When supporting troubled/troublesome people it can be hard to understand why they behave as they do. It is natural to focus on eliminating troublesome behavior. But a Positive Approach would instead look for the adaptive function a behavior serves, or its meaning, and teach a more acceptable but functionally equivalent alternative response. Techniques have been developed that allow us to understand the meaning of the behaviors of troubled/troublesome people. And when we can teach functionally equivalent responses, responses that achieve the same functional outcome, troublesome behavior will decrease.
Mary was placed in an institution when she was 12 years old. She was believed to be extremely suicidal. While living in the institution she frequently talked and wrote about suicide. She lived there for four years, until a community-based residential program agreed to accept the challenges she presented. At the community-based site she lived with teacher/counselors who worked a four-days-on, three days-off tour of duty. So the same people were with her around the clock. At first they responded to her suicide threats literally - as if she would act as she talked. They talked with her about why she was so upset and why she wanted to hurt herself. As they got to know Mary more and saw her in different situations, they began thinking of the suicide threats in a different way. Since the teacher/counselors were living with Mary, they knew what was happening throughout her day. Each time she began to talk about suicide or wrote a suicide note, they did not talk to her about suicide or about feeling bad about herself, but instead thought about the circumstances surrounding the occasion and asked her questions about what had been happening. They discovered that Mary had some problems that she didn't know how to solve, and to get people to help her she would talk or write about suicide. They discovered that she didn't know how to problem solve. So instead of talking about feeling suicidal, they coached her on how to identify her problem, choose an effective solution, and act on it. It was then that the suicide threats stopped.
Most of us have learned that people literally mean what they say. When someone says she is feeling depressed and wants to hurt herself, she is in fact actually depressed and might really hurt herself. When someone says he is hungry, he in fact is and wants to eat. We learn to expect a predictable correspondence between behavior and purpose, or meaning. There is an old saying, "If it looks like a duck, walks like a duck and talks like a duck, then it must be a duck."
For troubled/troublesome people, and especially for those with disabilities that interfere with communication, there can be a variety of circumstances that confound things. We assume that all behavior has meaning, but meaning for a troubled/troublesome person may not be what our experience would lead us to think. So it becomes important for us to learn new ways of discovering the meaning of behavior. Look again at the duck, but in a different way. Could it be a rabbit? Consider the beak to be the ears of a rabbit and the indentation of the head the mouth of a rabbit. Just because it looks like a duck, walks like a duck, and talks like a duck, doesn't necessarily mean it is a duck. When looked at from a different perspective it looks like a rabbit. There is an old mind teaser expression:
A respectful relationship involves starting with the assumption that we cannot take for granted what behavior means and that we need to discover the adaptive purpose of even the most troublesome behavior. Phil Quinn (1984) wrote about his experiences growing up in abusive families. He started his story as follows:
To understand the meaning of another's behavior, we must first learn to look at that person's behavior from his or her perspective. "You never really understand a person until you consider things from his point of view - until you climb into his skin and walk around in it" (Lee, 1960). Given a troubled person's unique life experiences and learning style, how can we interpret his or her behavior? When we are not sure what a person means, or what purpose the behavior serves, there is a group of techniques that we can use to discover the meaning of the behavior. These techniques have been referred to as hypothesis testing. The best-known examples are active listening and functional analysis. To understand how hypothesis testing is used, it may be useful to look at how the techniques are related to one another and to review examples of each. Hypothesis testing involves three steps:
To assess the meaning of behavior we find instances of the behavior by:
When trying to discover the meaning of behavior, we start out by collecting information about the behavior so that we can form a hypothesis about what the behavior means. Sometimes this comes from being with a person, observing behavior over time, and slowly beginning to form an opinion that some actions may mean something different than what we would typically expect. At other rimes, hypothesizing may be instantaneous. A person does or says something, and we immediately have an opinion about what was meant. In these cases we have directly observed the person engage in the behavior.
At other times the function of a behavior may be elusive to those who have directly observed it. When we are puzzled by or disagree on the function of a behavior, a structured interview with people who have spent a lot of time with the person and have been able to observe the person in lots of different situations can make generating hypotheses easier. O'Neill, Horner, Albin, Storey, and Sprague (1990) developed a functional analysis interview that includes questions designed to identify the context in which a challenging behavior occurs. The questions elicit (1) a careful definition of the relevant behavior; (2) items that potentially may affect the behavior (e.g., medications, medical complications, sleep cycles, diet, daily schedule, predictability, personal activities, presence of other people, outcomes of actions); (3) circumstances that seem to predict the behavior (e.g, time of day, setting, with whom, during what activity); (4) what happens for the behaving person when the behavior occurs (possible functions of the behavior); (5) how efficient the behavior is; (6) what the primary methods used by the person to communicate are; (7) what events, actions, objects are thought to be positive for the person, (8) what "functionally equivalent alternative" behaviors are known by the person; and (9) the history of the undesired behavior and the strategies that have been used in an attempt to deal with it. Participating in this interview can help the respondent(s) hypothesize what function a troublesome behavior may serve for the individual.
