ABCs, Aggression & Developmental Disabilities
Aggression is a common occurrence in households of children with disabilities. This can be overwhelming for most parents. The purpose of this post is to identify variables that affect aggression, along with basic preventative and response strategies. While these are strategies commonly used in various settings, a descriptive assessment or functional analysis should be conducted by a Board Certified Behavior Analyst (BCBA) to identify the function of aggression. After identifying the function, the BCBA can then assist in identifying individualized antecedent and response strategies, accompanied with functional replacement behaviors to decrease aggression and improve functional skills.
As a BCBA, there are many questions that pop into my head when I hear the word "aggression." This list includes a few variables that I look at:
- Height and weight
- Previous history and response to treatment
- Level of family and community support
- Topography of aggressive behavior
- Antecedents, behavior, and consequences (ABC)
The Topography of Aggression
In my experience, the topography of aggression is probably the least descriptive information received at first glance. Aggressive behavior can refer to yelling and swiping objects off a table versus biting and eye gouging. The topography should also give some indication of severity. Are we talking about biting that results in a little redness or biting that requires sutures? Simply, we want to know what the behavior looks like.
Once there is a clear understanding of topography, we take a look at the ABCs. Antecedent refers to what happened in the environment within the few seconds before the aggressive behavior. Was the iPad removed, a non-preferred food presented, the dog start barking, a demand placed to brush teeth, or did dad walk out of the room? As you may have noticed, the antecedent addresses environmental changes and not the behavior of the individual (this would be a precursor). We have previously discussed the behavior part of the ABCs; it looks at the topography and severity. The consequence refers to environmental changes following the behavior. This can include continuing to withhold the iPad, re-presenting the food, removing the demand to brush teeth, blocking hits towards others, or using gestures to redirect to the appropriate environment. Parents please don't feel embarrassed about disclosing the consequence. We aren't here to judge or call you out; we just want a better idea of how the behavior is possibly maintained so that we can be prepared to help.
Here are a few preventative strategies to consider:
- During drop-off, communicate between caregivers about the individual's morning and if there were any changes to their typical routine
- Communicate with other caregivers to identify early warning signs (AKA precursors) and triggers (AKA antecedents)
- Identify and communicate about highly preferred activities/items the individual can have access to while in different environments
i.e.,while at home, likes the computer, trampoline, or to take a brief nap
i.e, while in the car, likes the iPad, books, or crayons
- Provide options about which activity they would like to complete first
- Provide options for preferred items/activities they would like to earn for completing a task in the absence of aggression
- If the preferred item/activity is not available, then be more specific about the items they can choose from a list
- Highly preferred items should be delivered AFTER a desired behavior is exhibited and in the absence of challenging behavior
i.e., sitting at the table with feet down, completing an art project with peers, appropriately asking for the preferred item using desired number of words
- The more time spent with the preferred item, the less likely the individual is going to work for that item. Minimize free access to that preferred item if appropriate
- Arrange furniture for easy movement or escape if needed
- Listed below are some response strategies:
- Use a calm and neutral tone
- Minimize verbal instructions
- If verbal instructions are used, they should be short, direct, and not repetitive
i.e., "first sit, then go outside," "first Johnny's turn, then your turn," "walk to the restroom," "stand up"
- If individual does not respond to 1 or 2 verbal instructions, move to gestures (pointing)
- Don't comment on the individual's behavior to her or anyone else in the room
- Pillows, puzzle floor mats, bean bags, or any soft item can be used for blocking if an individual aggresses against caregiver or others
- If appropriate, gloves, long sweat bands, arm guards, or shin guards can be used to protect yourself and others
- Minimize physical contact when redirecting
It Gets Worse Before It Gets Better
Some of these preventative and response strategies may not be appropriate for your loved one, but I hope this post serves as a point of departure in your journey. We are all familiar with the saying "it gets worse before it gets better." This is true of an effective plan to reduce aggression; in the field of Applied Behavior Analysis (ABA), it's called an extinction burst. It is important to understand that when you start manipulating preventative and response strategies, you will likely see an increase in the frequency and severity of behavior, along with a change in topography. To better prepare for this change, it is recommended that you consult with a BCBA to identify the function of aggression and to identify an individualized intervention plan.