Question
The most consistent challenge we are having with children with Down Syndrome focuses on their aggressive behaviors. Do you have suggestions for resources on helping parents and therapists with behavior management?
Answer
Challenging behaviors can be one of the most significant associated issues for individuals who have severe communication disorders. Individuals with severe communication disorders do not have efficient or effective means to communicate. As a result, they often utilize atypical behaviors to communicate. Individuals who are frustrated by their inability to effectively communicate may demonstrate aggressive behaviors (e.g., kicking, screaming, biting, hitting) or passive behaviors (e.g., nonresponsiveness). Unfortunately, these behaviors may not be recognized as forms of communication. The behaviors are not recognized as meaningful so they are not acknowledged, and the person may be punished because the behavior is deemed inappropriate.
Interventionists should select proactive rather than reactive behavior strategies whenever feasible. Proactive strategies are designed to prevent inappropriate behaviors from occurring, thus eliminating or reducing the need for more intrusive or punitive approaches. Positive strategies for managing behavior should always be selected before those that are considered more negative in nature. Positive strategies teach alternative, appropriate behaviors in place of the unacceptable behavior. Furthermore, management strategies can be placed on a hierarchy, or continuum, from least intrusive to more intrusive. Less intrusive strategies are those in which the individual has more control of his/her own behavior. As strategies move down the hierarchy, the interventions become less child centered as the clinician takes more responsibility for behavior control. An overview of behavior management strategies that cover these issues can be found in:
Currie, P. S., Melville, G. A., & Stiegler, L. N. (1997). Behavior
management strategies for clinical or educational settings. The Clinical
Connection, 10(1), 18-22.
Other resources that discuss communication disorders and behavioral intervention strategies that emphasize the use of visual strategies, concrete symbols, and consistency can be found in texts dealing with a variety of disorders: autism, augmentative and alternative communication. Some helpful references are:
Carr, E. G., Levin, L., McConnachie, G., Carlson, J. I., Kemp, D. C., & Smith, C. E. (1994). Communication-based intervention for problem behavior: A user's guide for producing positive change. Baltimore, MD: Paul H. Brooks.
Hodgdon, L. Visual strategies for improving communication. Troy, MI: QuirkRoberts.
Hodgdon, L. (1999). Solving behavior problems in autism. Troy, MI: QuirkRoberts.
Hunter, K. (1999). The Rett Syndrome handbook. Clinton, MD: IRSA. Reichele, J., York, J. Sigafoos, J. (1991). Implementing augmentative and alternative communication Strategies for learners with severe disabilities. Baltimore, MD: Paul H. Brooks.
Dr. Paula S. Currie is the Head of Speech-Language Pathology at Southeastern Louisiana University. She has worked in a variety of settings for more than 25 years as a speech-language pathologist. She can be reached at pcurrie@selu.edu.
