Behavior Management Plan for Multiple Disabilities

Written for:
8-year-old girl
Hearing impaired (mild-moderate loss)
PTSD, ADHD, learning disorder
Self-contained hearing-impaired class with partial mainstreaming
Reader Submission


Overview of Behavioral Issues Associated with Post-Institutionalized Children

Specific Behavior Plan for [Child]
I. Create rules that target specific behaviors.
II. Provide constant positive feedback when rules are not being broken.
III. Provide immediate, unemotional time-outs when a rule is broken.
IV. Adjust the environment to make it easy to follow rules.
V. Assess effectiveness of plan on a regular basis and make adjustments.

Overview of Behavioral Issues Associated with Post-Institutionalized Children

In working with [Child] and managing her behavior, it will be helpful to understand a few things about the effects of institutionalization on young children.

While there is no single pattern of response to neglect and deprivation, children who have been institutionalized tend to display disturbances in four areas. All studies of post-institutionalized children have found that the presence and severity of disturbances are correlated with the institutional environment, length of institutionalization, and the child’s individual resilience. The four areas are:

• Attachment (characterized by indiscriminant social approach, an apparent lack of awareness of social boundaries, and difficulty in picking up social cues)

• Inattention/overactivity (generally associated with PTSD and anxiety)

• Quasi-autistic behaviors (stereotypies, motor and sensory impairments, obsessive compulsive behaviors, impairments in social-reciprocal relationships)

• Cognitive delays or dysfunction (with greatest delays in the area of language and verbal reasoning)

[Child] is affected in each of these areas and they, in turn, affect her behavior.

Socially and emotionally, [Child] functions at the level of a preschooler. She has made amazing progress in the areas of attachment and emotional development, but she is not caught up yet. Expectations, supervision, privileges, rules, and discipline must be adjusted to her developmental level, with constant pressure toward the next level.

Stress makes things worse. Sometimes she seems to be able to do things and sometimes she doesn't. Her ability to control her behavior declines in proportion to the amount of stress she is experiencing. The stress may have an obvious source -- classroom noise, difficult schoolwork, disruptions of routine -- or one that is less obvious. Sensory integration problems and hypervigilance make [Child] react to things in the environment the rest of us wouldn't normally notice. Sometimes loss of control happens after a stressful event: If she uses a lot of control to get through something hard early in the day, she may run out of control late in the day.

Language and memory deficits make it difficult for [Child] to comprehend, remember, and apply abstract rules.

Because of these difficulties, strategies that require an advanced level of maturity and responsibility or that increase the level of stress will be ineffective at best and may, in fact, escalate inappropriate behavior. These may include:

• Negative consequences
• Unduly large positive consequences
• Cumulative consequences
• Delayed consequences
• Abstract consequences (check marks or sticker charts)
• Reminders to stop behavior
• Offering a choice between compliance and negative consequence

On the other hand, strategies that don't put undue weight on behavioral slip-ups, that are suited to [Child]'s level of emotional maturity, and that decrease the level of stress will be more effective. These may include:

• Positive consequences, on a modest scale, delivered immediately.
• Brief time-outs, delivered consistently and matter-of-factly.
• Changing of environment to make success more likely.
• Behavior analysis to assist in changing the environment.
• Frequent positive feedback and encouragement.
• Concrete, clearly defined rules
• Choices in which both options are acceptable to adult.

Specific Behavior Plan for [Child]

I. Create rules that target specific behaviors.

• Translate abstract classroom rules into five or six specific directives targeted to [Child]'s particular needs. For example:

NO pushing, poking, hitting, or grabbing.
NO hugging or kissing anyone in school (student or adult).
NO interrupting the teacher.
NO using mean words like “stupid” or “shut-up.”
NO tattling
NO outbursts (crying, pouting)

• Post the rules where [child] can see them.

• Include only those items in rules that you will be willing to reinforce with a time-out whenever the rule is broken. Avoid things that are likely to recur with such frequency that she would be in time-out constantly, such as wiggling, or standing up at desk.

• You may want to include at least one rule that [Child] has little trouble keeping, so that she has a constant experience of success and control.

