Question
What are some functions of behavior that clinicians should be familiar with when working with children who have emotional behavioral difficulties?
Answer
One way to analyze behavior is to look at the function; what is causing the behavior to occur. It should be noted that not all behaviors are outbursts or aggressive. Children are trying to communicate something.
One function of behavior is attention. The patient wants contact with a person, or they are looking for attention. With some children, it doesn't matter if it is positive attention (e.g., being praised) or negative attention (e.g., being scolded). Many children don't care what type of attention they are receiving, as long as it's attention. In children who are attention-seeking, they might yell across the room to get your attention. They might throw things because they know that if they hit a child with a toy, people are going to come and stop them. That gets them a lot of attention.
Another function of behavior is it is tangible. The children desire access to something they can get their hands on, such as an item/object, or a snack. Especially for children who have decreased social skills who don't know how to ask for these items or how to interact with peers to get these items, we might see a lot of grabbing or stealing.
With escape and avoidance, the child might be presented with a task with which they have a negative association. They may try to escape or avoid this task. We have children pretending that they're asleep all the time, but then as soon as you say it's time for a snack, they jump up because it’s something that they want. A child may exhibit elopement, or running away from the situation; they may get up from the table, or try to leave the room, which can be a great safety risk for them. Some children will ask for frequent bathroom breaks, so as soon as you present that as an option, they automatically have to get up and use the bathroom.
As mentioned previously, not all behaviors are aggressive or look like outbursts. For example, there was a child who always avoided going to the bathroom to work on toileting. On his walk to the bathroom, he would use his social skills and talk to everyone along the way. He knew everyone’s name and was very engaging. Using this avoidance method, it would take him 30 minutes to walk down a hallway to the bathroom because he would stop and talk to every single person in the hallway. It took a lot of coaching from the behavior staff to tell people in the hallway, "Do not engage with him. He's trying to avoid this task of going to the bathroom."
The last function of behavior, which can be the trickiest to find a replacement behavior, is automatic or self-stimulatory. Often, the children have a sensory activity that they can engage in that will keep themselves entertained. For some of children with developmental disabilities, like autism, they will engage in “stimming,” where they will spin around or find toys that they love and they can keep themselves busy for a while without us being there.
When a children uses inappropriate behaviors, it is important to teach them a replacement behavior. If it's attention, we can teach them how to initiate interactions appropriately, like tapping someone on the shoulder, or approaching children in a group, and asking to play with them. For tangible items, we can teach them how to request these items in order to get access to them. For escape and avoidance, have the child use a visual schedule so they know after they finish a challenging task, something fun or more desirable will happen. Using visual timers can also be very helpful.