Sometimes it is possible to talk directly with the person engaging in the troublesome behavior. Examples of this strategy are presented later.
Assessment gives us the information on which to base a working hypothesis or "best respectful guess" concerning what purpose a challenging behavior serves. A useful hypothesis can be stated in terms of what a behavior accomplishes (the outcome) for an individual in a given situation (antecedent events). For example, "When a stranger gets too close to Joe, he engages in self-abuse until the stranger moves away." Sometimes it is more helpful to phrase a hypothesis as if there is a communicative function for the behavior. For example, "Joe's head banging means that you are physically too close to him and he wants you to move away." Phrasing the hypothesis as if there is a communicative function helps us to more readily identify what behavior to teach the person. But before assuming that we understand the purpose of a troublesome behavior, we need to confirm that the hypothesis is correct by testing it.
To test our hypothesis we can use a passive strategy such as naturalistic observation, in which we identify different situations that allow us to answer the question, "Does the behavior only occur in the context we thought it would, and not in other contexts?" Then we can observe what the person does when the context is present. Or we can use active strategies such as active listening (ask the person questions like, "Do you mean...?Ó) and functional analysis. The passive strategy of naturalistic observation involves careful observation of what a person does in situations that can be crucial to the validation of the hypothesis. Joe is a young man who was banging his head and grabbing others' hair. After observing him for some time, the people around him formed a working hypothesis that both of these behaviors functioned to control who was around him and how close they got to him. To confirm their hypothesis, they then paid careful attention to what happened in contrasting situations. They observed that Joe banged his head in the presence of strangers but not when with people with whom he was quite familiar. They also observed that if anyone came close to him suddenly and without warning, he would bang his head or reach out quickly and grab their hair. But if people approached Joe gradually and started a conversation before getting too close, he did not bang or grab. Observation of these consistent correlations led people to accept the hypothesis that head banging and hair pulling served as ways to escape social encounters with "strangers" or sudden social encounters; they could be thought of as communicating, "Stranger, you're too close," or, "Oh, you frightened me."
Naturalistic observation is a passive strategy and does not directly confirm or validate a hypothesis. For example, there may be subtle aspects of a situation that observers miss because they focused on identifying situations that confirmed a strongly held but incorrect hypothesis. An active test of a hypothesis provides a more definitive answer. One strategy, active listening, depends upon an individual's communication skills, while the second strategy, functional analysis, does not and is particularly useful when a person's communication skills are not effective for others.
Thomas Gordon (1970) has described active listening as using many of the skills counselors have developed - not to counsel an individual, but to understand the meaning of the individual's behavior. Active listening involves repeating back to a person your interpretation of his or her actions or words and asking for some form of agreement or disagreement. While active listening can take many forms , it is most simply described as a question in the form of, "Do you mean...?"
For example, a teacher/counselor described the case of Tom, a boy she was caring for, who would come into the house from playing outside after school and ask, "When are we eating?" Initially, the teacher/counselor assumed that Tom literally meant what he said, and would answer, "In a few minutes." Tom would become upset and repeat his question over and over, until the teacher/counselor told him to stop repeating himself.
Active listening involves not acting on an assumption or an interpretation of what was meant but instead presenting the assumption to the child to determine if the teacher/counselor understands. Instead of immediately answering Tom, the teacher/counselor learned to ask questions for clarification, e.g, "Are you hungry now? Are you asking how long can you play outside? Do you want to go somewhere?" This gave Tom the opportunity to tell her whether she understood correctly. He might have answered, "I want to do something fun." Given this description of what the child meant, the teacher/counselor was able to provide an answer that better met his needs "Dinner will be ready in a few minutes, and after we have finished dinner and cleaned up the kitchen, we can go to the park." When the teacher/counselor used active listening, not only did she better understand Tom, but he no longer became upset, and he stopped repeating himself. Active listening is different from the passive listening we typically engage in and involves actively questioning our interpretation of what we heard or saw.
Horner (1996) has described a somewhat more structured interviewing strategy. Through a sequence of questions the person is asked to identify when he or she engages in the troublesome behavior, what happens at those times just before the person engages in the troublesome behavior, and what the outcome of engaging in the behavior is (what happens immediately afterward). Some people are able to self-observe and analyze the function their own behavior serves when guided through the analysis with the right questions.