II. Provide frequent positive feedback when rules are not being broken.

• Using the rules above: If she refrains from interrupting, comment on it. Tell her you like the way she’s talking when she chooses words thoughtfully. If she handles a disappointment in an appropriate manner, compliment her on that.

• Use low-key, specific praise of her behavior: "I like the way you handled..." "You're doing a good job of..."

• People and behavior are not described at home as good or bad (except in the phrase "good job"). [Child] understands and responds well to:

Appropriate or inappropriate
Polite or not polite (rude is reserved for extremely impolite behavior and used sparingly)

• Augment the positive feedback with neutral statements indicating that she's being noticed in a non-negative way any time she is following the rules. Comment on the pencil she's using, the clothes she's wearing, the story she's writing, the number of problems she's done.

III. Provide immediate, unemotional time-outs when a rule is broken.

• Say something along the lines of, "Oops, you interrupted. Go sit, please." Be calm but firm.

• Do not give reminders before time-out. Reminders escalate [Child]'s behavior, especially when the behavior is induced or exacerbated by stress. She needs the framework of consistent, clear rules and consequences in order to feel safe.

• Do not allow [Child] to argue about the time-out. The broken record technique works well: Answer every attempt at argument with, "Go sit please," in a neutral tone. She will test you on this but, if you are consistent, the testing won't last long.

• Use a timer or other method of showing how long [Child] has to remain in time-out. A digital kitchen timer works well at home, pre-programmed to a set number of minutes and she waits for the beep. Again, the consistent, clear framework offers security: She doesn't need to panic that she'll be forgotten on the sidelines, and she can't sabotage the time-out by constantly asking if it's time to get up yet.

• Do not discuss the infraction after the time-out. She does her time and emerges with a clean slate.

• Do not ask why she misbehaved. She can't tell you, and being put on the spot only increases her anxiety.

• Keep the time-outs brief to reduce resistance. In the classroom, a minute might be sufficient. Treat it not as a punishment as much as an acknowledgment that a rule has been broken, and a break in the action to get herself together.

IV. Adjust the environment to make it easy to follow rules.

• Maintain an environment in which [Child] can feel safe. She needs consistency, routine, and a clear definition of roles and responsibilities.

• Follow set routines as closely as possible. If it's necessary to deviate from routine, notify [Child] as soon as possible and tell her what will not change, as well as what will. ("We will have an assembly at 10:00 today. That means we will miss ----. The rest of the day will be just like any other Thursday. We will go to the library as usual.")

• Under no circumstances should any adult at school hug [Child]. Hugging is for family members, and adults at school are not family members. Hugging and other "mothering" behavior by other adults confuses [Child] and, as a result, makes her feel less secure, rather than more.

If misbehavior appears to be escalating:

• Try to determine what might be causing stress. Possibilities include: disruption of routine; substitute or absence of adult in classroom; work that is confusing or too difficult; overstimulation at recess; noisiness or other sensory overload ([Child] is very sensitive to scent, some sound, and lights); boredom; need for movement; stress in the others ([Child] is hypervigilant: She acts out the moods of the people around her).

• Keep track of what seems to cause problems and prepare in advance for future occurrences. If possible, send word home in advance of schedule changes or absences so that [Child] can be prepared.

• Talk to [Child] about what you think may be causing her to lose control. "You seem to be having a hard time this afternoon. I think maybe you used up all your control sitting still at the assembly this morning. Let's try to pull you back together."

V. Work with parents to assess effectiveness of plan on a regular basis and make adjustments.

• Send daily behavior report home (in [Child]'s notebook or other simple format). Include information from classroom aide, lunch monitors, and general education teachers on a regular basis.

• Share with parent what seems to be working, and seek advice for what doesn't.

• Report any stress-inducing occurrences that may have affected behavior.

• Meet with parent regularly to discuss behavior that is causing a problem in the classroom and develop management strategies.

• Re-evaluate the rules from time to time and adjust them to reflect [Child]'s changing behavioral challenges and triumphs.

• Take advantage of resources available from the parent.

[This plan was written by Marie Lowry, adapted from a behavior plan for a child with fetal alcohol effects written by Terri Mauro.]

copyright (c) 2004 by Marie Lowry and Terri Mauro.

No comments:

Post a Comment

Note: Only a member of this blog may post a comment.