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Behavior Support Techniques

Christine Lackey, MS, CCC-SLP, BCS-CL, Adam Diggs, MA, CCC-SLP

May 22, 2017

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Question

How can behavior support techniques be incorporated into intervention?

Answer

Behavior support can be implemented throughout a therapy session, but it requires us to be aware of subtle changes in the demeanor of the children and being attentive to the verbal and nonverbal cues that the children are giving us. We can often avoid outbursts by incorporating strategies that allow children to feel supported, and decrease stress. Some of these techniques include:

  • Managing the Environment: Taking the abilities and triggers of participants into consideration when selecting activities and group arrangement. Managing the environment is simple in principle, but it can be difficult to address the many factors that can affect your group treatment sessions. The practice of managing the environment sets you up to be more successful, by setting up the clients to be more successful.
  • Prompting: Just about anyone who teaches or works with children does some prompting, which is verbal and nonverbal indicators and reminders of expectations and coming events. That can take the form of a schedule, handouts, written rules, or it can just be a simple verbal prompt that tells the children what is going on.
  • Hurdle Help: When a child is becoming overwhelmed by group expectations, or something that they anticipate is going to be difficult, we can provide them a boost to get past that barrier so they can continue. For example, a child may have word finding difficulties or poor reading skills. If we can give them that one word that they are having a hard time with, it helps them stay focused and decreases their anxiety.
  • Redirection and Distraction: This involves turning the child's attention away from an undesirable behavior or action by changing to a more desirable or less stimulating activity. If you see that a child is having difficulty sitting still or beginning to engage in negative behaviors, allow them to take notes for the group, or distribute worksheets.
  • Proximity: Moving closer or farther away can be helpful. Some children who have experienced trauma do not like people to be too close to them. Be aware of your proximity, moving closer to help them feel supported, or moving away if they are beginning to become triggered. When we think about moving closer, there are some children that when they feel singled out, their attention-seeking behavior escalates. Simply moving closer can allow us to give them a little bit of behavioral support, without having them feel like we are drawing a lot of attention to them.
  • Time Away: We can ask the child to go to a quiet place, so that they can deescalate and compose themselves, if something is triggering them. In this way, we are encouraging them to get it together on their own. This can be successful, because it allows them to take a voluntary time out, instead of being sent away from the activity. In other words, it is on their own terms. If we do ask the child to take time away, we must be careful how we select our words because some children will escalate further if we phrase things indelicately.
  • Caring Gestures: This is kind of like a shot of affection. We do things to indicate to children that we care about them, and that even when they are being difficult, we still do care. It can be something simple, like a comment, a pat on the back or the arm. It might take the form of asking them to explain something that they are interested in.
  • Directive Statements: Sometimes it is necessary to tell the child specifically what is expected, when the level of stress causes them to have a difficult time making rational decisions. If we give a clear, simple reminder of what is expected, rather than telling what the consequence is going to be, we can avoid the confusion that can be caused when children are starting to get upset. This is a more intrusive approach than prompting and redirecting.

Please refer to the SpeechPathology.com course, Social-Pragmatic Language Group Treatment for Adolescents with Language Impairments and Psychiatric Diagnoses, presented in partnership with Cincinnati Children's, for more in-depth information on the need for social-pragmatic group treatment with students having language impairments along with psychiatric diagnoses.


christine lackey

Christine Lackey, MS, CCC-SLP, BCS-CL

Christine Lackey, MS, CCC-SLP is a Speech-Language Pathologist II at Cincinnati Children's Hospital Medical Center at the College Hill Campus and the Lindner Center of Hope. She is a Board Certified Specialist in Child Language. Her clinical interests include apraxia, auditory processing disorders, autism, adolescent literacy and pragmatic language.   In addition, she has created and managed Creativity Connection, a therapeutic resource for the Speech Pathology Department at CCHMC. She has assisted in the development and organization of CCHMC resources to include therapeutic activities for adolescent pragmatic language groups and language/literacy tasks for elementary students.


adam diggs

Adam Diggs, MA, CCC-SLP

Adam L. Diggs, MA, CCC-SLP is a Speech-Language Pathologist in the Division of Speech Pathology at the Cincinnati Children’s Hospital Medical Center, College Hill campus. He conducts screenings and assessments, and provides individual and group treatment for in-patient and residential programs in the Division of Psychiatry. His areas of interest include language processing and pragmatic language disorders in children with psychiatric diagnoses, and speech sound disorders. Adam has been with the Division of Speech Pathology since June 2006, and previously worked as a school Speech/Language Pathologist for the Cincinnati City School System for 6 years.


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