Strategies - Promoting positive behaviour
Proactively promoting positive behaviour through the overall approach
Providing the young person with a plan for promoting positive behaviour
Reducing a negative behaviour by promoting an incompatible positive behaviour
Communicating appropriately when responding to challenging behaviour
Providing clear boundaries which inform the young person of what is acceptable behaviour
Informing the young person of impending changes in the usual routine
Ensuring that all events the young person is informed of in advance do actually happen
Introduction
When considering issues concerned with behaviour, many practitioners think in terms of eliminating or reducing behaviours which challenge. This stance is essentially negative, as it focuses on "problems"; indeed, it can even result in practitioners seeing the young people they work with as "problems".
When originally developing this guidance material, the members of the visual impairment and autism Project team did not wish to have any focus on "problems". Instead, the approach adopted was to be as positive as possible, so when the material was first produced as a CD-ROM, there was no section devoted to behaviour. "Problems" were (in the main) turned on their head and the strategies that were described were expressed in positive terms. These strategies were placed in the sections dealing with learning, sensory needs, wellbeing and so on. For example, there was no strategy on the "problem" of a young person becoming distressed when an expected event is cancelled; instead, there was a strategy called "Ensuring that all events the young person is informed of in advance do actually happen"; it was placed in the Underlying principles section.
When the material from the CD-ROM was posted online, no substantive changes were made. However, when an opportunity arose to add more material and to make improvements to the existing material, the issue of behaviour was reviewed. It had become apparent that many practitioners do think in terms of "problems" and are very concerned about "challenging behaviours". This section arises from those concerns. However, rather than give this section a title with negative connotations, it was decided to follow the original philosophy of being positive; thus the title of this section is "Promoting positive behaviour".
The strategy referred to above, and several others from the original Underlying principles section, have now been brought into this section on Promoting positive behaviour. Other strategies have been added.
In fact, this section mirrors a recent more general move away from thinking in terms of "challenging behaviour" and a growing preference for focussing on "promoting positive behaviour". The positive approach also reflects the fundamental principle that the young person must not be punished, nor denied any of the basic human rights; i.e. he / she must not be:
The material in this section should be seen as providing only a very general introduction to issues concerning behaviour. Users of this guidance material are strongly advised to seek professional advice in relation to behaviour, for example from a clinical or educational psychologist. Users are also advised to explore the wealth of information about promoting positive behaviour which is available online.
What is "challenging behaviour"?
This appears to be a simple question. But the answer varies. It depends on several factors, including
For example, some practitioners find the sound of teeth grinding extremely irritating, and regard it as a "challenging behaviour". Others do not even notice when someone else is grinding his / her teeth, and certainly do not view this as a "challenging behaviour".
In contrast, a behaviour all practitioners should certainly regard as challenging is a young person repeatedly pinching his / her peers.
It is worth bearing in mind that we all have behaviours that would challenge in certain contexts. For example, we all urinate, yet we do not consider that to be challenging. This is because (in the "developed world" at least) we (usually) perform this function in private, in a toilet. However, many people would regard an adult urinating in the street as challenging.
Also, a behaviour regarded as typical in one group of people may be regarded as challenging in another group. For example, many 2 year old children have temper tantrums which can be very trying for parents and other family members. Yet these children are not (usually) regarded as having challenging behaviours. However, similar behaviours in an adult with learning disability will almost certainly be seen as challenging.
Many autistic young people eat only a very restricted range of foods. This can be seen as challenging. However, when viewed in the context of the young person's sensory needs and his / her difficulties with communication, it should more properly be viewed as an element of his / her autism and a need to be addressed through those issues.
Users of this guidance material are urged to reflect on their own attitudes to "challenging behaviour" and on their own practice. This is because there are times when a young person's apparently challenging behaviour is actually an understandable response to an inappropriate demand. In this context, perhaps the practitioner's behaviour should be seen as challenging, not the young person's. See further treating challenging behaviour as communicative.
The fundamental principle of promoting positive behaviour
It is worth repeating here the fundamental principle that the young person must not be punished, nor denied any of the basic human rights; i.e. he / she must not be:
Proactively promoting positive behaviour through the overall approach
A key requirement of promoting positive behaviour is providing a team approach. As far as promoting positive behaviour is concerned, the composition of the team will depend on the factors which are impacting on the young person's behaviour. For example, in addition to the class team and the psychologist, it may be necessary to involve some, or all, of the following
Having a proper focus on promoting positive behaviour means permanently employing strategies which reduce the likelihood that challenging behaviour will occur. Being proactive in this way and promoting positive behaviour is far more effective than Waitingfor "challenging behaviours" to occur and then being reactive. Indeed, it is considerably preferable ethically, in terms of the young person's emotional well-being. It is also better for the young person's peers, staff team and the family.
