Behavior is a way of communication. School-age children with dual sensory impairment, severe mental retardation, or severe autism communication about their feelings using actions that may be viewed as severe challenging behaviors. Severe challenging behavior varies in intensity, frequency, and topography; for example, the behaviors may be aggressive such as hitting, stereotypical such as hand flapping, or self-injurious such as hand biting. Severe challenging behaviors may disrupt normal activities as they may result in property damage or become life-threatening when the behaviors result in injury to self or others. Occupational therapists have used various strategies to manage severely challenging behaviors. Traditional methods have proved problematic, while some have raised ethical issues. For example, behavior management strategies have proved difficult to generalize the intervention effects, while restrictive intervention strategies have raised ethical issues since affected children are unable to provide informed consent. O’Neill and colleagues developed the concept of comprehensive behavioral support as an alternative to traditional behavior management strategies.
O’Neill and colleagues developed CBS as a method for occupational therapists to understand the challenging behaviors, what triggers them, and the purpose the behaviors serve. Unlike the behavioral management approaches, CBS manages severely challenging behaviors by examining the behavior, the function that the behavior serves, variables that motivate the child to engage in the behavior, and attempts to eliminate the behavior by teaching appropriate behaviors to the child. Comprehensive behavioral support provides a permanent and aversive behavioral change, assisting the child in developing social-emotional capabilities and preventing problems arising from challenging behaviors.
To effectively apply CBS in coping with severe challenging behavior, an occupational therapist begins by performing a functional assessment of the challenging behavior. Once the functions have been identified, the therapist then develops and implements a CBS plan to prevent, decrease or eliminate challenging behavior. Function assessment involves examining challenging behaviors and determining the functions that the behaviors serve. According to Mu and Gabriel (13), severely challenging behaviors serve the four following functions. One, gaining social attention; two, obtaining tangible objects; three, escaping from work or tasks and lastly, obtaining sensory input. Children are motivated to engage in these behaviors by psychological factors, physiological factors, and physical contextual factors. The variables that maintain the behavior can be setting events. These are events that happened in the past, contributing to the challenging behaviors. Setting events include side effects of medication and lack of enough sleep. Variables that directly trigger challenging behaviors are referred to as antecedent events. Such events include interruption of daily routines. Variables that occur after the behavioral problems are referred to as consequent events. These variables play a significant role in motivating severely challenging behaviors. They include gaining social attention and raising the children’s arousal levels.
To collect information about the variables, occupational therapists employ various assessment strategies. The most common strategies, as outlined by O’Neill are the informant approach, direct observation, and experimental manipulation (Mu and Gabriel 14). In the informant approach, the occupational therapist works with people who are important to the child and who spend most of the time with the child. Such people include parents, siblings, teachers, and other service providers. The occupational therapist may collect information about the child using structured questionnaires or informal interviews. In the observation approach, the occupational therapist observes the child while the challenging behaviors are occurring. This enables the therapists to immediately understand what triggered the behavior and what consequent events did the child aim to achieve. Lastly, the OT may employ the experimental manipulation assessment strategy to understand the factors that affect the challenging behaviors. The OT generates hypotheses about challenging behaviors and experimental designs to analyze systematic changes in antecedent and consequent events (Mu and Gabriel 14). This assists the OT in understanding and develop strategies to cope with challenging behaviors.
The final stage of the CBS plan is the prevention or ultimate elimination of severe challenging behaviors. Comprehensive behavioral support bases its idea on increasing awareness of the setting events and challenging variables that trigger the challenging behaviors. There are several methods that an Occupational Therapist can use to reduce or eliminate severe challenging behaviors. First, an OT can rearrange the physical, social or sensory environment. The OT can do this by providing the child with choices of activities, for example, foot painting, mud kitchen, and making their own musical instruments. The OT can also use educational approaches such as teaching the child appropriate behaviors and skills. The OT must look into each child’s special needs and design the intervention appropriately. CBS designs its interventions in a wholesome manner to enable the child to survive in the physical and social environment (Mu and Gabriel 16). The strategies should teach the child how to participate in community activities and enable the child to engage in meaningful occupations.
The comprehensive behavioral support strategy requires collaboration between different members of society who are involved in the daily life of the child. For example, special educators play a significant role in the development of the CBS plan due to their expertise in curriculum development and involvement in the design of the physical and social environment of the child. Occupational therapists, on the other hand, have expertise and experience in sensory systems and sensory information. They can contribute to understanding the child’s reactivity to sensory stimuli and contribute to the implementation of a behavioral support plan for the child. It is, therefore, imperative for the whole team that is involved in the child’s life to understand and interpret the child’s behaviors and participate in implementing the behavior support plan.
Works Cited
Mu, Keli, and Linda Gabriel. “Comprehensive Behavior Support: Strategies to Cope with Severe Challenging Behavior.” OT Practice, vol. 6, no. 2, ser. 22, 2001, pp. 12–17. 22.
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