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BEHAVIOUR SUPPORT GUIDELINES FOR CHILDREN

(2nd Edition)

Prepared by psychologists:

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STATEWIDE SPECIALIST SERVICES


August 2008 To be reviewed in 2011

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Trevor Mazzucchelli Lisa Studman Paul Wilson Matthew Dunsire Lara Harmsworth Andrew Adlem

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Skills Training and Behavioural Strategies Including Aversive Procedures for Children with Developmental Disabilities

Foreword

FOREWORD
The Disability Services Commission has produced the Behaviour Support Guidelines for Children with developmental disabilities as best practice standards for anyone supporting a child with a disability. The document is based on contemporary literature and practice, and was developed following extensive consultation with a range of external agencies, non-government organizations, carers and families. Meeting the needs of children with difficult behaviour can be highly demanding and challenging. These guidelines document contemporary approaches and standards for the management of such behaviours. I recommend that all people who work with and care for children take the time to familiarise themselves with these guidelines. It is important that parents and carers consult with relevant health professionals for advice and or assistance if they are experiencing challenges implementing the behaviour support guidelines.

The authors thank Ritu Campbell, Antoinette Casella, Lois Lowe, Ellen Lee and Kate Smith for their contributions to the first edition of this document. We gratefully acknowledge the staff from the following agencies that have provided feedback on the first edition: Activ Foundation, The Centre for Cerebral Palsy, Department for Child Protection, Department of Education, Disability Services Commission, Identity WA, Lady Lawley Cottage, Mofflyn, Playgroup WA, Rocky Bay, State Child Development Centre, Resource Unit for Children with Special Needs, and Therapy Focus Inc. We also thank Deb Tedeschi, Debbie Lobb and Mia Huntley for their contributions to the second edition of this document. We thank all the parents who read earlier drafts and provided very useful feedback. Finally, we greatly appreciate the assistance of Lu Le Petit Ecolier.
Disability Services Commission (2008, June). Behaviour Support Guidelines for Children. Perth, Western Australia: Author.

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ACKNOWLEDGEMENTS

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Dr Ron Chalmers DIRECTOR GENERAL DISABILITY SERVICES COMMISSION

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Feedback on this document would be welcomed and can be provided to the Clinical Psychology Supervisors from the Commissions Individual and Family Support Program on either 9301 3800 or 9329 2300.

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Further copies of this document can be obtained from the Disability Services Commission Web Site: www.disability.wa.gov.au.

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Contents

CONTENTS
1. Introduction........................................................................................5 2. Developing a behaviour support plan....................................................6 3. Lifestyle interventions that promote child development and independence ...................................................8 3.1 Develop positive relationships ......................................................8 3.2 Find a way to communicate ....................................................... 10 3.3 Set up environments ................................................................. 11 3.4 Encourage cooperation and participation..................................... 12 3.5 Reinforce desirable behaviour .................................................... 13 3.6 Teach new behaviours............................................................... 13 4. Reducing problem behaviour.............................................................. 19 4.1 Constructive approaches to reduce problem behaviour ................ 20 4.1.1 Functional communication training ................................... 20 4.1.2 Redirection ..................................................................... 20 4.1.3 Teaching coping skills ...................................................... 20 4.1.4 Active listening................................................................ 21 4.1.5 Problem solving............................................................... 22 4.2 Punishment and aversive procedures: Issues to consider............. 22 4.2.1 Safeguards when using punishment ................................. 23 4.3 Punishment procedures ............................................................. 24 4.3.1 Reprimands..................................................................... 24 4.3.2 Blocking.......................................................................... 24 4.3.3 Escape extinction ............................................................ 25 4.3.4 Overcorrection ................................................................ 25 4.3.5 Time-out......................................................................... 26 4.3.5.1 Planned ignoring ............................................... 26 4.3.5.2 Response cost ................................................... 27 4.3.5.3 Brief interruption ............................................... 27 4.3.5.4 Contingent observation ...................................... 28 4.3.5.5 Quiet Time ........................................................ 28 4.3.5.6 Time-out ribbon................................................. 28 4.3.5.7 Exclusionary time-out ........................................ 29 4.3.5.8 Facial screening................................................. 30 4.3.6 Restraint, including the use of medication ......................... 30 5. Management of emergency situations ................................................ 33 5.1 Antecedent control strategies..................................................... 33 5.1.1 Removing seductive objects ............................................. 33 5.1.2 Removing unnecessary demands and requests.................. 34 5.2 Interrupting the behavioural chain and counter intuitive strategies ................................................................................................ 34 5.2.1 Stimulus change.............................................................. 34
Disability Services Commission (2008, July). Behaviour Support Guidelines for Children. Perth, Western Australia: Author.

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Contents
5.2.2 Diversion ........................................................................ 35 5.2.3 Capitulation..................................................................... 35 5.3 Restraint................................................................................... 36 5.3.1 Interpositioning............................................................... 36 5.3.2 Seclusion ........................................................................ 36 5.3.3 Physical restraint ............................................................. 36 6. Child Abuse ...................................................................................... 38 6.1 Actions which do not meet the Commissions standards and are not to be used ................................................................................ 38 Bibliography...................................................................................... 40 Appendix A: Behaviour Support Diary ................................................. 41 Appendix B: Emergency Management Procedures ............................... 42 Appendix C: Resources...................................................................... 44

Disability Services Commission (2008, June). Behaviour Support Guidelines for Children. Perth, Western Australia: Author.

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Introduction

1.

INTRODUCTION

These guidelines have been produced to inform and guide those who care for or teach children with developmental disabilities up to 18-years-of-age. They may be considered best practice for anyone supporting a child with a disability, including parents, carers, teachers, and support workers. Parents of children with developmental disabilities may also expect all the Commissions employees are familiar with and adhere to them. The guidelines are applicable to children with any kind of disability including physical, sensory, neurological, cognitive, intellectual and autism spectrum disorders. The information in this document is based on the most recent literature and extensive experience in the support and development of children with disabilities. There has also been extensive consultation with direct care staff, supervising staff and families. The document introduces behaviour support plans, and provides details on ways to promote child development and independence, and ways to reduce problem behaviour. It also outlines techniques that do not meet the Commissions standards and should not be used. It is not intended to be a training document. For further information on appropriate training and materials, see the resource sections in this document.

Disability Services Commission (2008, July). Behaviour Support Guidelines for Children. Perth, Western Australia: Author.

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Behaviour Support Plans

2.

DEVELOPING A BEHAVIOUR SUPPORT PLAN

The goal of behaviour support is to achieve long-lasting, meaningful improvements in childrens behaviour. Success is measured not only in terms of reductions in problem behaviour, but also by increases in the performance of alternative skills and improvements in the child and familys quality of life. Behaviour support plans consist of multiple interventions or support strategies that emphasise lifestyle enhancement, alternative skill training, and environmental adaptations. The four key components of behaviour support plans are outlined below: Lifestyle interventions that aim to provide a supportive child focused home, school and recreational environment. This might include providing a rich variety of activities that the child can choose from, helping the child participate in after-school activities of his or her choice, and teaching the childs peers to understand the childs communication system.

Developing a behaviour support plan begins with understanding why a child engages in problem behaviour. To develop such an understanding a functional assessment is typically required. The basic steps of such an assessment include: Collecting broad contextual information about the child: skills and abilities, preferences and interests, general health and quality of life. Collecting specific information that will pinpoint the conditions that are regularly associated with the problem behaviour and identify the function or purpose of the childs behaviour. Developing hypotheses that summarise the assessment information by offering logical explanations for problem behaviours. These statements guide the development of behaviour support plans.

This document outlines strategies and ideas that can be used to develop a comprehensive behaviour support plan.
Disability Services Commission (2008, July). Behaviour Support Guidelines for Children. Perth, Western Australia: Author.

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Deciding how to respond after the problem behaviour occurs. Possible responses include using an instruction to tell the child what to stop doing and what to do instead, using planned ignoring, or in the case of an emergency situation, moving to a safe place.

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Eliminating or modifying specific events that leads to problem behaviour. Examples of these modifications might include providing a favourite activity during a high-risk time, stating clear expectations for desired behaviours, and giving attention before problems arise.

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Teaching alternative means for achieving desired outcomes. Examples of this component might include teaching a child how to ask for help, to selfinitiate activities using an activity schedule to keep occupied, and / or to relax during stressful events.

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Behaviour Support Plans


It is important that the effectiveness of a support plan is evaluated. This can be done by keeping track of increases in the use of alternative behaviours, decreases in the frequency of problem behaviour and general improvements in lifestyle and quality of life. A variety of data-keeping methods may be found in the resources listed in the end of this section. If there is no improvement in the childs behaviour the childs behaviour support plan should be reviewed and changes considered. Assistance from a health professional may also be sought. When behaviour support plans are being developed and / or implemented by people outside of a family, these people and the parents and carers of the child should be involved. Agreement should be sought on the goals, rationale, and procedures that will be used as part of the plan. This is likely to enhance cooperation between all people concerned and the likelihood that the resulting plan will be followed accurately. Children should also be involved in developing behaviour support plans, particularly as they get older and develop an increased understanding of the supports provided to them. Parents and or legal guardians need to give written consent to any behaviour support plan developed especially for their child.

For Parents

For Service Providers

O'Neill, R. E., Horner, R. H., Albin, R. W., Sprague, J. R., Storey, K., & Newton, J. S. (1997). Functional assessment and program development for problem behavior: A practical handbook (2nd ed). Pacific Grove: Brooks/Cole Cooper, J. O., Heron, T. E., & Heward, W. L. (2007). Applied Behavior Analysis. New Jersey: Prentice.

Disability Services Commission (2008, June). Behaviour Support Guidelines for Children. Perth, Western Australia: Author.

