Recognizing Problem Behavior – Online Parent Training in Early Intervention (OPT-In-Early)

First, let’s talk a bit more about problem behavior. This can take many forms. Most often when we talk about problem behavior we think first of non-cooperation, which is refusing to follow instructions or rules. This can happen when children are asked to do something they don’t want to do. It can also happen when they want something that they cannot have.

IMPORTANT NOTE ABOUT NON-COOPERATION: All children engage in non-cooperation. We wouldn’t want a child to do absolutely everything they are asked to do without complaint or negotiation. In fact, we WANT all children to learn how to advocate for themselves, how to complain AND how to negotiate. However, some children are much less likely to do what a parent has asked them to do. This can become especially difficult when children have limited communication skills and do not know how to say no or how to ask for a little more time to do what they want to do, etc. When we talk about “non-cooperation” as a kind of problem behavior, or something that can lead to more serious problem behavior, we are talking about situations in which children generally understand what they are being asked to do, but usually do not do what they are asked to do. And this refusal is often accompanied by excessive whining, crying and/or more dangerous or destructive behaviors. We are NOT talking about the kind of non-cooperation that is typical of any very young child.

When parents don’t give the child what he wants, or when they try to get the child to do what he’s asked to do, this can often lead to tantrums. Tantrums can include loud crying, screaming, rolling or kicking on the floor, grabbing things, or trying to run away. Children may throw objects they can reach. They may break them, on purpose or by accident.

Sometimes, even worse problem behaviors can occur, such as hurting others. They may hit, kick, scratch, or bite another person.

Another problem behavior is when the child tries to hurt themselves. They can bite, hit, scratch or pinch themselves. They can bang their heads against a hard surface. Self-harm is any behavior that could result in hurting their own bodies. This is sometimes called self-injurious behavior (SIB).

Problem Behavior

Non-cooperation
Tantrums
- Loud crying, screaming and yelling
- Rolling around and kicking on the floor
- Grabbing objects
- Trying to run away
Throwing, grabbing, or breaking things
Hurting others
Hurting themselves

Stereotypic Behavior

Stereotypic behaviors are unusual behaviors that the child does over and over. They often do these things exactly the same way each time. They can be movements or noises that the child seems to like doing, or that may calm him. As you may remember, we talked about these repeating movements in the module on Expected Development. There, we said that a certain amount of repeating behavior is normal in early childhood. But this behavior is of concern if it takes up a lot of the child’s time. Or it may be a problem if the child gets angry or has a tantrum when you try to get the child to stop repeating and move on to other things. For example, you may want them to play with you or to eat dinner or get dressed.

Stereotypic behavior can take many forms. The following are just a few examples.

Looking behavior –
- watching the wheels of a toy car spin
- watching a toy vehicle move back and forth
- wiggling a toy or a piece of string in front of the eyes or just to the side of the eyes
- getting down on the floor to look at things lined up
- getting up close to a TV and watching the words that go up the screen at the end of a show. See a couple of examples of this behavior in the next two videos.

Movement–
- rocking back and forth
- jumping up and down,
- hand flapping
- picking at pieces of thread or small bits of dust,
- tensing and relaxing the muscles of the face, eyes, hands, or whole body. See a couple of examples of this behavior in the next two videos.

Touching
- rubbing a piece of cloth against the skin
- twirling a lock of hair around the finger
- pushing hard with the arm or hand against the chin.

Smell and Taste –
- sniffing or licking food, objects or parts of the body.

Vocal/Verbal–
- Making a high-pitched screeching or chirping sound
- Making grunting or whining noises
- Repeating a certain sound (like ticka-ticka-ticka-ticka)
- Repeating a word, a phrase, a song or lines from a movie or TV show over and over

Many young children do some of these behaviors, like hair twirling or rocking when they are bored, tired, or upset. The behavior is of concern when it happens several times a day or more, is hard to interrupt, or occurs often even when the child does not seem bored, tired, or upset.

What Kinds of Reinforcement Maintain Stereotypic Behavior?

Like any behavior that the child does over and over, we can ask what reward or reinforcement keeps it going. Stereotypic behavior often seems to feel good to the child. If it does, the reinforcer can be this good feeling it causes. We call this “automatic reinforcement” because the behavior itself causes the good feeling right away and automatically, without anyone else giving the child more reinforcement.

