ABCs of Behavioral Problems: Keeping Cool in a Crisis: being prepared for behaviors

Crisis Intervention Training
Behavioral crises involving people with autism are a common concern of professionals and parents. Parents don’t talk about them as much because of stigmas, but professionals rarely hold back. Sometimes the parent is blamed for spoiling the child. If so, I hope the professional has several children of his or her own, never needed to ask a question of a seasoned parent, and never made a parenting mistake with any one of their children. (People in glass houses shouldn’t throw stones!) Parenting is hard. Let’s avoid judgement and get down to work.

Why?
Crisis intervention training is not enough, but it is a necessary first step for parents and professionals: teachers, therapists, aides, and law enforcement. This post is appropriate for communication disorders. (I cannot claim to speak for mental illness.) Let me be clear. Generally, “aggressive” moves by people with communication disorders are a form of communication. Aggressive-Kids

Prevention is best. Many parents of people with autism suffer from the fear and memories of painful incidents of the past. The child’s behavior makes him a pariah, or changes how others treat him and his life choices.

First, however, you have to get everyone out of the current incident safely. The behaviors have to be addressed without judgement. Otherwise, behaviors can escalate and someone may be seriously hurt. Concepts and techniques of Crisis Intervention Training are similar regardless of the age and size of the person. I can tell you, fearing the person you love or need to work with doesn’t help the person at all. You have to be safe, confident, and fearless.

Crisis Intervention Training Should Include
This forum is not appropriate for providing crisis intervention training, but as a diligent and caring professional or family member, you should know what to ask for. The training involves learning and practicing a series of physical maneuvers that protect the responsible adult without harming the person with a disorder. If the people involved are verbal, de-escalation techniques will be covered.

Training should handle such situations as grabbing of clothing and grabbing of hair. This video from http://www.therops.com (a provider of instruction with which I have no relationship and whose training I have not reviewed) covers grabbing a shirt. 

It’s For You, & anyone living or working with people with developmental disabilities
Be prepared. Do not expect to need crisis intervention training. Do not give the training to someone who may abuse it, or abuse others. The person who could have triggered the incident may not know that he or she did, but the person who triggered it should generally step aside so another person can follow through with crisis intervention.

As a parent or professional evaluating the quality of a school, after-school, day, or residential program, check that staff and security personnel have this training. Sadly, crisis intervention training may be rare in the U.S. outside of some school settings. It is, however, perfect as topic for staff training sessions. Staff certification should be renewed every few years in any setting where physically inappropriate behavior may occur.

Here’s an example for sessions held for school transportation staff of Eden Prairie Schools:

The “A” in ABCs, an introduction to behavioral triggers
Antecedents are the “A” in “ABCs” of managing behavior.  Analyzing antecedents of a behavior is important, after the throes of an incident. Understanding these “antecedents” of behavioral problems will be the subject of further posts.

All situations that end in aggression have a kernel – medical or personal – in a concern that was not communicated effectively. These are examples from my personal experience with my son and other children with autism:

  • A middle ear infection causes pain, and the staff doesn’t understand how to help.
  • The child is expecting to see someone (a familiar therapist, a friend, a pet) at a certain time, and the person or pet isn’t there.
  • Lunch is “supposed to be” at exactly noon, and the child cannot tell you when he’s hungry, so 12:05 pm is “late.”
  • One kind of cookie is kept on the edge of the top shelf, and the child can’t see or reach it.
  • A migraine is coming on, and the child is in a public place.
  • When changing planes, the child knows a bowel movement is coming, cannot explain, refuses to leave a terminal restroom, nearly misses the connecting flight, and soils himself in-flight.

As someone who cares for and about people with developmental disabilities, I know we want to fix people. Now. That’s not realistic, but we can help, incrementally, and the people we care about can get better. Communication problems can cause a lifetime of misunderstandings, mistakes, and hurt feelings. As we fix the communication problem, we remove potential sources or future behaviors.

Coming up here: Why’d he do that! Consider “antecedents”

Copyright 2015, Laura Ann Weinberg

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