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Sanders, M. R. (2004). Every Parent: A positive approach to children's behaviour. Camberwell: Penguin. Sanders, M. R., Mazzucchelli, T. G., & Studman, L. J. (2003). Stepping Stones Triple P Family Workbook. Milton, Queensland: Triple P International

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MORE INFORMATION AND RESOURCES:

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Supporting Optimum Development

3.

LIFESTYLE INTERVENTIONS THAT PROMOTE CHILD DEVELOPMENT AND INDEPENDENCE

A lifestyle intervention that promotes child safety, development and independence is the basis of an effective behaviour support plan. When considered thoroughly, lifestyle interventions can prevent the development or persistence of problem behaviour. When children and teenagers have a well structured, nurturing and engaging lifestyle with an effective way of communicating and solving problems, problem behaviour is less likely to occur. All children need warm, safe and responsive interaction with others in a variety of environments such as home, community, education and work settings. They also need opportunities to learn how to:

Children with disabilities need additional support or teaching in some or all areas of development. They also need consistent support to participate fully in all or some environments. This chapter provides ideas on how to set up healthy balanced lifestyles for children and teenagers with disabilities. 3.1 DEVELOP POSITIVE RELATIONSHIPS Children are more likely to develop to their potential within the context of secure relationships that are warm, positive and predictable. When these relationships are formed with parents and carers, especially in the early years, children are less likely to develop behaviour problems. To develop secure relationships parents and carers need to be sensitive and responsive to children. Interactions to facilitate secure relationships include: Facial expressionshowing a child a calm, relaxed facial expression with lots of gentle and direct eye contact. Parents and carers need to be 8

Disability Services Commission (2008, July). Behaviour Support Guidelines for Children. Perth, Western Australia: Author.

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To solve problems. questioning needs to be options, make choices everyday problems such who to see.

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Be as independent as possible with appropriate levels of support from others. This involves keeping busy and engaged in play or other activities without constant adult attention, developing as much mobility as possible, and learning everyday tasks such as dressing, eating, and using the toilet. Their curiosity, interest, understanding and encouraged. Children need to learn to consider or decisions and think about alternatives to as what to wear, what to eat, what to do and

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Regulate their emotions. They need to find ways to express feelings in ways that are not harmful to themselves and others, to control aggressive impulses, to develop positive feelings about themselves, their families and others and to accept rules and limits.

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Communicate and get on with others. This includes expressing ideas and needs, asking for help when needed, cooperating with adult requests and taking turns to share with other children.

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alert, actively attentive and responsive to the situation and the childs mood. Vocal expressionusing a calm variation in tone of voice that is attuned to and adjusted according to the vocal expressions of the child or their mood. That is, if the child is excited and happy and using a high-pitched voice, then the parent / carer mirrors this. If they are sad or confused, then the adults vocal tone would reflect softer tones of concern and soothing. If they are angry and frustrated, then the parent / carers tone would be serious and supportive. The tone of voice should function to attract and maintain the childs attention. Position and body contactbeing physically available unconditionally. Parents / carers need to let the child develop a sense that they are available no matter what and to show appropriate physical affection depending on the nature of the relationship and the age / stage of the child. For younger children this can be plenty of time in the childs actual view so they learn to seek interaction. For older children and teenagers, this can mean regular quality time and being contactable at all times.

Disability Services Commission (2008, June). Behaviour Support Guidelines for Children. Perth, Western Australia: Author.

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Joint decision makingas children grow older and can participate in family discussions and decisions, hold regular meetings or gatherings where everyone in the family or house can contribute their ideas. Set an agenda so that everyone knows what topics are going to be discussed. It could be that the group needs to decide how to spend holiday time together, what house-rules to have, or to plan the housework roster for that week. Another topic could be to develop a plan so that a teenager can safely participate in a social event that has some risks. Keep the meeting brief (about 15 minutes) and focused on achieving a definite solution or plan. Having some rules for the meeting can help it run smoothly. Rules may include: speak calmly, only one person speaks at a time, everyone has a turn, and ask permission if you need to leave.

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Pacing of turnstiming interactions on the basis of signals or cues from the child to create rhythmical turn-taking. That is, giving a child time to make a response and encouraging their attempts by waiting and looking expectant for instance by, raising eyebrows, opening the mouth, and nodding. It also involves actively supporting a childs play or a teens activities by being interested, watching, commenting and approving.

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Expressions of affectionaffection can be expressed vocally, visually or through touch, such as stroking, hugging, and smiling. Parents and carers need to be responsive to child cues about how much physical affection is wanted. That is, it is important not to intrude into a childs personal space when they do not like it. Appropriate forms of physical affection changes with the childs age and stage of development. For example, trying to hug a child when they are angry and pushing an adult away or saying, stop, I dont like it, would not serve to develop a secure relationship.

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3.2 FIND A WAY TO COMMUNICATE Children will behave more appropriately and learn developmental tasks more quickly if they have an effective way of communicating. Children need to learn how to express their needs and feelings and to understand others. Communication encompasses a broad spectrum of methods. Speech is the preferred method of communicating because it is most used. When children experience difficulties with speech they will find alternative methods to make themselves understood such as through sounds, actions, expressions and behaviour. Effective communication is essential for the development of personal relationships and skills. Some children who find it difficult to communicate by speech may be helped by using augmentative and/or alternative communication (AAC). AAC can be used to help children express needs and ideas as well as to help them understand what is being communicated. AAC is the term used for all communication that is not speech and is used to enhance or to replace speech. Often children will use a combination of ACC in addition to any verbal communication. TYPES OF AAC Children can use a range of AAC methods. These include:

Signing - this involves the use of a formal set of signs, or signs which are particular to an individual. Signing is useful to help children to understand language and to express ideas to others who can use signs. Photos, drawings, objects and picture symbols - these are used to represent words in a visual way to assist the child to understand language and express themselves. For example, visual timetables, choice-making boards, Picture Exchange Communication System (PECS), communication displays, topic boards can all be used to assist children to communicate effectively. The symbols used are interactive and encourage both receptive language and opportunities for the child to make requests, comments and use social language. Chat books - these are books that may contain photos, pictures, symbols, words and messages about a child and their interests, e.g. pictures of family, pets, school, favourite places or activities may be included. Children who have difficulty with verbal communication use chat books to initiate social conversations with those around them. Speech generating devices these are computers that can be programmed to speak a message when a particular button, or sequence of buttons, are pressed.

Disability Services Commission (2008, June). Behaviour Support Guidelines for Children. Perth, Western Australia: Author.

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Natural Gestures this involves general or natural communication methods such as pointing, gestures, eye-pointing, mime, facial expressions and body language.

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3.3 SET UP ENVIRONMENTS Carers need to ensure that the childs environment is safe, predictable and offers positive learning opportunities. This often involves the use of specific routines and a communication system that is understood and can be used by the child. Safety. Young children need a safe play environment, particularly once they begin to crawl. Safetyproof the child's environment by putting dangerous things out of reach, fitting child resistant catches to drawers and cupboards, and using gates and barriers to block entry to dangerous areas. These restrictions can be gradually loosened as your child learns boundaries. As children grow older, they need to learn how to safely take on more responsibility around the home. They also need to learn to identify risky situations in the community and how to take appropriate action to keep themselves safe. Resources for safety-proofing a childs environment and teaching protective behaviours are listed at the end of this section. Rules. Children need limits to know what is expected of them and how they should behave. A few basic ground rules can help. Rules should tell everybody what to do, rather than what not to do. Walk in the house, Speak in a pleasant voice and Be gentle with others are better rules than Dont run, Dont shout and Dont fight. Rules work best when they are fair, easy to understand and follow, and can be backed up. To be effective rules must be enforcedcooperation and non-cooperation must have an outcome. When deciding on rules, it is a good idea to involve everybody who will be affected by them. Pictures illustrating rules can be a useful reminder for children who have not yet learnt to read. Supervision and monitoring. Parents and carers responsible for children need to know where they are, what they are doing, and who they are with at all times. Parents should monitor what their children are accessing through the television, computer, magazines and other media. As children get older they should be encouraged to become involved in organized, meaningful activities at school and elsewhere, where there is appropriate supervision and monitoring. Parents should get to know the parents of their childs friends, as this can expand the network of people who can help monitor their children. Routines. Daily routines are the sequence of events and activities that make up a childs every day life. For instance the morning routine may consist of having breakfast, getting dressed, brushing teeth and packing the school bag. Routines include regular activities in all areas of life. A predictable regular daily routine assists a child to make sense of their world, reduces anxiety and problem behaviour, and assists their skill development. Routines provide the foundation by creating opportunities to learn, practice and maintain skills through the course of daily activities. Children may be assisted to learn routines by being told or shown (e.g., walking the child through the activity or by using an activity schedule). Disability Services Commission (2008, June). Behaviour Support Guidelines for Children. Perth, 11
Western Australia: Author.

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Understanding routines can help children cope with changes at school, home and at other places. These changes can include the order of activities, location of activities, type of activity, people supporting them in an activity, and special events such as holidays or outings. Activity Schedules. An activity schedule can take many forms but typically consists of a set of pictures or words that cues someone to engage in a sequence of activities. Depending on the child, the activity schedule can be very detailedbreaking a task into all of its separate partsor it can be very general, using one picture or symbol to cue a child to perform an entire task or activity. Through physical guidance children are taught to refer to their activity schedule, perform the first task, and then refer to their activity schedule for cues to the next task. The goal of teaching schedule use is to enable children to perform tasks and activities without direct prompting and guidance from carers. Stimulation and Engagement. Children should have access to toys, equipment, and activities that provide a variety of developmentally appropriate sensory experiences. They also need interactions with others appropriate for their age and level of development that will keep them occupied. Engagement is appropriate play and participation in an activity. Children would not be considered to be appropriately engaged if they were sitting in a room staring at the floor while the television was on. Nor would they be engaged sitting at a table with appropriate materials but gazing at their hands. Low levels of engagement are often associated with a loss of skills and inappropriate or disruptive behaviour. High levels of engagement are associated with developmental gains and improved levels of functioning. There are a variety of strategies for promoting and encouraging engagement, the way to do this is in the following sections. 3.4 ENCOURAGE COOPERATION AND PARTICIPATION There are a range of strategies that can be used to encourage cooperation and participation, these include: Make requests at appropriate timesfor example, after Rons favourite television program has finished or as Rons attention is waning. Gain the childs attentionthis can done by moving to within arm's length of Ron, bending down to his eye level, and use his name to gain his attention. Tell the child exactly what to do using a calm but firm voicefor example, "Ron, time to clean your teeth. Go to the bathroom please." Make the task achievableprovide the necessary supports and modifications so the child can be successful. If required this might include using an electric toothbrush, fitting a modified grip, using a toothpaste dispenser, and providing physical guidance to get the toothpaste on the brush. Make the task enjoyablemake the task more rewarding or enjoyable for the child. This might be done by using Ron's favourite flavoured toothpaste and singing a song while he brushes his teeth. Disability Services Commission (2008, June). Behaviour Support Guidelines for Children. Perth, 12
Western Australia: Author.