Try to Engage Your Child In Appropriate Activities That Offer The Same Kind of Good Feelings

If you think this may be happening for your child, try to think of some more appropriate play that may cause a similar good feeling. Then try to keep this play going. For example, think of children who like to spin or wiggle objects back and forth in front of their eyes. They may enjoy chasing bubbles to pop them. They may also enjoy playing with a pinwheel. They might like a simple game that uses a spinner. Children who like to repeat sounds or words over and over, might enjoy playing with toys or books that make sounds, words or music. Try to gently interrupt stereotypic behavior by offering the child other, more appropriate activities. In this way, parents can help the child spend less time doing stereotypic behavior and more time playing with another person.

Stereotypic Behavior can Interfere with Learning

One reason that stereotypic behavior may be a problem is that it can limit the time the child spends learning new things. Some children like doing these behaviors so much that they spend a lot of time doing them. While doing this, they do not pay much attention to the people and things in the world around them.

Some children do these stereotypic behaviors to avoid learning tasks, especially those that require more effort. At these times, avoiding hard work can be the reward that maintains the stereotypic behavior. In this module, we will talk about how to teach some skills that lead to the same result as stereotypic behavior but are more appropriate. This includes teaching the child to say no, to ask for help, to ask to be all done and to ask for a break. These good ways to ask for a break can replace stereotypic behavior when it is done as a way to avoid the hard work of learning a new thing.

Problem Behavior Continues when it is Reinforced

Most problem behavior exists because it has been rewarded, either because it just feels good, or by the way adults respond to it. Of course, the adults don’t reward this behavior on purpose. But there is something that the child gets when he does the behavior that reinforces it, like getting extra attention or getting out of doing things he doesn’t want to do.

Caregivers play an important role in noticing what happens before and after a challenging behavior. When trying to understand what kinds of situations are likely to lead to a challenging behavior, we need to pay close attention to what happens just before it occurs. We call this the antecedent and we can think of this either as a trigger for the behavior or the conditions in which it is most likely to occur. We also want to learn what might be maintaining or reinforcing the behavior. For this, we need to pay close attention to what happens just after the challenging behavior occurs. We call this the consequence and we think about this in terms of how others respond to the challenging behavior or what happens in the environment that may reinforce the challenging behavior.

The same behavior can happen for very different reasons (also called “functions”). Careful observation helps caregivers identify the correct reason(s)/function(s) for the behavior. We do this by looking at what we sometimes call the “ABC’s of Behavior” where “A” is the antecedent, “B” is the child’s “Behavior” and “C” is the Consequence.

Let’s take an example: Amy, a 3-year-old with limited communication skills, has started to hit her sibling. Her parents are paying close attention to what happens just before and just after Amy hits her sibling. Here is what they have found.

Antecedent	Challenging Behavior	Consequence
Sibling takes her toy	Amy hits her sibling	Sibling lets go of the toy and leaves
Mom is giving attention to sibling	Amy hits her sibling	Mom gives Amy attention (saying “Amy, stop that, that’s not nice!”)
Mom asks Amy to stop playing and put on her pajamas and brush her teeth	Amy hits her sibling	Mom delays the transition to help Amy “make peace” with her sibling

Even though the behavior looks the same (hitting), the reason is different in each situation, so the strategies to address this behavior must also be different in each situation. In each case, it’s important for mom to adjust the environment and her own response so that hitting no longer works to get Amy what she wants, thereby ending or removing the reinforcement that Mom thinks is maintaining the challenging behavior. However, this alone is not enough. Amy’s parents can better prevent the hitting behavior in the future by teaching Amy alternative ways to communicate her wants and needs using her current language skills. In order to teach these alternative behaviors or replacement behaviors, they will need to help Amy practice these new behaviors many times a day during her daily routines.

For example:

Antecedent	New Behavior (Alternative Appropriate Behavior to Teach Amy)	Consequence
Sibling takes her toy	Amy says or gestures “my turn,” or goes to mom for help	Sibling gives the toy back to Amy.
Mom is giving attention to sibling	Amy gets close to mom and taps her shoulder for attention	Mom pays attention to Amy.
Mom asks Amy to stop playing and do homework/brushing teeth	Amy asks for more time to play	Mom delays the transition and gives Amy a little more time to play.

By showing Amy how to ask for what she wants, mom teaches her that appropriate communication, not hitting, is the way to get her needs met.

Based on the example above, the goal is to help children get what they want in appropriate ways instead of through problem behavior. This is called Functional Communication Training. The best time to stop problem behavior is before it starts, by teaching children to communicate their needs. This might look like:

Asking for attention from an adult
Requesting a toy, activity, or break
Saying “no” or showing they don’t want something

As children learn these communication skills, we can also help them build other important skills, like waiting when a request can’t be met right away, taking turns, and cooperating with reasonable instructions.