We have to be mindful that while Applied Behavior Analysis (ABA) is integrated into how first responders; Early Intervention Providers, CPSE, and CSE work within their interventions and disciplines, it does not address the whole of the motivations of a child’s behavioral difficulties.
Behavior is over determined. That is, there are many reasons behaviors come into being. Behavioral issues are not necessarily a function of developmental delays such as sensory, motor, speech, or cognitive delay. While these delays may contribute to the behavioral problems, how much they contribute is an unknown until interventions have had a chance to enable the child to reach their developmental potential. Interventions might resolve the behavioral difficulties, reduce them, or have no effect. At times, the behavioral difficulties could be so significant that the first responders are not able to clinically intervene as the behaviors interfere with their intervention and the child’s learning.
I often find that parents who have children who have special needs, may have been good enough parents with a typical child. However, because the child has special needs, parents are not sure how to adjust their parenting to meet the needs of the child. In some cases, the parents have significant internal conflicts and don’t use the best approach as they draw on their experience from their parents. A parent of a special needs child has to be a better parent then most as they constantly have to adjust their expectations to the reality of their child’s abilities. This is no easy process. A parent’s ability to adjust their parenting style is pretty limited in most cases. A parent’s ability to adjust to their child’s needs, will depend in large part how traumatic the parent’s childhood was. In extreme cases, where Grandparents were emotionally or physically abusive; emotionally disturbed, and/or a grandparent may have been physically and/or emotionally absent, among many other potential issues, the now parent is not likely to be able to adjust to the emotions and developmental abilities of their special needs child.
In typical children with parents who have had a poor parenting experience, the child calls for help by acting out either physically, socially, or verbally. When the child has special needs, the call for help can be masked by his/her other developmental issues. There is the notion that the interventions are going to resolve, not only the developmental issues, but the behavioral issues as well. However, there is a larger context that must be considered when addressing behavioral difficulties in children. For example:
Consider the impact on a special needs child where a parent;
The interventions of speech, OT, PT, and ABA would not necessarily be addressing this child’s emotional development and needs.
Consider the possibility of a child in preschool who is constantly disrupting the classroom routines, is always in motion, and not attending. Ah, ha! ADD/ADHD, I knew it! But consider the possibility at that within this child’s first 4 years of life a sibling is born with cancer.
Are behavioral interventions going to stop the demonstrated behaviors? If applied expertly, they can and should. Are we ready to move on without addressing the emotional communications of the behavior?
When clinicians are presented with a child exhibiting behaviors they set up positive contingencies to get the child to cooperate, engage, and learn. If they are on target the treatment outcome will be a success. If a clinician to able to gain the attention and work successfully with a child a parent would be well advised to watch the interaction and ask; “Why their child works with the clinician and does not act out?” Alternatively a parent can ask the clinician; “Why they think the child acts out at home?” The parent can ask themselves the last question as well. If they are able to both listen to the response and learn to respond differently than the acting out behaviors might diminish.
Another potentially helpful tactic for the Parent is to ask the clinician if they can watch and then practice working with their child in the treatment session. Ask the clinician to tell you honestly what you are doing right and wrong and provide suggestions how to do things differently.
When behaviors don’t stop we can assume there is a problem behind the identified need(s). In conversations with other clinicians and parents, I’ve heard statements, “The child is still acting out.” Or, “His mother gets into fights with him in the waiting room.” An honest dialogue with your child’s clinician could go a long way in resolving a child’s acting out.
By looking at the larger context (the parents’ parenting and the parents’ feelings about their own parents, as well as their feelings, attitudes, and thoughts about their child) the emotional communication(s) and needs of the whole family can be addressed.
It is my hope that in working with parents and first responders we can look beyond ABA and while behaviorally addressing the acting out, address these other motivators for a child’s difficult behavior(s). We can discuss how to emotionally intervene to resolve the behavioral issues from the inside at the same time we are addressing the manifest behaviors on the outside.
I am always available to work with parents and first responders to privately discuss concerns about a child. I find great joy in talking with parents and my colleagues, learning about their lives and work, and supporting them to help their children.
Adam J. Holstein, P.D., L.P.
Amy Reinstein, M.S., CCC - SLP