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Behavior Archive 2004

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Dru Saren, Ph.D
Behavioral and Education Specialist

I have taught pre-school through graduate school; general and special education; in public, private and psychiatric hospital schools; in New York City, New Mexico, and California. I received my doctorate in education, with a specialization in working with students with behavioral and emotional disorders, from the University of New Mexico in 1986.

Much of my success and failure in implementing behavior strategies, as well as maintaining some sense of humor about it all, can be credited to a 27-year post graduate course offered by my daughter, who has Down Syndrome, and her younger brother and sister, who have substituted when things were going too smoothly.

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  • My 11 year old son is diagnosed as having bipolar disorder, ADHD, and Oppositional Defiance Disorder.

Question:

My 11 year old son is diagnosed as having bipolar disorder, ADHD, and Oppositional Defiance Disorder. He is currently in a Santa Barbara County special education class for emotional disturbed children. Last year he was hit by a car and had a traumatic head injury. He is failing miserably in school. The behavioral issues are really bad and he is suspended on an average 2-3 times a week. I am very concerned about his lack of getting an education and I understand there is only so much a school can do. I have had countless IEP meetings, behavioral contracts, counselors, etc. I really need help and what the next step is or what I can get from the county or state. My son is extremely bright but his behavior prevents him excelling. He goes one step forward and two back. He was hospitalized this past summer for trying to kill himself, now he said he was just kidding but it was very serious. He is always picking at scabs, and trying to hurt himself. He can be very sweet but he has a really mean side and I am afraid he is seriously going to hurt someone. 

Could you please help me!!! 

Sincerely, 
Kim Anderson


Answer:

Dear Kim,

I have asked my colleague, Marji Stivers, Ph.D. who is a clinical and school psychologist, to address your question because it extends far beyond simply behavior. I would also suggest that you ask your district to refer your son to our sister-center, Diagnostic Center South in Los Angeles (http://www.dcs-cde.ca.gov/) because he is the kind of complex student we see. Here’s Marji’s response:

It sounds as though you and your son are facing some incredibly difficult and painful challenges. From your letter, I’m not entirely clear about the nature of your son’s disabilities or the services he is receiving. You mentioned that he has an IEP, attends a special education class, and that you and he have encountered a variety of 
counselors and behavior plans. I will do my best to describe the types of assessment, supports, and services that are appropriate for the situation you describe. If any of these evaluations and services has not been offered, you may call another IEP team meeting to request it.

  1. Is your son receiving good mental health therapy and psychiatric services? These services should be available from your county mental health department through a referral from his school district. If you have private insurance and prefer to use the providers on your health plan, you have that option. If you are not happy with the services provided, do not hesitate to obtain second opinions or switch providers. 
  2. Is your son on any medications that target attention, mood, or behavioral control? Have the medications been fine-tuned (doctors use the term “titrated”) for maximum benefits and minimal side effects? Is a physician trained in child psychiatry monitoring his medications? Is the physician receiving feedback from you, your son, and school personnel about changes in targeted behaviors? 
  3. Has a neuropsychological assessment been conducted to determine the specific functions affected by your son’s traumatic brain injury (TBI)? Is he receiving rehabilitation services based on the assessment results? TBI can have a wide variety of effects on processes such as attention, memory, sensory-motor integration, and other abilities. A thorough assessment can help pinpoint the deficits. Based on results of the evaluation, a good treatment plan should be developed that includes teaching your son strategies to compensate for deficits, providing necessary accommodations, and exploring other ways to minimize the impact of deficits. It is important to examine the potential links between any cognitive deficits he is experiencing and his behavioral difficulties. 
  4. Are the behavior contracts that have been tried based on a functional analysis of your son’s behavior? This is a very extensive examination of the reasons for his behaviors -- the needs that are met by behaving the way he does. A functional analysis of behavior results in a plan that supports him in learning and using other strategies to meet his needs. It is important for the plan to take into account the results of the neuropsychological evaluation. Deficits in memory, attention, or processing information from his environment must be considered in developing the plan. 
  5. If counseling and other services have not helped met your family’s needs, your son may be a very good candidate for “wraparound” services. These intensive services are for families of children who have not been sufficiently helped by other mental health services and are in danger of residential placement because their schools or families cannot manage their behavior. Under the wraparound model, professionals and families collaborate in developing a family plan and the wraparound staff works with the child at school and in the home, whenever and wherever the need is greatest.