Providing the young person with a plan for promoting positive behaviour
If a young person is regarded as having challenging behaviour, a plan for promoting positive behaviour should be provided. This plan should describe the behaviours that challenge, their functions, the situations in which they occur and the triggers that give rise to them. Links with other areas such as communication difficulties, sensory needs and medical issues, should also be specified.
In some situations, physical interventions are sanctioned for use with the young person. (There is more information on physical interventions in Safeguarding � Introduction .) If any physical interventions have been sanctioned, these should be specified and described, as well as the circumstances in which they should be employed.
The Positive Behaviour Plan should focus on promoting positive behaviour. Although SMART targets are usually seen as essential in developing educational plans, they may not be appropriate in relation to promoting positive behaviour.
SMART = Specific
Measurable
Attainable
Realistic
Timely
Setting SMART targets requires us to predict how and what the young person will learn. In a plan for promoting positive behaviour, the setting of SMART targets would require the detailed specification of how the young person is to behave at a specified time in the future. But this is not really feasible and it may be preferable to specify how other people will behave; as Emblem et al. (1998 ) argue, it may be more appropriate to write targets specifying the behaviour of the practitioners rather than that of the young person. Thus a plan for promoting positive behaviour would specify how the members of the staff team should behave in relation to the young person in order to promote positive behaviour and minimise the likelihood of the individual behaving in a challenging way.
Carrying out a functional behaviour analysis
Although the philosophy underlying this material is to be positive, there is no getting away from the fact that an aspect of promoting positive behaviour may involve reducing behaviours which are negative (in other words, which challenge).
A common first stage in this process is to conduct a functional behaviour analysis or assessment. In essence, the purpose of this procedure is to establish the reasons for the behaviour; it should provide the information necessary to develop a plan specifying how to promote positive behaviour and thus reduce the behaviour which is regarded as challenging.
The first step in conducting a Functional behaviour analysis or assessment is to collect a comprehensive range of information about the young person's behaviour(s). The information should include
- demands made on the young person
- communication addressed to the young person
- the young person's emotional status
- relevant information about the young person's physical status; e.g. whether the young person was believed to be hungry / thirsty / needing the toilet, etc; for an adolescent girl, it may be important to note whether or not she is menstruating
Having obtained this information, it must be analysed to identify patterns and the reasons (functions) of the behaviour(s).
However, there are difficulties with functional behaviour analyses. A key difficulty is that they require a great deal of time for collecting and analysing the information.
In some circumstances, a functional behaviour analysis fails to identify any clear reasons(s) for the behaviour. This was the case with Amanda, when urinary incontinence became a challenge. On returning to school at the start of a new academic year, Amanda initially appeared to cope well, but gradually presented with some difficulties as she settled back into the school routine. In particular, she experienced urinary incontinence, sometimes several times a day. Medical reasons for this were ruled out by the school nurse, but it was not possible to identify any clear reasons for it. Nevertheless, a programme was introduced to promote the use of the toilet.
Another difficulty is that a single behaviour can serve several different functions. This too can be illustrated by referring to Amanda. In addition to the urinary incontinence, a difficulty arose because she pinched her peers and members of staff. A functional behaviour analysis revealed a range of reasons for this behaviour: on different occasions, Amanda pinched in order to:
This could have meant that it was difficult for members of staff to know how to respond to any particular instance of Amanda pinching. Fortunately, this was not the case: the practitioners supporting her know Amanda really well and constantly monitor her behaviour and moods. On each occasion Amanda pinched, they used their knowledge of her and of the context in which the behaviour occurred to interpret her behaviour. For example:
Over time, all team members became skilled at interpreting Amanda's behaviour and, thus, at responding appropriately; good consistency between staff was achieved. In addition, all team members had built a close relationship and trust in Amanda. It is likely that these factors made an important contribution to the very marked reduction in Amanda's pinching, and thus to promoting her positive behaviour.
Therefore, if a functional behaviour analysis reveals several reasons for a single behaviour, responding appropriately relies on:
Safeguarding � Introduction
In some cases, an aspect of promoting positive behaviour involves reducing behaviours which have the potential to harm. Harm can be caused to:
In order to reduce harm, it may be necessary to adopt a system of physical interventions. Several such systems are in use and a wide range of organisations provide training in this area. It is worth noting that the British Institute of Learning Disabilities (BILD) has a Code of Practice in relation to the use of restrictive physical interventions. Users are advised to adopt this code.
Many, perhaps most, practitioners will work in a setting which has already adopted such a system of physical interventions and which provides training in its use. Some practitioners will need to adopt a system. Others may be considering changing the system they currently use to another one. Those in the last two categories should note that BILD also has a Physical Interventions Accreditation Scheme for organisations that provide training in this area.
It may not be feasible to completely eliminate the risk of harm. However, it is often possible to reduce it to a minimal level by identifying the triggers for the behaviours which have the potential to harm. These triggers can then be avoided.
