Goal: Replace Challenging Behaviors with Language

Challenging behaviors are a common occurrence with our population of children, particularly the younger ones who cannot communicate well.  Fortunately, these challenging behaviors are communication in themselves and we as SLPs have all of the tools we need to turn these challenging behaviors into positive communication skills.  Here is a quick guide for how to approach challenging behaviors and teach appropriate communication skills to replace them.

Sample Goal:

During a 20-minute observation in the classroom (or select another setting), Client will communicate _____ by using language (speech, sign language, or AAC) while refraining from using inappropriate behaviors (insert example behaviors here) on four of five observed opportunities (in this case, an observed opportunity includes when Client seems to want/need to ________).

EXAMPLE:
During a 20-minute observation in the classroom, Client will communicate that he wants to escape an activity by using language (speech, sign language, or “break card” visual) while refraining from using inappropriate behaviors (ex: crying or hitting) on four of five observed opportunities (in this case, an observed opportunity includes any time Client tries to escape an activity).

Download the No-Prep Therapy Kit:

We have a start-to-finish therapy kit that will give you everything you need to practice this skill in therapy and send home homework.  Click the packet below to open it.  Then, print it out and place it in the child’s notebook or binder.

Therapy Phases:

Prep Work: 

This goal requires some amount of prep work to determine what function the client’s challenging behaviors are serving.  We can’t replace inappropriate behaviors with communication unless we know why they are happening in the first place.  Here are the stages for the prep work:

  1. Collect Data about the Behavior: The SLP (or other professional) will collect data about the challenging behavior.
  2. Determine the Function of the Behavior: The SLP (or other professional) will analyze the data and determine the function(s) of the behavior.
  3. Choose Replacement Behavior: The SLP (or other professional) will choose an appropriate replacement behavior to teach instead of the mal-adaptive behavior

Direct Therapy:

Once the function has been determined and the replacement behavior has been selected, it is time to move to the direct therapy portion of this skill.  Her are the phases for direct therapy:

  1. Practice Replacement Behavior: When prompted during a structured activity, Client will communicate ______ using language (speech, sign language, or AAC) while refraining from using inappropriate behaviors (such as _____) on four of five observed opportunities, with verbal and visual cues as needed.
  2. Use Replacement Behavior with Prompts: When prompted during an activity, Client will communicate _____ by using language (speech, sign language, or AAC) while refraining from using inappropriate behaviors (insert example behaviors here) on four of five observed opportunities (in this case, an observed opportunity includes when Client seems to want/need to ________), using visual and verbal cues as needed.
  3. Use Replacement Behavior and Wait: During a 20-minute observation in the classroom (or select another setting), Client will communicate _____ by using language (speech, sign language, or AAC) and wait a short time or complete another part of the task as needed while refraining from using inappropriate behaviors (insert example behaviors here) on four of five observed opportunities (in this case, an observed opportunity includes when Client seems to want/need to ________).
 

Additional Information:

First, we must collect data about the behavior.  This can be done by you or by another member of the child’s team.  What we need to collect data on are the ABC’s of the behavior:

A = Antecedent
B = Behavior
C = Consequence

Antecedent: Record what happened immediately before the behavior.  What was the environment like?  What activity was happening?  What were the other people doing?  What was the child doing?  What was the child paying attention to?

Behavior: Describe the behavior in detail.  What happened?  What did the child do?

Consequence: What happened immediately after the behavior?  What did the child do?  What did those around him do?  How did the environment change?  What was the punishment or reactions that he received from the adults?  

You can simply draw two lines down a piece of paper and have the teachers in his classroom record this type of data each time it occurs.  Or, you can use a more formal data sheet like the one on page 6 of the behavior webinar handouts:

Click Here to Download the Behavior Webinar Handouts

Once you have data on many different occurrences of the behavior, you’ll need to analyze the data to look for patterns.  Do they all happen at the same time of day or same part of the session? What seems to happen right before that triggers it?  What seems to make the behaviors better or worse?  What keeps happening as a result of the behavior that may be unknowingly reinforcing it?  Keep in mind there may be multiple causes for challenging behaviors depending on the situation or circumstances.  For example, my son used to throw toys.  Sometimes it was for sensory input.  We could tell because he never seemed to notice if he hit anyone during those times.  Other times, he would specifically throw at another child and then watch to see her response.  That one, we knew was to gain attention.

Based on your data, you will need to determine the function or cause of the behavior.  Here are the 5 possible functions:

  1. Attention-Seeking (from peers or adults)
  2. To Get Something They Want
  3. To Escape from Something
  4. To Avoid Having to do Something
  5. Automatic Reinforcement (the activity itself is reinforcing, like stimming)

Choose one function of one behavior to target at a time.  If the behavior has multiple functions, like the example of my son throwing toys above, you’ll need to teach the replacement behaviors separately.