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Link the task with enjoyable activitieslet the child know what he can look forward to after he has completed the task, "Ron, when weve finished brushing we can read a book together". This works best if it is stated positively rather than as a threat of what the child will miss out on if they do not participate. Alternating difficult tasks with easier ones that are more fun may help maintain the childs cooperation and participation.

Social reinforcement (e.g., "Good work!", thumbs up, a pat on the back) is the most available and potentially useful of all reinforcement. When using social reinforcement it is important to be enthusiastic and genuine. When tangible reinforcement (e.g., juice, chocolate, stars) or activity reinforcement (e.g., a push on a swing, a drive in a car, reading a book) is used, they should be given at the same time or just after social reinforcement. Another way to reinforce behaviour is to allow a child to do or have something that they are not usually permitted at that time if they have behaved well (e.g., extra time on the computer than usual, extra time to stay out and socialize with peers, or even uninterrupted time to engage in self-stimulatory behaviours such as looking at lights or spinning wheels on toys). When a person uses reinforcement often and shares preferred activities with the child, it will encourage that child to associate that person with feeling good and it will be much easier to encourage appropriate behaviour. 3.6 TEACH NEW BEHAVIOURS All children need to learn new behaviours at every stage of development. Some children with disabilities need more opportunities and extra support to learn these. When teaching a new behaviour show or tell the child what to do, help them to do it and provide reinforcement for doing it.
Disability Services Commission (2008, June). Behaviour Support Guidelines for Children. Perth, Western Australia: Author.

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Reinforcement will be most effective in encouraging appropriate behaviour when given immediately after that behaviour. As the behaviour is learned, it should be reinforced only every now and then.

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REINFORCE DESIRABLE BEHAVIOUR Reinforcement happens when an event or object follows a behaviour making the behaviour more likely to occur again. Reinforcement is essential to teach children new skills and to maintain existing skills and development. For example, Wendy is told she is doing a good job when she puts her plate in the sink and this results in her doing it in the future without having to be prompted. Or Eddie gets a stamp on his chart every time he puts a piece in a puzzle and over time this leads to him working on the puzzle on his own. Finding the most powerful and socially acceptable reinforcement for each individual child is important. Never assume that what is reinforcing for one child will be reinforcing for another or what is reinforcing one day will be reinforcing the next. There are several ways of finding out what is most reinforcing for a child. These include asking the child or carers, completing inventories, or offering items to the child and seeing what they reach for or resist having taken away.

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To increase teaching opportunities throughout the day, arrange the childs physical and social environment with objects and materials that promote engagement. Interactions with the child should be enjoyable and reinforcing. Enthusiastic praise for any improvement in skills should be used. Alternating difficult tasks with enjoyable or easier ones that are more fun may help maintain the childs motivation to learn. End teaching session on a success. The techniques commonly used in this process are: Task analysisbreaking up a task into small steps (e.g., picking up the toothbrush, picking up the toothpaste, removing the cap, applying toothpaste to the bristles and so on). Modelingshowing a child how to behave or do a task (e.g., "Watch how mummy does it"). Promptingusing words, gestures, pictures, or physical guidance to help a child complete a task (e.g., putting your hand over Mandy to help her hold a pencil). As the child learns reduce the prompts let her do more and more by herself until she is completing the task independently. Shapingprovide reinforcement to the child for behaviours that are close to what is wanted (e.g., initially praising Mandy for picking up the pencil, later only praising Mandy for scribbling on a piece of paper). Chaininglinking steps of a task together so that the child does more of the steps independently before getting a reward. You may begin by linking the steps from the beginning of a task (forward chaining), from the end of a task (backward chaining), or throughout the task (global chaining). An example of teaching handwashing using backward chaining would be to initially give physical guidance for all the steps. Then guidance may be reduced on the last step, drying hands on a towel, before the reward is given. Once the child does this step without any help, prompting on an earlier step, such as turning off the tap, may be reduced. This is an example of backward chaining because the child begins to learn the last step of the task first. The techniques above can be used in structured or planned teaching sessions as well as when opportunities arise during the day. All types of teaching are important and should be used at different times depending on what specific skill is being taught and the childs ability. An accurate assessment of the childs current level of ability is required when decisions are made about what teaching approach to use. Teach skills that will enhance current or future learning. Incidental teaching, activity-based teaching and direct teaching all require differing levels of planning and structure. Incidental teaching is child initiated and directed whereas direct teaching and activity-based teaching are teacher or parent initiated and directed. Incidental teaching and activity-based teaching occur during the normal routine activities of the child and can result in greater generalization of the skills taught. Direct teaching sessions are highly structured and allow for more repetition or teaching trials than either activity based teaching or incidental teaching. Disability Services Commission (2008, June). Behaviour Support Guidelines for Children. Perth, 14
Western Australia: Author.

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Incidental teaching This process is essentially a naturally occurring one and can take place at any time during the day. The most important condition for incidental teaching is that the child initiates the teaching moment. As incidental teaching occurs during the normal routine activities of the child it can result in greater generalization of skills taught. Some advanced planning can certainly help the process. Adults can promote initiations by arranging the childs physical and social environment with objects and materials that promote engagement and being available and paying attention to the child and what they are doing. For example putting a favourite toy out of reach on the floor to encourage crawling, putting crisps in a glass jar so that a child needs to practice their communication skills to request help to open it. To encourage ageappropriate social behaviour in teenagers you might make teenage materials such as magazines and CDs available. Incidental teaching should help the child take the next step, but skills that are presently beyond the childs reach shouldnt be requested. Incidental teaching involves waiting for the child to approach and initiate communication by showing or requesting something. Give the child your full attention and make sure you understand what the child is saying. Before you give the child what they want prompt the child to extend their language or thinking by asking the child to elaborate, expand, explain or clarify. If the child doesnt answer prompt her. If the child still doesnt answer or answers incorrectly tell her the answer and ask her to repeat it. Reward the child. Activity-Based Teaching Activity bases teaching occurs where skills are taught in the situation and time of the day you would expect the child to use them (e.g. teaching teeth cleaning after meals, wiping after going to the toilet.). It is directed by the teacher or parent who maintains control over the instructional activities. As with incidental teaching activity-based teaching occurs during the normal routine activities of the child and can result in greater generalization of skills taught. If the skills are complex a task analysis may be necessary. An assessment needs to be made of the level of the childs skills so you know where to start and which of the techniques (e.g. modeling, type of prompting etc) can be used at various stages to ensure learning occurs. It is necessary to plan and make sure any materials are available and distractions are reduced. Direct Teaching Teaching of this type (e.g. Discrete Trial Training) is directed by the teacher or parent who maintains tight control over the instructional activities. It occurs in well prepared short sessions under highly structured conditions and gives more opportunities to teach the skill by allowing for more repetition of teaching trials (practice). With direct teaching it is important to plan in advance for the generalization of the skills taught. Disability Services Commission (2008, June). Behaviour Support Guidelines for Children. Perth, 15
Western Australia: Author.

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First a decision needs to be made about what skill to teach. If the skill is complex a task analysis may be necessary so the composite skills required may be taught. Second the skill and the conditions under which it is to be performed needs to be defined so the skill is used when it is required. The child can be moved onto the next step once mastery has been achieved. Third, a decision on what instructional materials are needed and how they will be presented has to be made. Fourth, the teaching needs to occur at a time and place to minimize distraction. Fifth, reinforcers that can be used to motivate the particular child need to be on hand. MORE INFORMATION AND RESOURCES:

For Parents
Baker, B. L., & Brightman, A. J. (1997). Steps to independence: teaching everyday skills to children with special needs. Baltimore: Paul H. Brookes. Protective Behaviours o Feel SafeAn intervention for teenagers and adults, available through Disability Services Commission. o People 1st Programme: Corner of Roe Street and Lake Street, Northbridge. www.people1stprogramme.com.au Safety products o Kidsafe WA Child Accident Prevention Foundation: Godfrey House, Princess Margaret Hospital, Corner of Roberts Road and Thomas Street, Subiaco. www.kidsafewa.gom.au o Also, see hardware stores (e.g., Bunnings) and baby specific stores (e.g., Baby on a Budget) Ralph, A., & Sanders, M. R. (2002). Teen Triple P Group Workbook. Milton, Queensland: Teen Triple P Group Workbook. Sanders, M. R. (2004). Every Parent: A positive approach to children's behaviour. Camberwell: Penguin. Sanders, M. R., Mazzucchelli, T. G., & Studman, L. J. (2003). Stepping Stones Triple P Family Workbook. Milton, Queensland: Triple P International

For Service Providers

Alternative and Augmentative Communication www.aacinstitute.org Frost, L., & Bondy, A. (2002). The Picture Exchange Communication System: Training Manual. Newport: Pyramid Educational Consultants Lutzker, J. R. (1998). Handbook of child abuse research and treatment. New York: Springer. McClannahan, L. E., & Krantz, P. J. (1999). Activity schedules for children with autism: Teaching independent behavior. Bethesda: Woodbine House. PECS Training Pyramid Educational Consultants of Australia www.pecsaustralia.com Overview of strategies Cooper, J. O., Heron, T. E., & Heward, W. L. (2007). Applied Behavior Analysis. New Jersey: Prentice. Disability Services Commission (2008, June). Behaviour Support Guidelines for Children. Perth, 16
Western Australia: Author.