For example, the young person may find the school's assemblies very aversive; this may be due to the large number of people present, the range and intensity of the sensory stimuli and the young person's lack of understanding of the proceedings. Being required to attend assembly may trigger behaviours that have the potential to harm. For the present, it is probably advisable to remove the trigger by providing the young person with an alternative activity at assembly time. It may be decided that it is important to enable the young person to attend assemblies at some time in the future, but this is likely to be a gradual process over an extended period of time, requiring a range of carefully planned strategies.
Practitioners should constantly monitor the young person's behaviour and moods and monitor the environment.
Safeguarding the young person
For many young people, an aspect of promoting positive behaviour involves reducing behaviours which have the potential to harm. When this is the case, it is essential to put into place measures to safeguard:
Winnie is at risk for harming herself at times. She attends to educational activities for no more than 5 minutes at most. Therefore, during a work session the teaching assistant (TA) monitors Winnie's behaviour and mood for signs of stress / anxiety. The TA sometimes sings to Winnie to enhance her engagement in educational activities. If the TA feels Winnie is becoming stressed or anxious during an educational activity, and she is not already singing to her, she tries doing so: this can have a calming effect on Winnie, sometimes preventing her stress / anxiety level rising any further. However, if it is clear that Winnie's stress / anxiety level cannot be reduced by singing to her, the TA brings the session to a close. If the TA does not do so, there is a risk that Winnie will go into crisis or become overloaded. When in crisis or pverload, Winnie sometimes bites her left hand and hits her head with her fists.
In order to safeguard Winnie, therefore, it is essential that practitioners are proactive and do all they can to minimise the risk that Winnie will go into crisis / become overloaded.
Safeguarding peers
For many young people, an aspect of promoting positive behaviour involves reducing behaviours which have the potential to harm. When this is the case, it is essential to put into place measures to safeguard:
It is essential to put in place measures to minimise all risks to the young person's peers.
As noted in the previous section, Winnie attends to educational activities for no more than 5 minutes at most. Therefore, during a work session the teaching assistant (TA) monitors Winnie's behaviour and mood for signs of stress / anxiety. The TA sometimes sings to Winnie to enhance her engagement in educational activities. If the TA feels Winnie is becoming stressed or anxious during an educational activity, and she is not already singing to her, she tries doing so: this can have a calming effect on Winnie, sometimes preventing her stress / anxiety level rising any further. However, if it is clear that Winnie's stress / anxiety level cannot be reduced by singing to her, the TA brings the session to a close. If the TA does not do so, there is a risk that Winnie will go into crisis or become overloaded. When in crisis or overloaded, Winnie occasionally hits another person who happens to be close to her. This may be a peer.
In order to safeguard Winnie's peers, therefore, it is essential that practitioners are proactive and do all they can to minimise the risk that Winnie will go into crisis / become overloaded.
Bob used to become over-aroused when exposed to excessive noise in the classroom. On top of the background sounds of humming computers, strip lights and traffic, peers talking loudly could present significant difficulty for Bob. When Bob�s over-arousal reached a certain level, he typically rushed out of the room. At these times he was very likely to inadvertently push peers out of his way. As he was bigger and heavier than his peers, this posed a real risk to their safety, as they could be knocked over. Clearly, there was a need to safeguard Bob�s peers. In addition, of course, it was important to address Bob�s own needs effectively. For several reasons, the decision was made to provide Bob with a low arousal environment. An element of Bob�s low arousal environment is that he is not required to participate in activities in classrooms or to eat his lunch in the dining room. He only joins groups of peers when he chooses to do so, and is free to leave as and when he needs to, for example, when he becomes over-aroused by excessive noise. Introducing a low arousal environment for Bob had a range of outcomes. In terms of proactively promoting his positive behaviour, an important outcome was that it eliminated the risk that he would rush from classrooms and the dining room when over-aroused. This contributed greatly to safeguarding his peers.
Safeguarding staff
For many young people, an aspect of promoting positive behaviour involves reducing behaviours which have the potential to harm. When this is the case, it is essential to put into place measures to safeguard:
It may not be feasible to completely eliminate the risk of members of staff being harmed. However, it is often possible to reduce the level of harm they experience by using a staff dress and presentation code. For example: members of staff who
Safeguarding property
For many young people, an aspect of promoting positive behaviour involves reducing behaviours which have the potential to harm. When this is the case, it is essential to put into place measures to safeguard
Very often safeguarding property requires no more than moving items out of the young person's reach during times of challenging behaviour.
Although this strategy has its place, it is reactive; i.e. it is a reaction when negative behaviour occurs. As part of the overall approach to proactively promoting positive behaviour, it is preferable to adopt a proactive approach to safeguarding property.
This can involve several strategies. For example, if the young person sometimes damages educational resources left within reach in the classroom, it is preferable to ensure that such items are stored out of reach of the young person.