I wish you the best and hope that this information is helpful.

  • How valuable do you think Class Meetings are and how much time do they take?

Question:

Dear Dru,

I have heard a lot about Class Meetings and am thinking of starting one in my 6 th grade class but there is so little time after we do our required academics. So, what I guess I’m wanting to know is how valuable you think they are and how much time do they take?

Thanks.

Lucille in Solano County


Answer:

Dear Lucille,

Thanks so much for your question. I understand your dilemma. What I would urge you to consider is that one of the most important things children learn in school is to work in a community. That is, how to subsume some of their own needs for the greater good, how to communicate clearly, how to demonstrate respect for themselves and others. The teaching and practice of these skills are enhanced by involvement in Class Meetings.

While it would be nice to have a meeting every day, if you can spare 30 minutes once a week it will make a big difference.

Here is a very nice overview from:

http://www.teachervision.fen.com/lesson-plans/lesson-4864.html?detoured=1

 

Class Meetings

Class meetings can be an excellent multipurpose tool for your classroom. This simple strategy of setting aside time for students to discuss classroom issues as a group can yield far-reaching benefits. For example, you can hold class meetings to involve students in important decisions such as "How should cheating be handled?" or "What can we do about teasing in our school?" Don't be afraid to let students think about these weighty issues. You may be surprised by the thoughtful and creative solutions your students propose.

While each teacher and class needs to find what works best for them, it is worthwhile to have a weekly time set aside for class meetings. It may require only 20 to 30 minutes, but it will be time well spent.

Why have class meetings?

  • To get kids involved in constructive decision-making in their classrooms and schools.
  • To build a climate of trust and respect between teacher and students, as well as among students.
  • To help build self-esteem by getting kids involved in decisions that impact their world in important ways.

Rationale

  • Students often develop a better sense of responsibility when given a chance to make meaningful contributions to the world around them.
  • When children believe they are contributing to the school environment in a significant way, they feel a more positive attachment to school and are more motivated to learn.
  • Students who are allowed to problem solve and make some of their own decisions are likely to buy in to the solutions.

Benefits

  • Just as families can use family meetings as times to connect and reflect on their goals and/or problems as a family, class meetings can achieve similar results.
  • Class meetings provide children with opportunities for assuming responsibilities.
  • Class meetings may help children to take ownership for their actions by involving them in the process of understanding and questioning rules, guidelines, limits, and consequences.
  • Children are able to reason/reflect on their actions, think about the consequences of their behavior, and comprehend the impact they have on others.
  • Class meetings can help students learn to associate their successes with their own efforts and abilities, thus boosting self-esteem.
  • When children feel they are making an important contribution to the world, their motivation and sense of control in their lives can greatly increase.

Boundaries of class meetings

Allow students an active voice:

  • If students believe their ideas are respected and valued, they will more likely be productive participants.
  • Follow the rules of brainstorming.
  • Use techniques such as mirroring to help hone students' ideas.
  • Establish a regular schedule for classroom meetings.

Remember your role in the classroom:

  • As a teacher, you hold "veto" power; use it sparingly for best results.
  • Remember the advantages of "Socratic questioning" to help students think through the logic of their proposals.
  • Allow students to learn from their mistakes. Let them try out their ideas, even if you're convinced they won't work, as long as no obvious harm could result.

Brainstorming

  1. Allot 20 to 30 minutes for the session.
  2. Record all ideas on butcher paper so everyone can see them and they can be retrieved at a later date.
  3. Encourage all ideas. Perhaps offer a sticker to the person with the most ideas or with the most creative suggestion.
  4. Do not accept judgmental tones, remarks, body language, or facial expressions that indicate the ideas are good, bad, or funny.
  5. Use others' comments to think of new ideas.
  6. Keep discussion of the recorded ideas to a minimum. Allow time for an exchange of views later.

Mirroring

Mirroring is a listening technique where one student describes a problem, idea, or conflict to another. The second student listens and then repeats or "mirrors" the first student's thoughts to ensure that the ideas were properly understood. The first student confirms the information is correct or the listening student tries again until it is.