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Sanders, M. R., & Dadds, M. R. (1993). Behavioral family intervention. Boston: Allyn and Bacon. SulzerAzaroff, B., & Mayer, G. R. (1991). Behavior analysis for lasting change. Fort Worth: Holt, Rinehart and Winston. Behavioural Momentum Davis, C. A., Brady, M. P., Williams, R. F., & Hamilton, R. (1992). Effects of high probability requests on the acquisition and generalization of responses to requests in young children with behavior disorders. Journal of Applied Behavior Analysis, 25, 905-916. Ducharme, J. M., & Worling, D. E. (1994). Behavioral momentum and stimulus fading in the acquisition and maintenance of child compliance in the home. Journal of Applied Behavior Analysis, 27, 639-647. Mace, F. C., Hock, M. L. Lalli, J. S., West, B. J., Belfiore, P., Pinter, E., & Brown, D. K. (1988). Behavioral momentum in the treatment of noncompliance. Journal of Applied Behavior Analysis, 21, 123-141. Mace, F. C., Lalli, J. S., Shea, M. C., Lalli, E. P., West, B. J., Roberts, M., & Nevin, J. A. (1990). Journal of the Experimental Analysis of Behavior, 54, 163-172. Singer, G. H. S., Singer, J., & Horner, R. H. (1987). Using pretask requests to increase the probability of compliance for students with severe disabilities. Journal of the Association for Persons with Severe Handicaps, 12, 287-291. Smith, M. R., & Lerman, D. C. (1999). A preliminary comparison of guided compliance and high probability instructional sequences as treatment for noncompliance in children with developmental disabilities. Research in Developmental Disabilities, 20, 183-195. Compliance Handen, B. L., Parrish, J. M., McClung, T. J., Kerwin, M. E., Evans, L. D. (1992). Using guided compliance versus time out to promote child compliance: A preliminary comparative analysis in an analogue context. Research in Developmental Disabilities, 13, 157-170. Errorless compliance Training Ducharme, J. M. (1996). Errorless compliance training: Optimizing clinical efficacy. Behavior modification, 20, 259-280. Ducharme, J. M., Pontes, E., Guger, S., Crozier, K., Lucas, H., & Popynick, M. (1994). Errorless compliance to parental requests II: Increasing clinical practicality through abbreviation of treatment parameters. Behavior Therapy, 25, 469-487, 469-487. Incidental Teaching Hart, B. M., & Risley, T. R. (1982). How to use incidental teaching for elaborating language. Austin Texas: Pro-Ed. Reinforcement (Assessment) Cautela, J. R., & Brion-Meisels, L. (1979). A children's reinforcement survey schedule. Psychological Reports, 44, 327-338. Fox, R., & Rotatori, A. F., Macklin, F., & Green, H. (1983). Assessing reinforcer preference in severe behaviorally disordered children. Early Child Development and Care, 11, 113-122. Disability Services Commission (2008, June). Behaviour Support Guidelines for Children. Perth, 17
Western Australia: Author.

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Mason, S. A., McGee, G. G., Farmer-Dougan, ,V., & Risley, T. R. (1989). A practical strategy for ongoing reinforcer assessment. Journal of Applied Behavior Analysis, 22, 171-179. Pace, G. M., Ivancic, M. T., Edwards, G. L., Iwata, B. A., Page, T. J. (1985). Assessment of stimulus preference and reinforcer value with profoundly retarded individuals. Journal of Applied Behavior Analysis, 18, 249-255. Wacker, D. P., Berg, W. K., Wiggins, B., Muldoon, M., Cavanaugh, J. (1985). Evaluation of reinforcer preferences for profoundly handicapped students. Journal of Applied Behavior Analysis, 18, 173-178. Structured Teaching Maurice, C., Green, G., & Luce, S. C. (1996). Behavioral intervention for

young children with autism: A professionals. Austin, Texas: Pro-Ed.

manual

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4.

REDUCING PROBLEM BEHAVIOUR

Behaviour does not occur in a vacuum, it always occurs within a context. No matter how difficult or unusual a problem behaviour may appear, certain conditions give rise to and trigger it and the consequences of the behaviour maintain it. In this way the behaviour is said to serve a function. Four functions of problem behaviour are to: avoid or escape an event or situation (e.g., misbehaving at the dinner table to avoid having to eat disliked food), gain more social interaction (e.g., interrupting adult conversations by screaming), obtain some tangible item or activity (e.g., snatching toys from other children), obtain a sensory reward (e.g., rubbing eyes hard to get visual shadows and light distortion). The same behaviour, such as a tantrum (screaming and rolling on the floor), depending on its context, may serve a different function for the child. In the context of sitting at the table in front of a plate of tripe the tantrum may serve the function of having the meal removed. In the context of an adult conversation that the child cannot follow, the tantrum may serve the purpose of interrupting the conversation and gaining attention. In the context of the supermarket, the tantrum may serve the function of gaining access to a bag of lollies. In the context of an uninteresting room, the tantrum may serve the function of gaining interesting sensory stimulation. At times it can be difficult to determine the function of behaviour within particular contexts, and a thorough assessment may be required. Information about triggers and what function a particular behaviour may serve can be obtained through functional assessments such as structured interviews, checklists, rating scales or questionnaires with people who are very familiar with the child (e.g., teachers, parents, carers or the person themselves). Functional assessment can also be done by recording what happens before the behaviour (e.g., he was watching TV and I told him to turn it off for dinner) and after the behaviour (e.g., I let him eat dinner in front of the TV). This is called Narrative ABC (Antecedent-BehaviourConsequence) recording. Behavioural assessment can vary in complexity from asking carers what seems to trigger and maintain certain behaviours to more scientific approaches, such as functional analysis. Functional analysis is usually done by a psychologist and involves generating and testing hypotheses about why a particular behaviour occurs.

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4.1 CONSTRUCTIVE APPROACHES TO REDUCE PROBLEM BEHAVIOUR 4.1.1 Functional Communication Training Functional communication training is teaching a person ways of getting their needs met by using appropriate communication instead of problem behaviour. We need to teach children behaviours that achieve the same result as their problem behaviour. The new behaviour needs to be as easy for the child to perform and one that achieves the same result just as effectively. That is, the new behaviour must achieve results as quickly and as often as the problem behaviour. For example, a child may be taught to say or sign finished instead of throwing their plate when they do not want any more food; Talk to me if they want attention instead of grabbing you by the hair; or I want when they want something instead of screaming or flapping their hands. To teach your child to communicate what they want a parent or carer needs to recognize what context and triggers the problem behaviour and prompt the child to use the communicative response. Preferably this should occur before the problem behaviour occurs. This means that, at least initially, every time they use the new method they must succeed in getting what they want, otherwise they might revert back to inappropriate behaviour.

4.1.3 Teaching Coping Skills Everyone needs to use specific skills to cope with difficulties they come up against on a daybyday basis. Children often need to cope with situations they find unpleasant such as waiting, accepting unexpected changes in routine, and noisy environments. Keeping children busy and engaged can help them learn to cope. For example, a parent could prompt their child to select a book in the doctor's surgery when they notice that they are looking bored or agitated. Parents could also teach their child how to relax by breathing slowly, and then remind them to use this skill in situations that they find distressing. Another way to promote positive coping is to teach children how to express how they feel. You can start to teach a child to label their basic feelings such as happy, sad, angry and scared from a young age. Do this by commenting Disability Services Commission (2008, June). Behaviour Support Guidelines for Children. Perth, 20
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4.1.2 Redirection This involves getting the childs attention before the behaviour becomes a problem and redirecting them to another task or activity. It is useful when it is anticipated that a child may misbehave or that a situation could get out of hand. For example when a child is holding a crayon and walking towards a wall, get their attention and give an instruction, "Kate, draw on paper", while pointing to the paper on the table. If necessary physically guide Kate to the table and help her to begin. When Kate is drawing on the paper, provide reinforcement, "Good drawing Kate".

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on their expression, for example, when a child is smiling say, Hey you look happy when you smile. Can you say happy? Or when they are frowning, Youre frowning, you look like youre getting angry. For children who do not use words, they can be prompted to point to pictures showing different feelings. Other ways of teaching emotions is through commenting on your own or other peoples feelings. This can also be done by commenting on emotions depicted in books, television and movies. 4.1.4 Active Listening When interacting, it is common for people to not listen attentively to one another. It is easy to be distracted, thinking about other things, or thinking about what you are going to say next. This is especially common when the speaker is distressed. When someone does not feel heard or feels misunderstood or contradicted, this can cause or increase distress. Active listening is a structured way of listening and responding to others. It involves suspending ones own frame of reference and suspending judgment in order to focus attention on the speaker. Active listening can be a particularly useful strategy to help children identify how they are feeling, reduce their distress, and help them to develop effective ways of managing upsetting circumstances. Active listening involves stopping what you are doing and paying attention to the child. This includes observing the childs behaviour and body language. If the child is talking, stay silent, but listen closely to what they are saying. Do not interrupt, tell them they are wrong, or try to make them feel better. You may ask a clarifying question if you are having trouble following what they are saying. When they have finished, repeat what you think the child has told you, but use your own words. Check with them to see whether you got it right. It is important to note that you are not necessarily agreeing with the childsimply stating what was said. If a child is upset, you may listen for feelings. Rather than merely repeating what the child has said, you might describe the underlying emotion, Sounds like youre really angry at your brother? Try to help the child put a name to the feelingonce they have learned to label a feeling accurately, it is easier to talk about and deal with it. Reassure the child it is okay to feel that way. Be cautious when labeling the childs emotions, it is often better to make tentative suggestions. This allows your child to give a different label if it does not quite fit. It is often difficult trying to put labels on other peoples feelings, but if handled with care, it can be extremely helpful. After reaching this point, and after the child has begun to calm down, ask them what they want you to do. This may be to just listen, to help them cope with their current feelings, or perhaps to set a goal for change. It may be helpful to help them to problem-solve the situation.

