Turning the Tables on Challenging Behaviour

Working with Children, Young People and Adults with Severe and Profound Learning Difficulties and/or Autistic Spectrum Disorders

Peter Imray

• Publisher: Routledge
• Year: 2017
• ISBN:
  9781317374824
• Edition: 2
• Topic: Bildung
• Subtopic: Bildung Allgemein

Fully updated, and with new sections on behaviourism, attachment disorders, neuro-scientific developments and working with dis-engaged learners, this second edition of Turning the Tables contains real-life case studies, strategies for identification and handy hints and tips throughout. It is the authoritative guide to tackling challenging behaviour and working effectively with children, young people and adults with severe learning difficulties (SLD), profound and multiple learning difficulties (PMLD) and those on the autistic spectrum with a dual ASD and learning difficulties diagnosis.

With a unique approach, the author stresses the need to diagnose not only the correct difficulty but the degree of learning difficulty for a lasting resolution, as well as tackling common behavioural problems such as attention needing and task avoidance.

Chapters are split into three specific areas, SLD, PMLD and ASD/SLD, covering:

• the 'Magnificent Seven' fundamental principles of challenging behaviour
• strategies for correct identification of the main area of learning difficulty
• improving teaching methods and strategies to resolve challenging behaviour, including handy hints and tips when things don't go to plan
• extensive use of real case studies to illustrate strategies for resolution
• guidance on writing your own Behaviour Support Plan.

This is a practical and authoritative guide to dealing with the myriad of challenging behaviours that constantly puzzle practitioners. It is an essential read for all professionals, parents and carers working with children, young people and adults with SLD, SLD/ASD and PMLD.

CHAPTER 1
The problems involved in challenging behaviour and learning difficulties

In many ways, this chapter might be considered to be a strange way to start a book on challenging behaviour because there are lots of problems and even more negatives. This is perhaps my way of getting them all out in the open before moving on to what we might be able to do about them, because I do believe that all of them are solvable if we’re willing and able to work together. I repeat, this is not an academic book, this is a practical book which reviews what works, and what works consistently, as long as we follow certain key principles. These principles are expanded on from Chapter 5 onwards. But first the problems!

In the first edition of this book, I related an account of an experience I had in a mainstream primary school where a teacher was expressing her concern that any pupil could be so out of control that she (the teacher) could be ignored, sworn at and walked out on ‘without as much as a by-your-leave’.

It is accepted that nearly 50% of primary-aged children with SLD, 50% of primary-aged children with ASD and some 10% of primary-aged children with PMLD are educated in mainstream primary schools in England (Pinney, 2017), but it is likely that the children described in this book, those who display habitual and severe challenging behaviours, will (precisely because of these challenging behaviours) mostly be in special schools. I was not therefore trying to diminish the real stress that behaviours seen in most mainstream primary schools might cause or the real tensions that might arise as a result of such challenging behaviours, but rather it was an attempt to set in context the regular occurrences in an SLD school which tend to be more varied than that displayed in this mainstream primary school at least.

The list below is not exhaustive and is in no particular order, but gives a flavour:

• Physical attacks on others, including hitting, kicking, scratching, biting, pinching, pulling hair.

• Spitting, vomiting (projectile and otherwise), regurgitating.

• Deliberate incontinence, soiling, smearing.

• Self-injurious behaviours (SIB) including hand and arm biting, head-banging, eye-gouging, lip-biting, skin-picking, pulling hair out.

• Shouting, swearing, screaming, making loud noises.

• Pica – the obsessional need to have (non-edible) objects in the mouth.

• Distractibility and hyperactivity.

• Obsessional behaviours.

• Repetitive and stereotypical actions and movements.

• Non-compliance and resistance to change.

• Verbal abuse.

• Interfering with or destroying others’ work.

• Lack of awareness of danger.

• Inappropriate sexualised behaviour including open masturbation, open touching of others and their own private parts.

• Running away, both indoors and out.

• Dropping to the floor as a dead weight.

• Climbing whatever happens to be near – for example, desks, chairs and cupboards or fences and outlying buildings in playgrounds.

• Throwing whatever happens to be near irrespective of how dangerous this might be.

Clearly some of these are harder to deal with than others, though it is not uncommon in extreme cases for one individual to display many of these behaviours at the same time.

The fact that these behaviours are occurring does not however mean that they are challenging per se. Climbing, throwing, running and dropping to the floor, may be perfectly acceptable in P.E. or Dance; spitting may be OK when done into a spittoon; head-banging may be tolerated in a soft play area. It needs more than just the existence of the behaviours to make them challenging.

Defining challenging behaviour

Behaviour can be described as challenging when it is of such an intensity, frequency or duration as to threaten the quality of life and/or the physical safety of the individual or others and is likely to lead to responses that are restrictive, aversive or result in exclusion.

(Learning Disabilities Professional Senate, 2016, 4)

Ashton (2015, 151) considers that the term ‘challenging behaviour’:

refers to a range of behaviours that present as a problem to others, not something intrinsic to the child. They represent the greatest of unmet needs.

O’Brien (2016, 27) notes the same sentiment in slightly stronger terms as ‘all negative behaviour communicates an unmet need’.

Emerson and Hatton (2007) estimate the prevalence of diagnosable conduct disorders as 21% among British children with learning difficulties, compared to only 4% among British children without learning difficulties. Numerous researchers have pointed out the stark differences in risk for the development of behaviours that challenge emerging in early childhood (Emerson and Einfeld, 2010; Einfeld et al., 2010; Totsika et al., 2011a; Totsika et al., 2011b for example) which can be highly persistent over time (Emerson et al., 2014).