Even when a person cannot answer because of a communication disability or heightened emotional arousal that is disruptive to the person's communication skills, we can still use active listening and watch the person's reaction. Many people can understand what is said to them even when they are not able to express themselves clearly. Changes in their actions may provide us with answers to our questions. For example, Dave gestures and makes vocalizations that are difficult to understand. At first his teacher/counselor made assumptions, e.g., that he was hungry, and gave him something to eat. He might start to eat it but would then throw the food at the person feeding him. When active listening was used, the situation looked something like this: When Dave gestured and vocalized, a teacher/counselor thought about what he wanted and asked him by both stating a question and showing him what she meant. She said something like, "Are you hungry? Do you want a banana?" and handed him the banana. If he didn't reach for the banana or show any other sign of wanting it, she speculated that he might not be hungry but wanted something else. She then asked him if he wanted a drink and showed him something to drink. If he again showed no interest in the drink but continued to gesture and vocalize, she would have realized that she still did not understand what he wanted and tried something else. She might have asked him if he wanted to go outside and taken him to the door. If he then went outside and seemed content, she might assume that was what he wanted. While the teacher/counselor cannot be positive that Dave was trying to communicate that he wanted to go outside, his behavior indicated that it was the better choice among those that she presented. And she was teaching him that she was willing to listen actively to his communication efforts.
Conducting a functional analysis in the form of function probes (Evans and Meyer, 1985) can prove informative when a person does not provide a useful response to the kind of questioning just described. Function probes involve arranging for the occurrence of contrasting situations to actively test the function of a behavior. For example, when asked to complete chores, Mike would throw his toys and swear at his foster parents. Generally he was very sullen and would not answer when asked why he was upset. The typical routine was that when Mike came home from school there was a set of chores that he needed to complete. The foster parents began testing a series of hypotheses for the functions of these "tantrums " They started with the assumption that he did not like the parent who was making the requests. (Troublesome behavior often feels like an attack on the caretaker and it is easy to assume that the function of the behavior is to get the caretaker to back off.) To test this hypothesis the parents took turns asking Mike to do his chores. Mike demonstrated that he was just as likely to swear at either parent and invalidated the initial hypothesis. The parents then speculated that the chores were either too difficult, or too time consuming, or too numerous. They tested each of these possibilities by alternating their requests to do one chore versus many chores, to do easy chores versus difficult ones, or to do time consuming chores versus quickly performed chores. They discovered that Mike was capable of completing his chores whether requested in isolation or as a group of tasks to be completed. The foster parents next speculated that Mike didn't like to be disrupted from a play activity by a parental request. To test this hypothesis, the parents created a list of chores and required Mike to choose which ones to complete each day and when. They alternated this arrangement with their own requests to do chores. They discovered that there were many fewer outbursts when Mike chose when to complete the chores assigned him. They learned that they needed to teach him to negotiate what was being requested of him (functionally equivalent behavior) rather than throw toys and swear.
One behavior can often serve many functions. For Mike one function was to escape or delay disruption in his play. Since the tantrums continued to occur occasionally in other contexts, the parents continued to identify other functions that tantrums served for Mike. They discovered that Mike would sometimes engage in a tantrum as he came in the door from school. Initially the parents speculated that these particular tantrums were associated with poor scores on his daily school report, but his behavior proved not to be consistent with this hypothesis. Upon further questioning, the parents discovered that Mike was being teased by older boys on his school bus when they found out that he had a school report with poor scores. This was a negative experience for Mike, and through passive observation the parents discovered he would throw a tantrum at home once he was out of harm's way of the older boys. His tantrums only occurred when he was teased on the bus. A functionally equivalent response for Mike was learning to describe negative experiences to adults who could advise him on new ways to act when negative experiences (e.g., teasing) occurred.
Our typical experiences may lead us to see a duck when something walks like a duck and talks like a duck. Our experiences may lead us to assume that a troublesome behavior "means" for another what it would mean for us. A respectful relationship with a troubled/troublesome person starts with "walking in his shoes" and is based on the assumption that challenging behavior serves a useful, valid function for that person. Our role is to understand that function and help the person learn a more acceptable but functionally equivalent response.
Duck, it's a rabbit.
Evans, I.M., & Meyer, L.H (1985) An educative approach to behavior problems: A practical decision model for interventions with severely handicapped learners. Baltimore: Paul H. Brookes Publishing Co.
Gordon, T. (1970). P.E.T.: Parent effectiveness training. New York: Penguin Books Ltd.
Horner, R. (1996) Positive Behavioral Support. The NIDRR National Behavior Management Conference. Philadelphia.
Lee, H. (1960). To kill a mockingbird. New York: Warner Books, Inc
O'Neill, R.E., Horner, R.H., Albin, R.W., Storey, K., & Sprague, J.R. (1990). Functional analysis of problem behavior: A practical assessment guide. Pacific Grove, CA: Brooks/Cole Publishing.
Quinn, P.E. (1984). Cry Out! Nashville, TN: Abingdon Press.
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