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4.1.5 Problem Solving Children and teenagers need to learn to think for themselves, particularly when faced with a problem they have not encountered before. Problem solving involves following a number of steps that will help children solve their own difficulties. Step 1 involves prompting the child to clearly state their problem (e.g., wanting to watch a different program to their sister on Tuesday afternoons). Step 2 involves prompting the child to come up with several possible options to solve the problem (e.g., only watching your show on alternate weeks, record the program and watch it later, see if its in a video shop, hide the remote). Sometimes a solution may require seeking more information or help (e.g., asking someone else how to program the video recorder). Step 3 involves rating each of the possible options, or deciding what the likely consequences will be for each option. Sometimes an option will solve the problem but have undesirable side-effects (e.g., hiding the remote might lead to a fight). Step 4 involves giving it a go. Once the best option or combination of options has been selected, prompt the child to trial the solution. Step 5 involves reviewing whether the option has worked or not. This is a great opportunity to praise your child for solving their own problem, or prompting your child to try out another option previously identified. Either way, it is important to praise both cooperation and success. 4.2 PUNISHMENT AND AVERSIVE PROCEDURES: ISSUES TO CONSIDER Punishment is something that follows a behaviour that decreases the chances of that behaviour occurring again. Positive punishment involves adding a stimulus following a behaviour (e.g., a reprimand). Negative punishment involves removing a stimulus (e.g., walking away when a child is screaming). Sometimes what is intended to be reinforcement is actually punishment, for example some children find kisses and cuddles unpleasant or embarrassing. Whether a consequence is reinforcing or punishing is often determined by the context in which it is applied. Providing a chocolate might be a reinforcer if a child is hungry, neutral if the child has just eaten enough chocolate, and a punisher if so much chocolate has been eaten that the child is nauseous. Similarly, taking a child to their bedroom might be punishment if the child would prefer to be with the rest of family, but reinforcement if the child is tired or would prefer to avoid a difficult task. Mild and acceptable forms of punishment are often referred to as discipline and can be useful to discourage problem behaviour. Ethically, punishment should not cause pain or harm to an individual.

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The main problems in using punishment, particularly when positive strategies are not used as well, are as follows: Punishment can be used without addressing why behaviour is occurring. For example, it would be better to recognise that a child may have a middle ear infection and requires medical attention rather than ignoring their crying. Punishment may not teach the child what they should be doing instead. For example, a child could be taught how to ask and wait for a turn rather than being told"Dont snatch". Some kinds of punishment teach the very behaviour parents do not want the child to do (e.g., smacking a child shows the child it is okay to hit). Punishment can create distress to all parties, that is, the carer doing the punishing, the child and those observing (e.g., siblings). Punishment may lead to an increase in other problem behaviours such as aggression, emotional outbursts, withdrawal, or avoidant behaviour. Punishment can lead to a poor relationship between the carer and the child and interfere with the child's ability to learn from the carer and others. Increasing levels of punishment may be required to keep the problem behaviour under control in the longer term. This can increase the possibility of the carer losing control, leading to the risk of physical and / or emotional damage.

As stated in section 2 of this document, parents / carers and agencies working with a child should agree on the specific procedures that may be used as part of a childs behaviour support plan. 4.2.1 Safeguards When Using Punishment It is good practice to monitor the strategies used and the behaviours to be changed, this will indicate whether the plan is working or whether it needs to be modified. If punishment is being used constantly to manage a problem behaviour, it is a sign that there may be something wrong with the overall behaviour support plan. For example, there may not be enough emphasis on teaching new behaviours. If there is no improvement in the childs behaviour over a 2-week period review the plan and consider seeking assistance from a psychologist. A sample monitoring sheet for keeping track of the use of behaviour change strategies is provided as Appendix A.
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Despite these problems, there is a case for the use of mild forms of punishment as part of a behaviour support plan. Punishment can result in a rapid decrease in problem behaviour, but should be combined with reinforcement procedures to teach the appropriate behaviour and promote longlasting behaviour change. For example, taking a toy from two children who are fighting over it would make it less likely that they would fight over it again. However, they would still need to be taught how to share the toy appropriately. In this way, punishment is used to discourage fighting and then reinforcement is used to teach new behaviours.

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4.3 PUNISHMENT PROCEDURES In this section, a number of punishment procedures are described, along with information relating to their potential uses and risks associated with their use. The information in this section can help inform decisions regarding what procedures are acceptable. 4.3.1 Reprimands A reprimand is an expression of disapproval. Research has shown that a firm reprimand such as No! or Stop! Dont do that! delivered immediately after the occurrence of a behaviour can reduce the likelihood that the behaviour will happen again. A reprimand is most effective if it tells the child what not to do, but also what they should to do instead, John, stop jumping on the couch, sit down. A reprimand should: be used sparingly (otherwise children can get used to it and it will lose its effect), be given in a firm and controlled voice without shouting, be communicated in a way that the child understands, refer to the behaviour and never be demeaning or insulting (e.g., by attacking a childs character), be used in combination with frequent praise and attention when the child behaves appropriately.
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4.3.2 Blocking This involves physically interrupting a childs behaviour momentarily to prevent its completion. Some examples include placing a hand in front of a child's mouth to stop them from biting their own hand, or quickly moving your hand to prevent one child from hitting another. Blocking should be combined with other strategies to teach appropriate behaviours.
ADVANTAGES
Is usually a natural response to prevent dangerous behaviours. Prevents instances of the problem behaviour from occurring. Has been used effectively for reducing rates of self-injurious and repetitive behaviours.

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A socially acceptable minimally aversive procedure. Can tell the child what the unacceptable behaviour is. When combined with an instruction telling the child what to do instead, gives the child an opportunity to learn appropriate behaviour.

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DISADVANTAGES

If a child is seeking attention, a reprimand may reinforce problem behaviour. Can be easily overused. Can trigger other problem behaviour.

DISADVANTAGES
Requires close physical proximity to the child. Can lead to a tussle and injury to the person blocking. May accidentally lead to the problem behaviour being reinforced.

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4.3.3 Escape Extinction Escape extinction is preventing a child from avoiding or escaping a task they do not wish to do, by misbehaving. It is based on the assumption that the problem behaviour functions as a way of avoiding or terminating a certain activity such as school work. Escape extinction consists of presenting the activity while ensuring participation by using verbal requests, blocking and graduated guidance. This procedure works best when ontask behaviour is reinforced. Escape extinction would usually be combined with other procedures to increase participation in the activity such as reducing task difficulty, decreasing demands and increasing how rewarding the task is. Also, appropriate ways of terminating disliked activities or seeking assistance should be taught. An example of escape extinction is a child at their activity schedule who starts flapping their hands. A physical prompt is used to make them point to the next picture in their schedule, teeth cleaning, and then another prompt to begin moving towards the bathroom.

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4.3.4 Overcorrection Overcorrection has two components, restitution and positive practice. Restitution involves restoring the environment to the state it was in before the problem behaviour, and perhaps to a state improved on what it was before the problem behaviour. Positive practice requires the child to repeatedly demonstrate a relevant prosocial alternative to the problem behaviour. For example, after drawing on the wall with a crayon, a child may be first required to wash the wall (restitution), including an area of the wall not marked by crayon, and then guided to use crayons on drawing paper (positive practice).

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Can produce a rapid reduction in the problem behaviour and an increase in adaptive behaviours. Can be effective for serious problem behaviours including selfinjury. One of few procedures useful for behaviour motivated by escape or avoidance.

Can be a very intensive and complex procedure to implement. Can result in a temporary increase in attempts at problem behaviour. May require additional support to implement depending on the size of the child or the intensity of the behaviour. Risks associated with blocking are also relevant for escape extinction.

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DISADVANTAGES
Child may be unwilling to complete tasks during the restitution and positive practice process. Child may not understand how the positive practice is related to the problem behaviour and may learn to perform both the problem behaviour and the positive practice in the future.

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4.3.5 Time-out Time-out involves preventing a person from getting positive reinforcement for a specific period of time following targeted problem behaviour. Time-out may be useful when the analysis of the problem behaviour suggests it is maintained by positive reinforcement such as attention or access to certain toys. Time-out should not be used unless it is part of a behaviour support plan that rewards positive and appropriate behaviours, or teaches the child to request objects, activities, and attention appropriately. When time-out is used it is extremely important that it is done correctly and consistently. For guidelines and issues to consider, see the reference list below. There are two broad classes of time-out. Nonexclusionary time-out occurs when the child is allowed to remain in the place where the problem behaviour occurred. Exclusionary time-out involves removing the child to a previously arranged secluded place. There are a number of time-out procedures and these are explained below. 4.3.5.1 Planned Ignoring Planned ignoring occurs when social reinforcers such as attention, physical contact or verbal interaction is removed for a short period of time when the child engages in a problem behaviour. Planned ignoring will only be effective if the function of the problem behaviour is to get attention. Even negative attention like nagging and reprimanding can reinforce the problem behaviour. Planned ignoring may lead to a brief increase in the rate and intensity of the problem behaviour, in this case ignoring should be continued unless it changes into another behaviour that should not be ignored, for example whining that turns into aggressive behaviour. Another procedure should then be used for the behaviour that cannot be ignored. Planned ignoring should be used for minor problem behaviours such as pulling faces, tantrums and swearing. It should not be used for dangerous or destructive behaviours such as hitting themselves or other children, throwing stones at windows, or playing with knives. Some children learn quicker when they are told that their behaviour will be ignored. Indicated planned ignoring is when a parent or carer tells the child what behaviour will be ignored and what alternative behaviour will get the attention they want. For example, a parent can say, I am not going to listen to you whine, when you tell me calmly what you want, I will listen.
ADVANTAGES
A non-intrusive procedure that can be applied quickly and conveniently. When planned ignoring is used in combination with procedures involving the reinforcement of other appropriate behaviours, it can result in children learning new adaptive behaviours more rapidly.

