Repetitive Behaviors: Detection and Intervention – An Example

Definition:

There may be  more complex reasons for behaviors defined by family members as “tics” that can not be addressed in this educational forum. If there is a diagnosis of OCD or Obsessive Compulsive Disorder, see a professional who specializes in this area. This may include a family physician, a psychiatrist, and/or a cognitive behavioral therapist.

 

For this educational forum we will provide an example of how to discern causes and consequences of the behavior in the school setting by using an ABC Chart. That  information will then be used to create possible strategies. In this example the cause of the behavior is work that is presented and perceived by the student as overwhelming. The consequence is the attention given to the behavior that then maintains it. Strategies to make work “doable”  including “chunking” and “choices”are briefly presented. These strategies can be found in other answers on this site (see resources below).  The use of interruption and redirection vs. attention to the behaviors, interrupts or stops the behavior and then redirects it to a more appropriate or desired response.

Situation:

My child has multiple diagnoses including ADHD, PDD NOS, and OCD. He has many self-calming behaviors and vocal tics in school. He may clear his throat and ‘zone out.’ He may keep his fingers crossed. These behaviors are concerning me. What can I do to decrease them?

  • Situation

    My child has multiple diagnoses including ADHD, PDD NOS, and OCD. He has many self-calming behaviors and vocal tics in school. He may clear his throat and ‘zone out.’ He may keep his fingers crossed. These behaviors are concerning me. What can I do to decrease them?

  • Summary

    The first step for the behaviors of concern is to check in with a professional who specializes in this area. If the student has a diagnosis of OCD and is currently taking medication, it is paramount to determine if the behaviors are related to medication. In addition, working with a physician and/or a therapist provides additional strategies for behaviors that cannot be answered in this educational forum. Although there may be multiple and overlapping reasons for some of the behaviors, there are strategies that can be explored to help to prevent or decrease the behaviors of concern in the school setting.  If the behaviors are assumed to be “self-calming”, it is important to determine what is happening to cause the student to feel the need to self-calm. Is he being presented with tasks that are perceived to be overwhelming? Are there sensory issues such as noise level? Is his seating placement in the classroom causing distress? Do the behaviors occur during wait times or lengthy class discussions? Knowing what happens before the behavior occurs may provide answers for the prevention. Completing an ABC chart will help determine possible triggers for the behaviors. Ask your educational team to fill out such a chart. The “A” stands for Antecedent or what happened before the behavior. The “B” stands for the actual targeted Behavior. The “C” stands for the Consequence or what happened right after the behavior. Sometimes adults give attention to behaviors of concern and this response may actually serve to maintain the behaviors. To provide an example of this procedure,  this answer will assume that the Antecedent is work that appears overwhelming and that the Consequence is attention paid such as discussion of the behavior of concern to the student.  This answer will highlight methods for creating strategies to decrease the anxiety regarding tasks and for using a strategy called interruption redirection to prevent or decrease the behaviors as they occur.

  • Definition

    There may be  more complex reasons for behaviors defined by family members as “tics” that can not be addressed in this educational forum. If there is a diagnosis of OCD or Obsessive Compulsive Disorder, see a professional who specializes in this area. This may include a family physician, a psychiatrist, and/or a cognitive behavioral therapist.

     

    For this educational forum we will provide an example of how to discern causes and consequences of the behavior in the school setting by using an ABC Chart. That  information will then be used to create possible strategies. In this example the cause of the behavior is work that is presented and perceived by the student as overwhelming. The consequence is the attention given to the behavior that then maintains it. Strategies to make work “doable”  including “chunking” and “choices”are briefly presented. These strategies can be found in other answers on this site (see resources below).  The use of interruption and redirection vs. attention to the behaviors, interrupts or stops the behavior and then redirects it to a more appropriate or desired response.

  • Quick Facts
    • Child's Age: 0-2, 3-5, 6-10, 11-13, 14-17, 18+
    • Planning Effort: Moderate
    • Difficulty Level: Moderate
  • Pre-requisites

    Use of an ABC Chart to determine reason for the behavior

  • Process
    • Request that the team in your child’s school complete an ABC chart (follow the link example) for a minimum of three days.

    • Use the results to determine if the behavior occurs due to sensory issues, work issues, when the student is unengaged,  if it is self reinforcing,  and/or the student  hears talk of the behavior which tends to maintain it.
    • If the team determines that it is most likely because work is overwhelming and adults tend to talk to him regarding the behavior then continue with the next steps.
    • Explore a variety of strategies that make the work appear doable. These strategies include “chunking’” and the use of a variety of visual supports.  Have the teacher write instructions on the student’s paper after each “chunk” that tells the student what to do after  each “chunk” is completed. Examples may include:”Bring to me”, “Get a drink”, “You are finished”, or “Use the computer.’” If the behavior occurs during lengthy discussions or long lasting verbal instructional time consider “layering’” related alternative activities that will engage the student. Some ideas may include assigning the student  to explore answers on the computer, accessing related computer/iPad programs or  drawing a picture related to the topic of discussion if drawing is a talent or area of interest.(Many answers on this site demonstrate these strategies. Please refer to the related resources for other answers which may be helpful.)
    • If the student begins to engage in the behaviors, interrupt and redirect with a strategy that will replace the behavior. For example, if the student is continually clearing his throat in an obsessive manner do not tell him to stop or bring attention to the behavior. Instead  ask a question regarding the topic or related to his interests; engage him verbally. If the student is engaging in a behavior such as finger crossing or other bodily repetitive behaviors, give him an errand or hands-on task in the classroom such as handing out materials, erasing the board  or taking a heavy item to the office. Each of these “replacement” tasks will interrupt and redirect the student.  In some cases, the behavior could just be ignored if it is not disrupting the class or interfering with the learning and socialization of peers.
    • As always – seek the opinion of a professional that may be working on the educational team,  such as a behavior therapist, special education teacher or occupational therapist.

  • Documents and Related Resources

    Modifying Open-Ended Questions (link to resource on this site)

     

    Visual Chunking (link to resource on this site)

     

    Color Coding Adaptation for Comprehension (link to resource on this site)

     

    Motivation Spice (link to resource on this site)

     

    ABC Data Chart for ‘tics’ (Word document)

     

    If you have questions or concerns about the Watson Institute’s use of this information, please contact us.

     

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