Some young people with visual impairment and autism need support to make spontaneous requests. For those who have some functional vision, it is helpful to store items out of reach, but in such a way to ensure that they are visible. This is discussed more fully in enticing in order to provide opportunities to communicate and promoting the ability to initiate.
Some young people occupy themselves, perhaps to obtain stimulation, by repeatedly abusing items of furniture or the fabric of the building in a minor way. For example, a young person notices a section of wall where a very small hole has been made in the plaster by a trolley banging into it; the young person explores this hole with his / her fingers, resulting in more plaster coming away and thus extending the damage.
A young person with visual impairment and autism is clearly less likely to begin to cause this kind of harm to property as a result of seeing existing damage. But a young person who explores items by touch could become fascinated by a flaw in the surface of a table and cause further damage by picking away at it.
Good maintenance and ensuring repairs are timely contribute to safeguarding property. In addition, young people should be provided with motivating and interesting activities and their sensory needs are addressed, making it much less likely that they are unoccupied and need to seek sensory stimulation or to find something to do.
Practitioners should also monitor the young person's behaviour, e.g. to promote his / her emotional wellbeing. If, in the course of doing so, they become aware that the young person is causing harm to property, they should take steps to deal with this. The most effective approach is to establish the reason that the young person is harming property and then to remove that reason. For example, the young person may be seeking sensory stimulation; addressing sensory needs may well be the solution. Alternatively, the young person may need an activity to pass the time; providing more interesting and motivating activities may well be the solution.
Reducing a negative behaviour by promoting an incompatible positive behaviour
In many circumstances, it is possible to reduce, or even eliminate, a negative behaviour by promoting another behaviour that is incompatible with the negative one. This incompatible behaviour should, of course, be positive.
This can be illustrated by considering Kiran, who is not featured in the case studies in this guidance material. Kiran habitually chewed the sleeves of her clothes, a behaviour which distracted her from educational activities and made her clothes very wet, resulting in sore patches on her wrists. The sounds associated with this chewing also distracted and irritated her peers. On the advice of the occupational therapist, Kiran now wears a chewy bangle. She also wears clothes with short sleeves, or with sleeves that have been shortened to allow her unrestricted access to the bangle.
This strategy is very similar to calming the young person by providing an activity incompatible with the one he / she is currently using.
Treating challenging behaviour as communicative
Practitioners should constantly monitor the young person's behaviour and should treat all behaviours as potentially communicative; they need to be continuously asking themselves the questions:
Responding appropriately to a challenging behaviour relies on being clear about the functions of that behaviour. Sometimes carrying out a functional behaviour analysis is helpful.
Responding appropriately may also rely on being reflective. Reflecting is important because there are times when a young person "challenges" as a result of one of our own actions. This can be illustrated by considering two young people.
Jo has pinched a practitioner just before going out into the community. Reflecting on this may enable the reason to be determined. For example, it may be known that Jo
Having reflected on this, it may be decided that Jo pinched to avoid going out. Rather than viewing him as being at "fault", this should help the practitioners involved to realise that they should not have expected Jo to go out into the community. Providing a programme to help Jo tolerate dogs may be the next step in promoting his positive behaviour in this context. An alternative might be to take Jo only to places where dogs are not very likely to be encountered. It would be necessary to monitor the environment very closely, and take appropriate action. For example, when walking along a road, it would be necessary to keep a look out for a dog coming the other way, and to cross the road before meeting the dog.
Su has pinched as a result of becoming overloaded by an activity. Reflecting may show that the activity went on too long for her. Presenting the activity very briefly may be the next step in promoting Su's positive behaviour.
As indicated already, practitioners should constantly monitor the young person's behaviour and moods and monitor the environment. Very often this monitoring will enable the trigger(s) for a challenging behaviour to be identified. In the early stages of promoting the young person's positive behaviour, avoiding the trigger(s) may be the most appropriate strategy. In the longer term, it may be important to gradually reintroduce a trigger and to support the young person to tolerate it.
Because of the focus on promoting positive behaviour with both Jo and Su, the outcome was to adjust demands to reduce the likelihood of the behaviour being repeated. Being proactive, rather than reactive, is a key element of promoting positive behaviour.
As far as responding to challenging behaviour is concerned, a factor to bear in mind is that some young people with visual impairment and autism need predictability and so repeat a behaviour in order to elicit the same response as on previous occasions. This may be the case even if the response has been aversive in some way.
Communicating appropriately when responding to challenging behaviour
Careful consideration should be given to the spoken responses made following a challenging behaviour. This is because there is a risk that even minimal spoken responses can serve to maintain the behaviour. The advice is to avoid saying anything in response to a challenging behaviour.
Practitioners should also avoid the use of negatives with young people who have visual impairment and autism. This is because negatives only tell the young person what not to do; this is unhelpful. Young people with visual impairment and autism need very clear information about what they should be doing. It is therefore advisable to avoid saying things such as "Don't run in the corridor". Furthermore, the word "no" itself should be avoided. This is because it is a trigger for some young people, and can result in the individual going into crisis.