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DISADVANTAGES
Planned ignoring may lead to a brief increase in the rate and intensity of the behaviour. More severe problem behaviours, such as aggression, may also be exhibited. Because it can lead to an escalation in the behaviour it can be difficult for parents and carers to stay calm and continue using the procedure.

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If used inconsistently can make problem behaviours worse. Can be harder to implement if the child gets attention for their problem behaviour from peers or siblings.

4.3.5.2 Response Cost This involves taking away reinforcers following a problem behaviour, for example a toy is removed when the child is using it destructively. This form of response cost could also be termed a logical consequence because it is logically related to the misbehaviour. Other examples of response cost might include having water instead of a soft drink for shaking up the bottle, or receiving less pocket money for not completing chores. If the reinforcer was logically related to the problem behaviour it would usually be reintroduced after a short period to provide the child with another opportunity to learn how to behave with it. Children may need a reminder or support to use it appropriately. For example, the TV is switched off for five minutes when children are arguing over what channel to watch. Then it is turned on after the set time and assistance is given to the children to come up with an agreement about to watch. Response cost works best when it is carefully planned, immediately follows the problem behaviour, and is carried out every time the problem behaviour occurs.

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Care should also be taken when selecting consequences. The procedure should not restrict learning or social opportunities. For example, stopping a child from attending a birthday party when they are rarely invited to one is not appropriate.

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A minimally intrusive procedure that can be applied quickly and conveniently.

4.3.5.3 Brief Interruption Brief Interruption involves a period of interruption (10 seconds to 2 minutes) in response to disruptive behaviour such as self-injurious, repetitive or destructive behaviours. If the child engages in disruptive behaviour the parent or carer blocks their behaviour and instructs, or if necessary, guides their hands downward to their lap where they remain for the required amount of time. If the child is not calm at the end of the required amount of time, the duration of the interruption is extended until they are calm for a few seconds. For a more complete description see Azrin et al. (1988).
DISADVANTAGES
Requires being in close physical proximity to the child. Can lead to a tussle and may inadvertently lead to the problem behaviour being reinforced.

The child can be maintained in the situation and consequently may be effective for behaviours that are maintained by escaping or avoidance.

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May make childrens behaviour worse in the shortterm when the reinforcer is removed.

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4.3.5.4 Contingent Observation Contingent observation involves removing the child from a group activity after a problem has occurred and having them sit on the periphery in order to observe the alternative prosocial behaviour of others. During this time the carer may point out the alternative prosocial behaviours to help the child discriminate acceptable from unacceptable behaviours. When the child indicates that they know how to use the appropriate social behaviour they are allowed to rejoin the activity. If a child does not cooperate during contingent observation a back-up strategy such as exclusionary time-out would need to be used in the short-term.
ADVANTAGES
Can be used to address a variety of problem behaviours, such as refusal to share or take turns, being disruptive, or failure to remain on task.

DISADVANTAGES
Negative peer attention and instructions from carers during the observation period can reinforce the problem behaviour.

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4.3.5.6 Time-out Ribbon In this procedure, all children in a group are given a ribbon or button to be worn. With the ribbon in place, a child receives positive reinforcement in response to appropriate behaviour. As the child is receiving this reinforcement, the appropriate behaviour is described and the fact that the ribbon is present is commented upon. Over time, this consistent pairing of the ribbon with reinforcement helps the child understand that wearing the ribbon is a prerequisite for delivery of positive reinforcement. Thereafter, a non-exclusionary time-out can be put into effect by removing the ribbon for a set period of time, such as 3 minutes, whenever the child demonstrates a targeted problem behaviour. During the interval in which the ribbon is withdrawn, all forms of social interaction are removed. If the problem behaviour still occurs after the time period, the interval is extended until the behaviour stops. At this point, the ribbon is replaced and the caregiver looks for an opportunity to provide positive reinforcement for acceptable behaviour.
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Can be used to address a variety of problem behaviours, both in group settings (e.g., refusal to share or take turns) and when the child is alone with the carer (e.g., not following an instruction).

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4.3.5.5 Quiet Time Quiet time involves removing the child from the activity in which a problem occurred and having them sit quietly on the edge of the activity for 1 to 5 minutes. During this time they are not given any attention. Once they have remained quiet for the set time, they can rejoin the activity. If a child does not sit quietly during quiet time a back-up strategy such as exclusionary timeout would need to be used in the short-term.
DISADVANTAGES

The child may learn to delay or avoid certain activities by displaying problem behaviour. Becomes less age appropriate as the child gets older.

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The effectiveness of the procedure will depend on whether the child wants the social attention that is given when the ribbon is on.
ADVANTAGES
The presence versus absence of the ribbon is obvious not only to the child and his or her peers, but also any involved caregiver. The ribbon can be worn in many different settings, facilitating the consistent application of non-exclusionary time-out.

DISADVANTAGES
May require a long period before becoming effective. Removal of ribbon may lead to aggression toward the caregiver or a temporary escalation of other behaviours such as tantrums or property destruction. Children may have difficulty understanding why the ribbon is removed at the end of the class. Potentially stigmatising to children involved in such a programparticularly if it is only used with children who have a disability or worn out in the community.

Because of the risk of inadvertently reinforcing problem behaviour, it is recommended that the use of exclusionary time-out is monitored. Each use of exclusionary time-out should be recorded as well as how long it takes before the child is quiet for the set time. If effective, the child should become quiet more quickly and time-out should be needed less often. A sample recording sheet of monitoring the use of time-out (and other strategies) is provided in Appendix A.

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4.3.5.7 Exclusionary Time-out Exclusionary time-out involves removing the child who misbehaves from "timein" to a secluded time-out area. The time-out area should be uninteresting, yet safe, with good lighting and ventilation. Misbehaviour and calling out while the child while in the time-out area is ignored. Time-out is over when the child has remained quiet in time-out for a specified period of time, usually 5 minutes or less. At this time, the child is returned to timein and the caregiver looks for an opportunity to praise the child's alternative appropriate behaviour. It should be emphasised that time-out will not be effective if timein is not sufficiently reinforcing for the child. For specific procedural guidelines on the use of exclusionary time-out, see Sanders and Dadds (1993).

Can send a clear message to the child that unacceptable behaviour has occurred. Provides an opportunity for both the child and the parent to calm down. Can help children learn to manage feelings of anger and frustration.

Disability Services Commission (2008, June). Behaviour Support Guidelines for Children. Perth, Western Australia: Author.

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DISADVANTAGES
Child can receive reinforcement while being taken to the time-out area. The child can delay or avoid the required task during time-out (and consequently be reinforced for the problem behaviour). There is a risk of dangerous or destructive behaviour by the child during time-out. Carers can be reinforced for using timeout and may leave the child in time-out for too long or use time-out too frequently.

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Exclusionary time-out is difficult to use in public places. Becomes less socially acceptable as the child gets older.

4.3.5.8 Facial Screening Facial screening involves applying a face cover, usually a soft cloth, a blindfold, or the caregiver's hands, to block out visual input for about 5 to 15 seconds following each occurrence of the unwanted behaviour. Because of issues concerning the acceptability of this strategy it should only be used in circumstances where the risk to the child outweighs the social costs of using this procedure. Less intrusive procedures should be used in preference.
ADVANTAGES
Has been successful with a variety of selfinjurious and repetitive behaviours.

DISADVANTAGES
A tussle can occur should the child try to remove the screen. The procedure may be devaluing to the person. May not be socially acceptable to members of the public.

4.3.6 Restraint, Including the Use of Medication Restraint involves a variety of mechanisms used for the purpose of restricting the free movement or decision-making abilities of another person. There are four main types of restraints: 1. Physical Restraintincludes any manual methods to restrict, subdue or prevent the movement of any part of a persons body, and involves physically holding the person against their will. 2. Mechanical Restraintinvolves the use of any devices, equipment or materials to restrict, subdue or prevent the movement of, or access to, any part of the persons body. This could include (but is not limited to): seat belts (other than those required by law), wheelchair lap belts, wheelchair tray tables, clothing that the person cannot remove (e.g., mittens, overalls), or placing a person in chairs or in beds that they cannot get out of. It can also include not helping someone with a disability move when he or she wants to. 3. Chemical Restraintinvolves the intentional use of medication to control a persons behaviour when no medical condition or psychiatric disorder has been diagnosed or is being treated. 4. Seclusionincludes locking a person in a room or any other location, or locking them out of an area The use of restraints to manage problem behaviour is questionable because it not only stops the problem behaviour, but can restrict other behaviours as well. For example a restraint to prevent a person from sucking their hands can also prevent that person from learning to feed themselves or from playing. For this reason a thorough assessment should be conducted and a behaviour support plan incorporating alternative strategies developed.
Disability Services Commission (2008, June). Behaviour Support Guidelines for Children. Perth, Western Australia: Author.

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A behaviour support plan should state how, when and for how long restraint is to be used, and when the behaviour support plan is to be reviewed, as set out in the Commissions Use of Restraints Policy. Staff such as a clinical psychologist, therapists and a doctor may be involved in developing these procedures. Use of Restraints Policy specifies that using a restraint as an emergency procedure requires a restraints program if it is to be used for longer than 24 hours.
ADVANTAGES
May stop the behaviour immediately and may allow children with severe behaviour problems to access activities that they might not otherwise be able to access (e.g., excursions into the community). Restraints may be necessary in the shortterm to manage dangerous self injurious or aggressive behaviours.