Here are other web sources that have some great ideas:

http://www.education-world.com/a_curr/profdev012.shtml

http://www.ilovethatteachingidea.com/ideas/subj_class_meetings.htm

http://www.discovery-school.org/html/classmtg.html

http://homepage.risd41.org/cschoenings/stories/storyReader$691

http://homepage.risd41.org/koalatykid/stories/storyReader$169

http://www.devstu.org/csc/how_ways.html

The basic book on Class Meetings:

Nelson, J., Lott, L. & Glenn, H.L. Positive discipline in the classroom (around $15. new) Available at

http://www.empoweringpeople.com/store/page13.html

Another great thing about Class Meetings is that you will enjoy them too, and you will be amazed at how your students grow.

Good luck!

Dru

  • Help needed!

Question:

Dear Dru,

My son, Aidan is 4 years old and an identical twin.  My boys had Twin to Twin Transfusion Syndrome before they were born and had successful experimental in utero surgery to correct the problem.  Both boys have had 2 years of special ed due to an initial speech delay and (mis) diagnosis of Aidan with "severe" Autism.  They were released from special ed and sent on to public Kindergarten which they are scheduled to start next week.  I am still very worried for Aidan and don't know where to turn.

Aidan is very different than "other" children, and "other" children see it where adults have not.  Aidan is teased at school, but his brother Bryce is not.  Aidan has a hard time communicating with other children because most of his interaction involves things like "is that from this world or another world?" (?) He makes odd faces that don't seem appropriate for the situation.  He asks inappropriate questions and says inappropriate things - often to strangers.  And these things will often be filled with hostility toward them - maybe based on the fact that their skin is a dark color or the fact that he doesn't like their face  ("I don't like them.  They have a bad face." - accompanied with a scowl and growl in his voice).  He is also hostile toward anyone who is not wearing a shirt - he may start screaming and pointing at them.  One morning he woke up and told me about a dream he had where his twin brother was not nice to him.  After he told me about it, he went in where his brother was still sleeping and starting beating on him and screaming at him.  There was nothing I could do to make him understand that it was a dream and that his brother was not responsible, and that it was his own dream.  All I could do was pull him off and hold him so his brother could get away and Aidan could eventually "switch gears" and think about something else.

If Aidan doesn't get his way, he often says violent things such as the other day in the store.  He wanted some animal paper plates.  I said, "Well, we'll think about it."  He flew off in a rage in his characteristic growl and said, "Mommy, if I don't get those plates, I will cut myself with a knife!"  First of all, my children watch only PBS except for some children's videos, so where the violence or even the wording comes from is beyond me.  He may say "I want to go under water and die" or something like it too.  But I cannot even get him to understand that what I said was "maybe".  He 100% heard "NO!" And there is no reasoning to get him to hear that.  He goes into this violent mode and can no longer hear.  Then a minute or so longer, he is onto something else and has maybe forgotten all about the exchange.

(Just now he was behind me and said, "My soccer coach is going to say, 'Come on, Aidan, practice is starting." (said in a sweet voice)  Then in a dark growl, he said, “He will only say it to ME not to Erin - he will not say it to Erin!" (his sister - one year older)  Then he walked up to me and whispered in my ear very sweetly, "I love you, Mommy.  I love you, love you, love you!"  This is all out of the blue.  He will be starting soccer for the first time next week, and was just thinking about it out loud.)

Academically, he seems ok.  He can count to forty, he knows his numbers and letters.  He refuses at this point to write or draw anything other than what he calls "loopty loos." Sort of scribbling with continuous circles.  Hmm, if this adds anything to the equation, he has sort of been obsessed with anything with wheels, but specifically trains and Thomas the Train.  He used to line his vehicles up in rows.  He no longer does this.  He is very verbal and well spoken.

I know there's more, but maybe this is a start.  Any ideas?  (Aspergers has been suggested)  He was tested last year as to anything on the spectrum, but they said they could not diagnose anything at this point but that if I was still concerned, I should have him tested again at a later age.  I'm just worried that time is going by where I could get him some help.  I don't know what kind of help.

Sincerely,
Lynn Gehlbach


Answer:

Dear Lynn,

Thanks so much for your letter. I don't know anything about Twin Transfusion Syndrome or whether that has anything to do with the early speech delays or behavior, but Aidan sounds like a very unusual and complex 4-year-old.  While he may be too young to diagnose, I can certainly understand your level of concern. 

Despite the wealth of information you provide in your letter, it is impossible to diagnose Asperger's Syndrome or any other impairment, without seeing the child and doing a thorough assessment. With a child as young and complex as Aidan, I would be wary of ANY quick diagnoses. A thorough assessment is needed and it may take time to figure out what's going on.