It is important to note here that communicating involves a great deal in addition to spoken language. Practitioners should also be aware that non-verbal behaviours may serve as responses. For example, sighing, laughing, turning away, changing facial expression or body language could all be recognised by the young person as responses. If possible, practitioners should also avoid any of these potentially communicative responses if at all possible. They should also avoid showing any clear emotion such as annoyance or anger in any way.
Praising the young person for positive behaviour
Young people with visual impairment and autism have difficulties with social understanding, and many do not understand or respond well to praise. For some of these young people, tangible rewards are effective.
Many individuals with visual impairment and autism are not concerned to please other people, so are not motivated when someone else is pleased with them and praises them. Indeed, some individuals find praise aversive or confusing. Lavish verbal praise can result in the young person becoming overloaded, especially if it is accompanied by a loud voice, clapping or physical contact. It is therefore important that practitioners use intonation and facial expression with care.
However, it is essential to remember that autism is a wide spectrum and that young people vary enormously. Some young people with visual impairment and autism do respond positively to praise, but care is required when using it.
For example, Amanda was praised as part of an approach to reduce her hair pulling. On returning to school at the start of a new academic year, she initially appeared to cope well, but gradually presented with some difficulties as she settled back into the school routine. One of these difficulties was that she began to pull the hair of other students and staff. Her hair-pulling was ignored or received a minimal response using simple language (e.g. "no pulling") in a neutral tone. Positive behaviour (in this case, gentle hands) was praised frequently. Members of Amanda's staff team decided it was also important to praise other aspects of positive behaviour, such as good walking.
When giving praise following successful completion of a task some practitioners say "Good job" rather than, e.g. "Good girl / boy". This is because some young people with visual impairment and autism respond better to a positive comment that refers to the task / behaviour rather than to direct praise that refers to them. This strategy can be adopted when praising a young person for behaving well. This was the case with Amanda: practitioners supporting her said "Good gentle hands" or "Good walking" rather than "Good girl".
An advantage with this approach is that it reminds the young person of the behaviour that is viewed positively, i.e. the behaviour that is expected. Directly praising the young person with "Good girl / boy" does not do this.
As noted, members of staff sometimes responded to Amanda's hair-pulling by saying "no pulling". Although using the word "no" in this context did not appear to present any difficulties, in general practitioners should also avoid the use of negatives with young people who have visual impairment and autism. This is because negatives only tell the young person what not to do; this is unhelpful. Young people with visual impairment and autism need very clear information about what they should be doing. It is therefore advisable to avoid saying things such as "Don't run in the corridor". Furthermore, the word "no" itself should be avoided. This is because it is a trigger for some young people, and can result in the individual going into crisis.
If the young person responds well to being praised for positive behaviour, it may also be appropriate to praise his / her learning.
Providing tangible rewards for positive behaviour
Many young people with visual impairment and autism do not understand or respond well to praise.
Tangible rewards can be coupled with praise; this was the case in the programme to reduce Amanda's hair-pulling. Praise was accompanied with the reward of a star, which was placed on a chart which Amanda could refer to when she wished. As soon as she had obtained five stars, Amanda was rewarded with a favourite item. This was a cup of tea, which was highly motivating for Amanda. She could earn up to two cups of tea a day.
As noted in the fundamental principle of promoting positive behaviour, no young person should ever be deprived of his / her basic rights and needs such as food, fluids, personal care or emotional support. Amanda was always provided with plenty of drinks during the day. The cups of tea she earned as part of her programme to promote positive behaviour were additional drinks.
It is important to note here that a cup of tea was not an ideal motivator. For example, it meant a member of staff having to abandon other tasks for a few minutes to make it. In addition, tea is a diuretic, and this was a particular difficulty in relation to Amanda, because of her urinary incontinence. However, despite much effort to do so, no other item had been identified which was as powerful a motivator as a cup of tea.
It may take time for a tangible reward to become effective, as was the case with Amanda. At first she found it difficult to wait for the cup of tea. Frequent verbal support was therefore provided, always augmented visually. Over time, Amanda engaged with the reward system and her hair-pulling reduced substantially.
Tangible rewards can also be useful in promoting learning.
Avoiding verbal prompts when promoting positive behaviour
When promoting positive behaviour, great care is required concerning the use of verbal prompts. In fact, they should be avoided whenever possible. So, reminders (i.e. verbal prompts) to the young person to behave in a certain way may not be advisable. This is because it may not be possible to fade verbal prompts, resulting in the young person becoming prompt dependent.
Providing clear boundaries which inform the young person of what is acceptable behaviour
Like all young people, those with visual impairment and autism cope most effectively when they have clear rules to guide their behaviour. However, whereas most typically developing young people are able to model their behaviour on that of others, those with visual impairment and autism cannot do so:
Young people with visual impairment and autism need to be made aware explicitly of what is acceptable behaviour.