Allen et al. (2007) have estimated that around 10–17% of people with a learning disability behave in a way that challenges whilst Lloyd and Kennedy’s (2014) research review estimates 10–15%. Einfeld and Emerson (2013), pooling studies conducted in the UK and Australia between 2005 and 2011, posited that 29% of those with an intellectual disability will also have significant emotional and/or social difficulties, though this might not, of course, translate into challenging behaviour. In a study conducted among 181 children and adults with PIMD (Profound Intellectual and Multiple Disabilities) Poppes et al. (2010) found self-injurious and stereotypical behaviour in 83% and aggressive and/or destructive behaviour in 45% of the participants. Such behaviours were also shown to occur very frequently.

Harris et al. (1996) emphasise the fact that we cannot isolate behaviour as being the sole responsibility of the person who is doing the ‘behaving’ by opining that challenging behaviour represents a relationship between the behaviour displayed by one person, or persons, and the interpretation placed on that behaviour by other people. Both parties in the relationship, therefore, contribute to the challenge and both share the responsibility for addressing or overcoming it.

‘Challenging behaviour’ is a socially determined construct. Reiteration of this construct and its accepted definition is necessary to focus assessment, formulation and interventions on the relationship between the individual and their environment, rather than on the elimination of behaviours.

(Learning Disabilities Professional Senate, 2016, 4)

Let’s just deconstruct this statement, because this is very, very important. Challenging Behaviour, with capital letters and as a ‘category’ or as a label which we might assign to a child, young person or adult is not the same as severe learning difficulties or profound and multiple learning difficulties or autism. These are also categories or labels, but it is not possible to change them. A child who has SLD will grow into an adult with SLD and there is nothing anyone can do about this. It is not because of bad teaching, or bad schooling, or bad parenting; it is what it is. It might be considered to be an impairment, in the same way as having no right arm is, though it is not necessarily disabling, if we as a society choose not to make it so.

Challenging behaviour, on the other hand, is a label assigned by us (society) and we are as much responsible for it as the person whose behaviour we find challenging. This means that we have to work together to find a solution and it means that we will both have to change if the solution is to be lasting.

Challenging behaviour is a socially constructed concept. For an individual’s behaviour to be viewed as challenging, a judgement is being made that this behaviour is dangerous, frightening, distressing or annoying and that these feelings, invoked in others, are in some way intolerable or overwhelming. The impact on others, and therefore the characteristics of the observer, have to be incorporated in the application and understanding of the term challenging behaviour.

(Learning Disabilities Professional Senate, 2016, 8)

There are a number of issues which arise out of this statement, all of them relating to our attitude as leaders, managers, teachers, TAs, service providers, parents and carers, not only to the children, young people and adults with learning difficulties who might display challenging behaviours but also to the challenging behaviours themselves. These issues are:

1) Getting in the firing line.

2) Getting the right funding and placement.

3) Coping and helping.

4) Delivering a broad and balanced curriculum.

5) Attachment and attachment disorders.

6) Challenging behaviour is normal.

1. Getting in the firing line

Any school leader or service manager responsible for organising a response to challenging behaviour will often be in the position of trying to encourage staff to put themselves ‘in the firing line’; that is, work with pupils who are very likely to hurt them. I am fortunate enough to have had the privilege of working directly with some truly fantastic staff in my time, who not only got into the firing line again and again and again, but generally (especially support staff) got paid a pittance for doing it! They give of themselves day after day, and they do it with love. It is an issue much discussed by a number of authors (O’Brien, 1998; Cornwall and Walter, 2006; Delaney, 2009, for example) and it is an issue I will return to again.

There are however, a few staff who are reluctant travellers, and who disclaim responsibility, saying something like:

I do not come to work to get hurt. It is not my job, and I don’t get paid enough to deal with severe challenging behaviour which may after all, cause me stress, anxiety and injury.

Well, at the risk of upsetting such people I can only say that you’re in the wrong job! There are lots of jobs that do not involve the risk of physical injury – as far as I know, check-out tills and telephones don’t bite. Staying in a special school for learners with SLD, PMLD and ASD when you don’t want to work with challenging behaviours is like working as a nurse when you can’t stand needles. Of course, schools must do their utmost to ensure that incidents resulting in injury, however slight, are kept to a minimum, but it is folly to believe that even the best-run schools are risk free. Life’s too short – do something else!

2. Getting the right funding and placement

There is another tack that I’ve also heard a few times, which relates to reaching the breakdown stage, where schools feel they can no longer cope with extremes of behaviour from a particular child or student.

It is not fair to other (pupils/service users) that they are expected to put up with others’ challenging behaviours with all the consequent drain in resources this involves. Pupils with severe challenging behaviour should be separately educated.

Though I have more sympathy with this line since there may well be persons with extremes of behaviour that even the most clued-up school is not going to be able to manage, not to mention the difficulties parents face at home leading to pressure for a residential placement being applied, it strikes me that schools often miss a trick here in looking for the residential specialist option too early. The ideal option must be that SLD schools continue to cater for extreme cases, provided they are given the resources to do so.

Pinney (2017) estimates that there are over 5,200 children with the most complex needs in SEN residential placements in England, a figure that will include a considerable number with either SLD, ASD/SLD or PMLD. This is, however, a considerable reduction on the numbers from a decade earlier (Pinney, 2005) when some 9,500 children with S...