Once you know the function of the behavior, you can come up with a plan for what to teach the child to do instead.  Think about what a typically-developing child might get that need met.  For example, how does a typical preschooler communicate that he wants something?  Or that he’s all done with something?  Here are three key elements to keep in mind when picking a replacement behavior: 

  • Make it easy: As easy if not easier than the challenging behavior that the child is currently using. Match it to the child’s communication level
  • Make it effective: It needs to get the need met as well if not better than the current challenging behavior
  • Make Sure Everyone Is On Board: Get the whole team on board so that the child’s behavior is responded to the same way in every situation

Once you’ve chosen what you would like to do instead, move on to the next step.

 

Now, you’ll need to teach the child what to do instead of the old behavior.  I suggest using social stories to show the child the expected behavior and then role play it out while the child is calm.  Here’s a link to how to use social stories: 

Escape/Avoidance:

If you’re working on escape or avoidance behaviors, my favorite place to start is with a simple break card.  Here’s a video of how to use the break card strategy as well a a PDF handout of some break cards you can print and use right away:

Break Card PDF:

To Obtain Something: 

For more ideas of replacement behaviors, watch the webinar linked at the top of this page.

Once the child can use the behavior in a structured activity, it’s time to start working it into his daily activities.  For this, you’ll need the whole team on board.  This will only work if it is consistently implemented across environments and across people.  Make sure everyone is ready to implement this plan.  The plan is simple:

  1. Pre-Correct the New Behavior: When any adults see a situation coming where the old behavior may be used, the adult will provide a pre-warning reminder to the child to remember to use the new behavior if needed.
  2. Extinguish the Old Behavior: The old behavior is to be ignored.  It CANNOT be effective to get the need met anymore.  For example, if the behavior is attention-seeking, NO ONE can give attention for the old behavior.  If the behavior is avoidance/escape-based, the child MUST NOT be allowed to leave the activity (until he’s used the replacement behavior).
  3. Redirect to the New Behavior: When the old behavior is seen, adults will immediately redirect the child to the new behavior.  This may require some hand-over-hand assistance to help the child remember what to do.  That old behavior is probably well-ingrained.  
  4. Immediately Allow New Behavior to Work and Offer Praise: Even if the child needed help, the new behavior should immediately be rewarded by giving the child what he wants.  He needs to see that it works.  Praise the child for the new behavior by explicitly stating what the child did well (even if he needed help).  For example, you would say “You used your break card.  You may have a break.”
  5. Gradually Fade the Effectiveness Over Time: We know that these children can’t be given what they want all of the time.  But at first, that’s exactly what we must do to help them learn the new behavior and re-establish that as their go-to behavior.  Once the child is using the new behavior automatically to get what he wants, you can work on fading back the effectiveness of it.  You will do this by gradually having the child wait longer amounts of time before getting the “reward”.  For example, if the child asks for a break, you’ll start by offering that break right away.  Once the child is automatically asking for the break instead of throwing a fit, you will start by saying “You can have your break after I count to 3: 1, 2, 3.”  Then the break is offered.  Gradually, you’ll increase the expected wait time.  Work your way up to having them complete one more repetition of the activity, and then eventually finishing the whole activity before getting their break.  Do this very, very slowly so that the child doesn’t revert back to the old behavior.

Supplemental Materials

Here are some other resources that may help you when working on this skill:

Behavior to Communication No-Prep Kit – $15

This paid kit is a more in-depth version of our free no-prep kit above and includes everything you need to work as a team to teach a child to replace challenging behaviors with communication strategies for children who are non-speaking or minimally-verbal.  Click here to get your 30% discount code!

Break Cards

If you’re working on escape or avoidance behaviors, my favorite place to start is with a simple break card.  Here’s a video a PDF handout of some break cards you can print and use right away.

Download Our Speech Rules Poster

Here are some great tips that will help you set up your therapy sessions in a way that will promote the behaviors you want to see and decrease the behaviors you don’t.

Training Videos:

Need some extra help on treating this skill?  Check out these related training videos:

Webinar Recordings:

Looking for in-depth information about this topic?  Our hour-long webinar recordings will give you a deep dive into the topics.

Resources, Tools, and Training for Speech-Language Professionals

*** The SLP Solution is for informational and educational purposes only and does not provide medical or psychological advice.  We provide general resources but cannot tell you exactly what should be done for a specific client.  Every client is different and your clinical judgement should be used when making decisions about specific individuals.

 

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