DISADVANTAGES
On their own, restraints do not teach the child more appropriate behaviours and can result in the emergence or escalation of other problem behaviours Restraints are particularly susceptible to overuse. The extended use of restraints can result in physical injury to the person by reducing circulation, causing welts, and muscle and bone wastage. Restraints typically deprive the child from participating and interacting with their environment. When applying restraints, a tussle may occur. Children can grow to like or expect the restraint and the restraint can be difficult to eliminate or fade out. May result in the loss of dignity for the person wearing them. May not be socially acceptable.

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MORE INFORMATION AND RESOURCES: Baker, B. L., & Brightman, A. J. (1997). Steps to independence: teaching everyday skills to children with special needs. Baltimore: Paul H. Brookes. Sanders, M. R. (2004). Every Parent: A positive approach to children's behaviour. Camberwell: Penguin. Sanders, M. R., Mazzucchelli, T. G., & Studman, L. J. (2003). Stepping Stones Triple P Family Workbook. Milton, Queensland: Triple P International

For Service Providers


Communication Skills Egan, G. (1990). The skilled helper: A systematic approach to effective helping. Pacific Grove, CA: Brookes / Cole. Gordon, T. (1970). PET: Parent Effectiveness Training. New York: Peter H. Wyden, Inc.. Establishing Operations Michael, J. L. (1982). Distinguishing between discriminative and motivational functions of stimuli. Journal of the Experimental Analysis of Behavior, 37, 149-155.
Disability Services Commission (2008, June). Behaviour Support Guidelines for Children. Perth, Western Australia: Author.

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For Parents

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Procedures to Reduce Problem Behaviour


Ethical Guidelines Australian Psychological Society (2002). Ethical Guidelines (4th ed). Melbourne: Author Functional Analysis / Assessment Emerson, E. (2001). Challenging Behaviour: Analysis and Intervention in People with Intellectual Disability (2nd Edition). Cambridge: Cambridge University Press. Iwata, B. A., Vollmer, T. R., & Zarcone, J. R. (1990). The experimental (functional) analysis of behaviour disorders: Methodology, applications, and limitations. In A. C. Repp & N. Singh (Eds.), Aversive and nonaversive treatment: The great debate in developmental disabilities (pp. 301-330). DeKalb, IL: Sycamore Press. Functional Communication Training Carr, E. G., Levin, L., McConnachie, G., Carlson, J. I., Kemp, D. C., & Smith, C. E. (1994). Communicationbased intervention for problem behavior: A user's guide for producing positive change. Baltimore, M.D.: Brookes. Durand, V. M. (1990). Severe behavior problems: A functional communication training approach. New York: The Guilford Press. Punishment Cooper, J. O., Heron, T. E., & Heward, W. L. (2007). Applied Behavior Analysis. New Jersey: Prentice. Lutzker, J. R., & Wesch, D. (1983). Facial screening: History and critical review. Australian and New Zealand Journal of Developmental

Disabilities, 9, 209-223. OBrien, F. (1989). Punishment for people with developmental

Disability Services Commission (2008, June). Behaviour Support Guidelines for Children. Perth, Western Australia: Author.

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disabilities. In E. Cipani (Ed.) The treatment of severe behavior disorders: Behavior analysis approaches (pp. 37-58). Washington DC: AAMR. Van Houten, R. (1980). How to use reprimands. Austin, Texas: Pro-ed. Restraints Disability Services Commission (2006). Use of Restraints Policy. Perth, Western Australia: Author.

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Management of Emergency Situations

5.

MANAGEMENT OF EMERGENCY SITUATIONS

There can be occasions where carers are faced with scenarios, which have not been planned for, and there is a need to resort to emergency management procedures, such as those listed in Appendix B. Although the aim should be to provide adequate support to prevent problem behaviour, children can still have behaviour outbursts which can place themselves or others at risk of serious injury. Examples might include a child who begins to threaten other children and carers with a cricket bat, a child who runs towards a busy road ignoring a carer's calls to stop, or a child who punches herself in the face. Having strategies which carers can use in situations where preventative measures have not succeeded is essential in any behaviour support program. There are a number of strategies that can be used to defuse emergency situations, such as distraction and redirection, active listening, facilitating relaxation and selfcontrol, and giving the child what they want. The main purpose of these strategies is to diffuse the situation as soon as possible and protect the individual and others from further harm. This has the increased risk of accidentally reinforcing the problem behaviour. Emergency management strategies should be embedded within a broader plan that supports the individual to develop other more appropriate ways of having their needs met. If emergency management strategies are used regularly, the behaviour support plan should be reviewed. When carers use emergency procedures the incident should be documented and the incident should be discussed with the child's parents afterwards. At this time steps to prevent such a scenario from occurring in the future can be discussed and how to manage any similar incidents in the future can be agreed upon. It is not the place of this document to cover all these emergency strategies (for a comprehensive list see Willis & LaVigna, 1996). For severe assaultive / destructive behaviour, the following strategies may be appropriate, often in combination with other emergency strategies. 5.1 ANTECEDENT CONTROL STRATEGIES 5.1.1 Remove Seductive Objects Particular objects or materials can act as a cue for a child to approach and engage the object which can then result in a potentially serious situation. By removing the object, or by eliminating access to the object, a potentially serious episode might be avoided. Examples of this strategy might be to lock the front door to prevent a child from leaving the house unattended, putting away small objects that might be swallowed, or not giving a child a particular toy because they will refuse to participate in all activities from that time on.
Disability Services Commission (2008, July). Behaviour Support Guidelines for Children. Perth, Western Australia: Author.

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In most circumstances the objects and materials can be gradually reintroduced as the child is taught alternative behaviours.
ADVANTAGES
Prevents occurring. serious situations from

DISADVANTAGES
If objects are not re-introduced, the child is not given opportunities to learn how to manage their behaviour in their presence.

Prevents occurring.

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When used in isolation, the effect of stimulus change is only temporary. The more often the same novel event is used, the less effective it is likely to become. A wide repertoire of novel things to do and to say may be needed. Stimulus change may be a useful short term strategy until a comprehensive assessment and a behaviour support plan can be implemented.
ADVANTAGES
Works quicklyif stimulus change works at all, it works immediately. Provides opportunities for use of alternative strategies (e.g., reinforcing of other behaviour). Disability Services Commission (2008, June). Behaviour
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5.2

INTERRUPTING THE BEHAVIOURAL CHAIN AND COUNTER INTUITIVE STRATEGIES 5.2.1 Stimulus Change Stimulus change involves presenting an unexpected stimulus or altering environmental conditions when the child is beginning to escalate or at the time of an incident. This can interrupt the course of the escalation and result in the problem behaviour lessening in intensity or even stopping. Examples of stimulus change might include performing an outrageous dance, bursting into laughter, turning on classical music, or turning out the lights.

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If requests are not re-introduced, the child is not given opportunities to learn how to cope when given such requests. Child can learn to escalate behaviour in order to avoid other demands / requests.

DISADVANTAGES
Effect on behaviour is temporary, especially if used in isolation. If used repeatedly, children may learn to disregard such changes. May accidentally reinforce the problem Support Guidelines for Children. Perth, 34

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5.1.2 Remove Unnecessary Demands and Requests Children sometimes become physically aggressive and destructive when presented with demands or are pursued for compliance. In these situations, removing or making easier requests is likely to reduce many serious behaviour episodes. At the same time, the child can be reinforced for cooperating with related demands and requests. For instance, if a child is known to bang his head on the floor when told, Do this puzzle, caregivers may choose not to make that request. Instead, the child might be encouraged for following instructions to participate in other activities. Puzzles may be reintroduced later, starting with ones that the child enjoys and is able to complete successfully.

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Management of Emergency Situations


Does not involve physical contact between the carer and the distressed child, reducing the risk of injury to either party. behaviour.

5.2.3 Capitulation Capitulation involves giving the child what they want in order to bring a problem behaviour under rapid control and prevent injury to the child or others around them. This is an approach used when other strategies have not yet been put in place. For example, if a child is banging her head on the door, wanting to go outside at an inappropriate time, capitulation would involve allowing the child to go outside in order to avoid further escalation and risk of injury.

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May quickly bring the problem behaviour under control Does not involve physical contact between the carer and the distressed child, reducing the risk of injury to either party. Provides opportunities for use of alternative strategies (e.g., reinforcing of other behaviour).

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May quickly bring the problem behaviour under control. Does not involve physical contact between the carer and the distressed child, reducing the risk of injury to either party.

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May accidentally reinforce the problem behaviour. Effect on behaviour is temporary, especially if used in isolation.

DISADVANTAGES
May accidentally reinforce the problem behaviour.

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5.2.2 Diversion Diversion involves redirecting or diverting a child to an activity or event that is compelling or strongly attractive. For example, suppose a child loves milk and has a history of dropping everything and going to the kitchen when you say, lets get some milk. This might be used to divert a child in an emergency situation. For instance, if the child picked up a screwdriver and threatened to hurt another child with it. This strategy is counterintuitive in that it has the strong potential to reinforce the problem behaviour and increase its future occurrence. Given this, safeguards should be incorporated such as teaching the child how to ask for milk appropriately so that threatening behaviour is not the only way to get access to milk. Diversion should be used as early in the behavioural chain as possible. Also, in high-risk situations, appropriate behaviour should be prompted and reinforced.

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Management of Emergency Situations


5.3 RESTRAINT 5.3.1 Interpositioning Interpositioning involves the use of the immediate environment to minimise or eliminate the consequences of assaultive / destructive behaviour. An example would be keeping a table between you and the child who is distressed while attempting to calm them down.
ADVANTAGES
Does not involve physical contact between the carer and the distressed child, reducing the risk of injury to either party.

DISADVANTAGES
May accidentally reinforce the problem behaviour if it turns into a game.