If the young person understands spoken language, it may be possible to explain rules verbally. However, spoken language should be augmented, e.g. using large print / tactile alternative. Because of their literal understanding and rigidity, young people with visual impairment and autism tend to obey rules very closely. Nevertheless, it is important to reward acceptable behaviour, either with praise or tangible rewards.
Sanctions for unacceptable behaviour are not usually effective with young people who have visual impairment and autism. They are best avoided. In fact, as noted in the fundamental principle of promoting positive behaviour, the young person should not be punished.
All boundaries put in place must take proper account of the young person's difficulties and needs. A young person may do something, or may be unable to do something, because of:
Boundaries should take account of these, and must be realistic. Many young people with visual impairment and autism have needs which mean they are not able to conform. Boundaries should not require them to do so.
Initially, Bob's needs were not well understood, and he was required to attend every lesson in the classroom with his peers. But he was unable to do so, as he found this environment grossly over-stimulating. On top of the background sounds of humming computers, strip lights and traffic, peers talking loudly could present significant difficulty for Bob. When Bob�s over-arousal reached a certain level, he typically rushed out of the room. At these times he was very likely to inadvertently push peers out of his way. As he was bigger and heavier than his peers, this posed a real risk to their safety, as they could be knocked over.
At this stage, staff regarded Bob's behaviour as challenging and unacceptable, and believed he should learn to conform. They also believed he needed the same boundary as his peers, i.e. "you must attend all lessons with your peers in the classroom". However, when the nature of Bob's autism and its effects on him were explained, staff came to understand that he was not being difficult; they also came to understand that the boundaries in place for his peers were not appropriate for him.
Clearly, there was a need to provide Bob with clear boundaries. There was an awareness that this would not be possible by providing spoken explanations; despite his reading skills, it was also felt that he would not be able to understand even if spoken language were augmented with large print. It was that the best way forward was to provide Bob with a low arousal environment.
So, the original boundary (set implicitly by staff) of "you must attend all lessons with your peers in the classroom" was completely inappropriate for Bob. In contrast, the boundaries provided (again implicitly) in the approach tailored precisely to his individual difficulties and needs (the low arousal approach) has resulted in him:
Although clear boundaries are important, it is essential they are appropriate for the individual. As this discussion of Bob indicates, the young person with visual impairment and autism may need very different boundaries from his / her peers.
Sebastian finds being thwarted very difficult. Thus, he does not cope when he is told he cannot do something he wants to do. A clear boundary is in place for dealing with this. In effect, it is made clear to Sebastian that he can engage with favourite activities at the times they are on the timetable. The timetable was restructured to provide "space" between educational activities. It is during these spaces, which are on his timetable, that Sebastian can engage with favourite activities. If he asks for an activity at a time when it is not on the timetable, the "now / next" approach is used: he is told, for example, "Work now. Tape recorder next." The restructuring of Sebastian's timetable illustrates the need for staff to consider changing the way they do things in order to enable the young person to keep within boundaries.
In order to ensure that clear boundaries are effective for the young person, it is important to promote consistency between staff.
For example, Sebastian does not readily respond to a new member of staff as well as to practitioners he is familiar with. Sebastian has a keen interest in music, and is skilled musically. At the end of musical activities he is often reluctant to put away the musical instrument he has been using. If his teacher, whom he knows well, tells him to put it away, Sebastian typically hesitates briefly and then puts it away. Sebastian is also supported by teaching assistants (TAs), one of whom has only recently started to work with him. If this TA tells him to put away the instrument, Sebastian typically tightens his grip on the instrument and pulls it closer to his trunk. The TA avoids showing annoyance, but provides sufficient processing time; i.e. "waits for eight". If, after about 8 seconds, Sebastian has failed to put the instrument away, the TA repeats the instruction, exactly as she first said it, and waits again. She persists with this until Sebastian responds by putting the instrument away. Sebastian is gradually responding more readily to this TA.
An important aspect of providing clear boundaries is that of communicating them to the young person. It is very easy to state boundaries as negatives, telling the young person what is not permitted, as in "You must not shout out in lessons". But this is very unhelpful for young people with visual impairment and autism, who need very clear information about what they should be doing, rather than what they should not be doing. See also:
Boundaries do not need to be expressed explicitly as rules given to the young person. Indeed this is inappropriate for many young people with visual impairment and autism because of their receptive communication difficulties. However, some individuals do understand simple rules, such as "Walk in the corridor". It may be necessary to augment spoken rules, perhaps with large print / tactile alternative. Some young people may find it helpful to have a story that supports their social understanding of rules in general or of a specific rule.
Providing explicit boundaries / rules for young people with visual impairment and autism requires careful thought and, sometimes, ingenuity. This is illustrated with reference to Tyler and Dominic.
