image:Extinguish Maladaptive Behavior in Children with Disabilities Step 2.jpg|center|550px]]
 * 3) *Describe and define the target behavior so that there is no confusion as to exactly what the problem is. [[Image:Extinguish Maladaptive Behavior in Children with Disabilities Step 3.jpg|center|550px]]
 * 4) Use praise and/or tertiary reinforcers to encourage the child. A tertiary reinforcer is something above and beyond what the child normally has as a part of daily living. Examples include a special movie, earning money towards a purchase of a book or toy, etc.  [[Image:Extinguish Maladaptive Behavior in Children with Disabilities Step 4.jpg|center|550px]]
 * 5) *Removal of something normally found in the child's life is considered punitive. It is best to avoid that for this purpose.
 * 6) Develop a BIP (Behavior Intervention Plan) also, especially if the child is likely to engage in SIB (self-injurious behavior) should the reward not be earned. [[Image:Extinguish Maladaptive Behavior in Children with Disabilities Step 5.jpg|center|550px]]
 * 7) Encourage everyone to be firm about the plan. Those involved must agree to stick to the plan, and not give in even if the child throws a tantrum in hopes of getting the reward. When the behavior arises, give a warning, and make the decision final if the child continues. [[Image:Extinguish Maladaptive Behavior in Children with Disabilities Step 6.jpg|center|550px]]
 * 8) *Giving in to a tantrum will hurt the child in the long run. If you do this, you have destroyed the plan and will need to create a new one in most instances.
 * 9) Talk to the child and then implement the plan. In the beginning, clearly explain to the child that it upsets them to see you struggling, and that you want to help them cope with it. If possible, talk to them about ways that they could cope with the trigger. [[Image:Extinguish Maladaptive Behavior in Children with Disabilities Step 7.jpg|center|550px]]
 * 10) *Present a clear coping mechanism that they can use in place of the maladaptive behavior. Simply telling the child "stop biting your arms" will leave them confused about how to deal with overwhelming emotions. Telling them "instead, you can bite on these chewy bracelets and take a break if you need to" will help them envision how they can act constructively.
 * 11) *Don't feel discouraged if the child doesn't start improving right away. Learning new coping behaviors takes time, and there may be a delay before the child understands what to do.
 * 12) When the child earns the reward, they will quickly figure out that using the new behavior is better than using the maladaptive one. There may be some lapses, due to severe distress or confusion, but in time the child will begin to use the better coping method all the time. [[Image:Extinguish Maladaptive Behavior in Children with Disabilities Step 8.jpg|center|550px]]
 * 13) Meet with the implementation team regularly to determine the effectiveness of the plan. If you see a spike in the target behavior, don't worry, because it is almost always temporary. Continue encouraging the child to adapt and it will eventually happen.  [[Image:Extinguish Maladaptive Behavior in Children with Disabilities Step 10.jpg|center|550px]]
 * 14) When the plan is working, make the rewarding more intermittent. After a certain amount of time in which the child hasn't behaved maladaptively, modify any rewards. Make longer stretches in between rewards, or increase the number of points to be earned. The plan can be faded out gradually until you no longer need it. [[Image:Confident Woman.png|center|550px]]
 * 15)  Relapse into the target behavior may call for re-implementation of the plan for a short period of time.  [[Image:Extinguish Maladaptive Behavior in Children with Disabilities Step 12.jpg|center|550px]]
 * 16) *Check up with a relapsing child. Relapses may be due to stress or overwhelming feelings. Identify any new sources of stress in the child's life (the death of a grandfather, a new school, the introduction of manipulative compliance therapy) and remove them or help the child work through them.

Tips

 * Make sure that everyone involved in the BIP (Behavior Intervention Plan) is emotionally prepared to say no. Some children may deliberately throw a tantrum in the hopes that the adult will give in. Giving in will hurt the child in the long run.
 * Do not use primary (things needed to live) or secondary (things that are normal for the child, such as dinner) rewards. That is considered abusive.
 * Check up with other caregivers regularly and read their records.

Warnings

 * If the target behavior continues for over a month, chances are the plan is not working. Someone may be mishandling the program (giving in or forgetting to reward), or the child may not be developmentally ready to let go of the maladaptive behavior.
 * If a caregiver raises concerns about the ethics of an intervention plan, listen closely.
 * Don't use behavior intervention plans frequently, as this can lead to an abuse of power. The child may become angry and defiant, or overly compliant and unable to refuse or ask for help when necessary. Make sure that the child is able to preserve their own identity and communicate when they dislike something a caregiver does.
 * Never attempt to extinguish stimming. If the child stims in a harmful way (e.g. hitting themselves or biting their arms), teach them an alternative stim to fulfill their needs, rather than discouraging stimming. If a stim looks strange but is ultimately harmless, then leave it be, because you'll do more harm than good by stopping it.

Things You'll Need

 * Tracking sheets to track the target behavior and to record whenever a BIP must be used. They may be done in a large, poster manner so the child can be aware of it as well. Keep a pen handy next to it.
 * A stable supply of rewards. If you run out, the child will become confused and distressed, and may stop responding to the plan.
 * A quiet, accessible place for the team to meet, as well as a babysitter or activity to occupy the child during the meeting.
 * Kind and understanding caregivers.

Related wikiHows

 * How to Calm an Autistic Child
 * How to Handle the Most Challenging Autism Behaviors
 * How to Reduce Meltdowns and Tantrums in Autistic Children

Sources and Citations

 * General Behavioral Psychology, Practice of.... *A0oG7l4Jj1ZSjhsAGCFXNyoA;_ylu=X3oDMTEzZGY3ZWlzBHNlYwNzcgRwb3MDMQRjb2xvA2FjMgR2dGlkA1NNRTI4OV8x/SIG=131eheeqi/EXP=1381433225/**http%3a//psychology.about.com/od/behavioralpsychology/Behavioral_Psychology.htm
 * Specifically Extinguishing Behavior
 * www.drchrustowski.com/DecreasingaBehaviorwithExtinction.pdf**
 * Extinction: Changing Minds, LTD
 * changingminds.org/.../behaviors/conditioning/extinction.htm

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