ADVANTAGES
Protects others from injury and gives the child space and the opportunity to calm down

5.3.3 Physical Restraint Physical Restraint includes any manual methods to restrict, subdue or prevent the movement of any part of a persons body, and involves physically holding the person against their will. Physical restraint involves the use of handson contact through the placement of the carer's body weight in such a manner as to briefly prevent the childs movement. It does not involve the use of restraining devices (see section 4.3.6). Physical restraint may be used when a persons behaviour becomes so uncontrollable that it presents a clear danger to the child or others. Examples of physical restraint include holding the child's wrists to prevent them from hitting others, wrapping arms around the child, bringing them down to ground level, holding them until they are calm, and physically taking the child to another area while holding their arms. These strategies involve physical risk to the people involved therefore carers should be fully trained in their quick and safe implementation.

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Can quickly bring the incident under control, protect the child and others from danger, and can minimise property damage.

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DISADVANTAGES
Can increase the risk of injury to those involved. Can result in an escalation of the behaviour. Can be resource intensive to implement effectively.

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5.3.2 Seclusion Seclusion involves taking the child to a specified area or removing yourself and others from an area and locking the door.
DISADVANTAGES

May lead to an escalation of the disruptive behaviour. There is risk of injury to the child and carer if physical contact is involved. May accidentally reinforce the problem behaviour if the child avoids a disliked activity.

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MORE INFORMATION AND RESOURCES:

For Service Providers


LaVigna, G. W., & Willis, T. J. (1997). Severe and challenging behavior: Counterintuitive strategies for crisis management within a nonaversive framework. Positive Practice, 2 (2), 1, 10-17. Willis, T. J., & LaVigna, G. W. (1996). Challenging behavior: Emergency management guidelines. Los Angeles: Institute for Applied Behavior Analysis.

Disability Services Commission (2008, June). Behaviour Support Guidelines for Children. Perth, Western Australia: Author.

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Child Abuse

6.

CHILD ABUSE

Child abuse is anything which individuals, institutions or processes do, or fail to do, which harms children or damages their prospects of a safe healthy development into adulthood. Physical abuse includes bruising, burning, shaking or beating children. Emotional abuse includes depriving a child of love, warmth and attention; yelling or "picking on" a child. Neglect includes failing to provide basic necessities of lifeadequate diet, medical care, clothing. Sexual abuse includes incest, rape, fondling, "flashing" and other sexual activity. 6.1 ACTIONS WHICH DO NOT MEET THE COMMISSIONS STANDARDS AND ARE NOT TO BE USED The Commission considers the following methods of punishing behaviour unacceptable. They may be considered maltreatment and result in concerns being raised about the child's welfare and further investigation.

Physical punishmentany action which inflicts pain on a child.

Threateningverbal threats of dire consequences. Refusing to provide or withdrawing meals without replacement.

IF YOU HAVE CONCERNS Anyone with concerns about the practices used with a child should raise the issue with those involved. Often problems are resolved through discussion with the person closest to the issue that is of concern. If this action does not immediately resolve the issue the next step may be to speak to this persons supervisor. If your concerns are still not resolved, a complaint can be lodged. If there is an agency involved, contact them and ask how to lodge a
Disability Services Commission (2008, July). Behaviour Support Guidelines for Children. Perth, Western Australia: Author.

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Introducing foul tasting or harmful substances such as chilli or tabasco sauce. Shouting or screaming at a child. Electric shocks or prods. Spraying substances at children such as water, lemon juice or ammonia.

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Child Abuse complaint. The Commission has a complaints procedure and may also be able to assist in having concerns resolved with other agencies. If you are worried that a child you know is being hurt it is important to trust your instincts. Talking to your doctor, child health nurse, Department of Child Protection officer, or Disability Services Commission staff member can be an important step in keeping a child safe from further harm and in getting help for the child, family and the person hurting the child.

Disability Services Commission (2008, June). Behaviour Support Guidelines for Children. Perth, Western Australia: Author.

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Bibliography

BIBLIOGRAPHY
Axelrod, S. (1987). Doing it without arrows: A review of LaVigna and Donnellan's Alternatives to punishment: Solving behavior problems with nonaversive strategies. The Behavior Analyst, 10, 243-251. Axelrod, S. (1990). Myths that (mis)guide our profession. In A. C. Repp & N. N. Singh (Eds.) Perspectives on the use of nonaversive and aversive interventions for persons with developmental disabilities (pp. 59-72). Sycamore, IL: Sycamore Publishing company. Azrin, N. H., Besalel, V. A., Jamner, J. P., & Caputo, J. N. (1988). Comparative study of behavioral methods of treating severe selfinjury. Behavioral Residential Treatment, 3, 119-152. Bambara, L. M., & Knoster, T. (1998). Designing positive behavior support plans. Washington DC: American Association on Mental Retardation. Iwata, B. A., Pace, G. M., Kalsher, M. J., Cowdery, G. E., & Cataldo, M. F. (1990). Experimental analysis and extinction of selfinjurious escape behavior. Journal of Applied Behavior Analysis, 23, 11-27. LaVigna, G. W., & Willis, T. J. (1997). Severe and challenging behavior: Counterintuitive strategies for crisis management within a nonaversive framework. Positive Practice, 2 (2), 1, 10-17. ONeill, R. E., Horner, R. H., Albin, R. W., Sprague, J. R., Storey, K., Newton, J. S. (1997). Functional assessment and program development for problem behavior: A practical handbook. Pacific Grove: Brooks/Cole Publishing Company. Sanders, M. R., & Dadds, M. R. (1993). Behavioral family intervention. Boston: Allyn and Bacon. SulzerAzaroff, B., & Mayer, G. R. (1991). Behavior analysis for lasting change. Fort Worth: Holt, Rinehart and Winston. Zarcone, J. R., Iwata, B. A., Vollmer, T. R., Jagtiani, S., Smith, R. G., & Mazaleski, J. L. (1993). Extinction of selfinjurious escape behavior with and without instructional fading. Journal of Applied Behavior Analysis, 26, 353-360.

Disability Services Commission (2008, July). Behaviour Support Guidelines for Children. Perth, Western Australia: Author.

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Appendix A

APPENDIX A: BEHAVIOUR SUPPORT DIARY


Instructions: Make a note of the day, the behaviour, when and where it occurred, and the procedure you used.

DATE AND TIME

BEHAVIOUR
(e.g., list the desired or problem behaviour)

STRATEGY USED
(e.g., descriptive praise; exclusionary time-out)

OUTCOME
(e.g., he giggled and kept working; length of exclusionary time-out)

Disability Services Commission (2008, July). Behaviour Support Guidelines for Children. Perth, Western Australia: Author.

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Appendix B

APPENDIX B: EMERGENCY MANAGEMENT PROCEDURES


An emergency arises when a child behaves in a manner which puts his or her or others safety at risk (e.g., physically assaulting others, dangerously throwing objects, or gouging their own eyes). When this happens immediate and decisive action is necessary. If there is an existing behaviour support plan that outlines what to do for the child and others involved, then follow that. Otherwise follow these steps. 1. Calmly approach the child and attempt to stop their actions by talking (if appropriate), finding out what is causing the outburst, listening to what they tell you, and generally trying to calm them down. Do not make any demands on the child. Remember what you know about the child and what will help to calm them down. This might be giving them a preferred item, talking to them about their favourite topic, putting on their favourite music. Seek backup help if it is needed and available. Monitor the child until they are calm and the crisis has passed. This may take some time (e.g., an hour or more, so dont panic if the child is not calm after a few minutes). If necessary, carers and others should remove themselves from the area and leave the child alone. Possible last resort options include: Leaving the child alone in a secure area until they are calm. Physically restraining and guiding the child to a secure area and leaving them there until they are calm. Physically restraining the child on the spot until they are calm.

2.

3.

4.

5.

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When the child calms down, set them up in an appropriate activity and reinforce them for their appropriate engagement. Finally: Take care of anyone who was hurt, including the child involved in the incident. Inform the child's parents and other relevant support staff (e.g., at school or day care) as soon as possible. Record what was done and why. Consider emotional support and trauma debriefing to anyone who may be seriously affected by the incident. Ensure that a review of the incident is undertaken. The review should include an assessment of the incident and how to prevent 42

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Appendix B
this occurring again. A psychologist could be consulted to help plan any intervention and to help determine how to avoid such incidents.

Disability Services Commission (2008, June). Behaviour Support Guidelines for Children. Perth, Western Australia: Author.

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Appendix C

APPENDIX C: RESOURCES
Disability Services Commission Head Office ............................................................................ 9426 Joondalup Office ..................................................................... 9301 Myaree Office ......................................................................... 9329 Accommodation Services ......................................................... 9426 Country Services ..................................................................... 9426 Complaints ............................................................................. 9426 9200 3800 2300 9200 9200 9200

Department for Child Protection Crisis Care ...................................................... 9223 111 or 1800 199 008 Family Helpline ..............................................9223 1100 or 1800 643 000 Parenting Line ................................................9272 1466 or 1800654 432 Department of Education and Training Check phone book for your District Education Office Centre for Inclusive Schooling.................................................. 9426 7111 Communicare 9251 5777 Resource Unit for Children with Special Needs (RUCSN) ............ 9221 5616 Independent Schools Check phone book for appropriate school

Therapy Focus ..................................................................... 9478 9500 Department of Health Check phone book for your local Community Health Service Centre State Child Development Centre............................................... 9481 2203 Psychiatric Emergencies ..................................9224 8888 or 1800 676822 Ngala Family Resource Centre Administration ........................................................................ 9368 9368 Police Check phone book for local police station Training in Implementation of Physical Restraint Professional Assault Response Training .............................(03) 9870 1249 Triple PPositive Parenting Program (parent and practitioner training) Contact your local Disability Services Commission office, community health service centre, or the Parenting Line Triple P International............................................................ (07) 3367 1212

Disability Services Commission (2008, July). Behaviour Support Guidelines for Children. Perth, Western Australia: Author.

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