Tyler talks a great deal about his favourite topic (vehicles), and used to do so during lessons. He has now been given a clear boundary / rule concerning this issue: "Work in lessons. Talk about vehicles at break." If he does talk about vehicles in a lesson, the rule is repeated and he is re-directed to the task. He is also praised when he is attending to the task by being told "You're working well. That's good." Tyler now rarely talks about vehicles during lessons. Initially, consideration was give to expressing the rule as "No talking about vehicles during lessons." However, this would have told Tyler only what is not permitted. It would not have told him what he should be doing in lessons, and would not have told him when talking about vehicles is permitted.
Dominic has limited awareness of his peers and the conventions of social interaction. He also has a degree of impulsivity, meaning, for example, that he:
Dominic's Student Profile states that, unless he has clear boundaries, he will find it difficult to know how to behave. Once he had a clear boundary / rule to address the issues outlined in the bullet points above, Dominic knew how he was expected to behave. Initially Dominic's rule was "While the teacher is talking, you don't put your hand up". It became clear he was finding it difficult to understand this rule; it was thought that he did not properly understand the negative ("don't"). Furthermore, although the rule informed Dominic of what he should not do, it did not tell him what he should do. The rule was therefore changed to "You may put your hand up when the teacher is not talking." Although there is a negative in this rule, Dominic does not appear to have any difficulty understanding it. There could be two reasons for this:
Using stories to support social understanding
For some young people with visual impairment and autism, stories are a useful way to support social understanding and therefore to promote positive behaviour. This is the case when a negative behaviour arises out of a misunderstanding or a lack of knowledge that the young person has about a social situation.
Cecily becomes anxious and stressed when facing a situation she finds difficult, including:
When anxious and stressed, Cecily flaps her hands, rocks and mimics crying (she produces crying-like sounds, but no tears). Cecily has several stories which are used to enhance her understanding of the social situations she finds difficult. These stories are based on the Social Story� approach. Practitioners involved with Cecily have agreed the topics for the stories written to date. Cecily has contributed to the process of writing each story. The stories are contained in a loose leaf braille book. Cecily is highly motivated by her story book and often asks for it. If she is experiencing a difficulty that is linked to an existing story, but she has not asked for her book, the teaching assistant reminds her of the story.
Archie has some difficulties with peer interaction skills and this means he is not sought out by peers, as he presents as arrogant and bossy. An aspect of Archie�s autism is that he tends to apply rules rigidly; he is not able to adapt his responses to the situation. Therefore he repeatedly reprimands peers when he believes them to be behaving inappropriately. In addition, although he has learned certain rules about acceptable behaviour, he does not understand that what is unacceptable behaviour in one context may be acceptable in another. For example, he understands that interrupting a peer during a question and answer session in class is not permitted. But he thinks that the same rule applies to conversations between peers at dinner time.
Thus, Archie has two particular difficulties that his staff team wished to address
These difficulties have been addressed partly by using "jigsawing" to promote peer relationships . However, Archie still lacks the ability to participate adequately in a conversation with a peer. Members of Archie's team are introducing a Social Story� to support his social understanding in this area; it explains the difference between conversations and formal turn taking interactions.
There is some evidence that using a story to support social understanding can be effective; see Akers (2011 ). See also using stories to support social understanding in order to promote peer relationships.
Minimising change
It is sometimes said that young people with visual impairment and autism do not like change and like a rigid routine. In fact, it is probably more appropriate to think in terms of them:
In order to promote positive behaviour, it may be necessary to manage routine and change very carefully. For some young people, minimising change is very important.
Some changes (transitions) are inevitable, so it is essential to support the young person to cope with transitions.
Although her school is large, Cecily has been with the same class of young people since she entered the school seven years ago. Minimising change in this way is thought to have been a major factor contributing to the progress Cecily has made.
Routines are very important to Tyler and he copes most effectively when there is constancy and predictability in his life. Thus, class layout remains constant for extended periods. Tyler becomes anxious when any change affects his belongings or learning space. When change is unavoidable, staff try to minimise the effects on Tyler by making only one change at a time, and ensuring those changes are as small as possible.
Keeping to the young person's usual routine
One way of minimising change is to keep to the young person's usual routine. Many young people with visual impairment and autism become anxious if they cannot predict what will be happening in the near future. They tend to have a good memory and need things to remain constant. Thus many of them have a good understanding of their usual routine and become anxious or stressed if this is violated. Thus, for many young people with visual impairment and autism, keeping to the usual routine supports the individual's understanding and allays anxiety.
Routine is very important to Sarah and she sometimes becomes very distressed if there is an unavoidable change in her routine. Thus, as far as possible, staff keep to Sarah's usual routine.
As well as trying to keep to Sebastian's usual routine, staff also try to:
Ali appears to know his usual routine. By keeping to this, staff support his understanding of what he is required to do / what is happening next.
Routines are very important to Tyler and he copes most effectively when there is constancy and predictability in his life. Thus, staff keep to his usual routine as far as possible.
Many young people with visual impairment and autism have an excellent memory for events and routine. Nevertheless, it is advisable to provide a schedule / timetable. This will serve to confirm for them that the usual routine is in place.
Routine is also discussed in
Informing the young person of impending changes in the usual routine
For many young people with visual impairment and autism, it is possible to promote of positive behaviour by:
Informing the young person of impending changes in the usual routine can also make a useful contribution.
Sebastian has an excellent memory for events, knows his routine and copes poorly with change. With the aim of supporting him to cope with changes in routine, staff inform him of such impending changes. On most occasions now he copes when there is a change in routine he has been informed of. Because Sebastian has relatively good receptive communication, he is able to understand when staff inform him verbally of changes.
Many young people with visual impairment and autism use a schedule / timetable. When there is an impending change in the usual routine, this should be amended jointly.
Selecting the most suitable time to inform the young person of an impending change may be difficult. To some extent, this may depend on the nature of the individual's schedule / timetable; if the young person has a full day schedule / timetable, it may be feasible to inform him / her of a change well in advance. However, some individuals cope best if the change is announced only just before it occurs.
Routine is also discussed in
Some young people with visual impairment and autism may benefit from strategies that can support coping with changes in routine. Two such strategies described elsewhere involve:
Ensuring that all events the young person is informed of in advance do actually happen
Staff working with Sarah know how important it is to avoid confusing her and disappointing her. Experience has shown them that Sarah becomes very distressed if an event which she expects to take place is cancelled. She is not able to understand a verbal explanation of a cancellation. So, once Sarah is expecting something to happen, it must do so. Sarah is provided with information about forthcoming events using her timetable. Naturally, once Sarah has been informed, by her timetable, of an event, she expects that event to happen. Therefore, staff ensure, as far as they can, that the event does happen.
Ensuring that all events the young person is informed of in advance do actually happen
is, in effect, ensuring that staff are honest and truthful. This is essential for building the young person�s trust in his / her practitioners.In the past, Sebastian quite frequently kicked people and objects; bit, scratched and head butted others; banged his head against objects; screamed; swore; and threatened others verbally. The triggers for this behaviour were not always known, though it is likely that being confronted with a change in routine was sometimes a factor. Sebastian has an excellent memory for events, knows his routine and copes poorly with change. As well as ensuring that all events he is informed of in advance do actually happen, staff also try to keep to his usual routine. In fact, these two strategies are closely linked. With the aim of supporting him to cope with changes in routine, staff now inform him of impending changes in the usual routine. On most occasions now, Sebastian copes when there is a change he has been informed of in the usual routine.
Avoiding triggers
In order to promote both positive behaviour and emotional wellbeing, it is very important that practitioners avoid things that are known to trigger:
Almost anything can act as a trigger, including
If Winnie becomes overloaded or goes into crisis, she self-injures: she bites her left hand and hits her head with her fists; occasionally, she hits another person who happens to be close to her. Once she has started to self-injure, Winnie seems to find it rewarding; she appears to get a "high". It is very difficult to bring the self-injuring to an end and "bring her down" again. It is therefore particularly important that staff monitor Winnie�s behaviour and moods and avoid known triggers. These triggers are
Cecily has a range of sensory needs. For example, she is very sensitive to being touched lightly by others, particularly on her hands and arms. Cecily finds this very aversive, and touching her lightly typically triggers an outburst from her; for example, when a teaching assistant (TA) touched her lightly on her hand, Cecily shouted "Ouch! She's snapped my fingers." Those who support Cecily therefore avoid the trigger of touching her.
Practitioners who work with visually impaired young people often use sensitive touch to remind the individual that they are still present, to attract the young person's attention, or to reassure the young person. However, the use of sensitive touch should be avoided when working with young people who have visual impairment and autism.
Indeed, it is advisable to avoid all touch with a young person who has visual impairment and autism, unless the individual initiates it, or experience shows that it is appropriate. For example, some young people with visual impairment and autism enjoy firm touch and / or find it calming. Cecily sometimes asks to have her back rubbed. Ali and Bob find firm touch calming.
Touch may be an important element in approaches such as intensive interaction: see providing a responsive environment .
An important underlying principle recommended in this guidance material is the use of the hand-under-hand approach in preference to the hand-over-hand approach. Using the hand-under-hand approach from the earliest stage may support the young person with visual impairment and autism to tolerate light touch more readily. Nevertheless, practitioners should be aware that some individuals will always find light touch aversive except when it is used very sensitively in very familiar contexts.
As well as finding light touch very aversive, Cecily dislikes another person unexpectedly coming close to her: she flinches when she feels the air movement caused by someone moving close-by. The TAs who support Cecily frequently need to be close to her; they avoid the trigger of moving in unexpectedly, by informing her before they approach.
It is, of course, important to avoid triggers at all times; this includes during lessons / educational activities.