Asperger's Syndrome and Bipolar Disorder are currently popular diagnoses and are given with great frequency. While I don’t have enough information to rule Asperger's in or out, Aiden sounds too interested in others, even though he expresses his interest in negative ways.

Given the information you present, there are four areas I would explore as soon as possible if he were my son:

1. His moods seem extremely intense and volatile, even for a four-year-old.

2. He may have unusual trouble, even for his age, in distinguishing his thoughts and fantasies from reality.

3. He is "out of touch" socially.

4. He refuses to draw or try to write letters.

The first three issues should be explored by a good child therapist, experienced in play therapy, to understand how Aidan views the world. This should help determine the reasons for his unusual behavior and identify the type of help he may need.  He may benefit from intensive support in working on social skills, with coaching and cuing during peer interactions. He might also be taught some relaxation, impulse control, and self-management strategies.

The third issue may benefit from work with a Speech and Language Specialist. Despite Aidan’s good verbal skills, his use of pragmatic, or social, language is not appropriate and, depending on the reason, speech and language therapy may be useful.

The fourth issue may warrant an evaluation by an Occupational Therapist to determine whether the problem is behavioral or based in fine-motor deficits.

Since Aidan is not currently in special education, I'm not sure how any of this would be done.  You may need to start with your medical provider or armed with the information you provided me, request re-evaluation for special education eligibility.

Aidan will probably have a very hard time adapting to a Kindergarten classroom.  If he has behavior problems in class, school personnel may request the services of a behavior specialist. If so, make sure that the behavior specialist starts by looking at the function of Aidan’s behavior. Your letter suggests that he craves attention and feelings of importance. If this is the function of some of his behaviors, he needs to be taught skills to meet these needs in ways that fit the norms of a classroom community. Some modifications in the environment will also be needed. By no means will a simple reward/punishment system be appropriate. It will be most helpful if the therapist collaborates with the classroom and support staff.

This must be a very difficult time for your whole family. I wish you well.

Dru Saren


  • I signed the IEP because I didn't feel I had any choice. Do I?

Question:

Dear Dru,

The district has my son, who is autistic, in a program for only 2 ½ hours a day. They say he can get his IEP goals met in that time and that his behavior indicates that he cannot tolerate more than that amount of time. They also require that I stay by the phone when he is in school in case they need me to come and get him. I don't have a cell phone so I can't get out to shop or run errands in the little time he is not home. I signed the IEP because I didn't feel I had any choice. Do I?

Lois


Answer:

Dear Lois,

I am glad you asked!! I run into situations like yours all the time and it is absolutely not okay. The IEP team is required to provide the student with a free and appropriate education (FAPE) in the least restrictive environment (LRE) in which he makes adequate yearly progress in the general curriculum and in mastering his goals and objectives. If he makes that kind of progress in less than half a day, he is clearly capable of greater progress in a full day!

If your son's behavior impedes his learning, or the learning of his classmates, he must be provided the kinds of services and supports he needs in order to benefit from FAPE. Positive behavioral interventions are those kinds of supports and services. A behavior support plan is one type of support that may be helpful. The local educational agency (LEA) cannot use a shortened day as a positive behavioral support!

A shortened day may be used briefly for a specific purpose such as:

Recovery from a serious illness when the child fatigues easily
Trial of new medication where the physician requests a gradual increase in the school day as the student accommodates to the side effects
Student with school phobia or similar condition who is in treatment for this condition Note that all of these are transitory conditions

Note that all of these are transitory conditions. Shortened days should be used rarely. The purpose must be clearly stated and this purpose must clearly require a shortened day. The IEP must include a plan to increase time in school until a full day is achieved. With beginning and ending dates specified.

In addition, when you are called to pick him up early, it constitutes a removal. A removal for behavior for a student with an IEP is subject to limitations. On the 11th day, a functional behavioral assessment must be conducted and a behavior support plan developed. While it's not clear if removal for a part of a day counts as one day, in your son's case, when he only has 2 ½ hours to begin with, he has clearly lost most of the day already.

Use Guidelines to Administer Shortened Days for Students with Problem Behaviors written by Diana Browning Wright, explains what is legal and offers alternatives to a full day in the classroom that might allow a student to make progress.


  • He chews on my car door and actually has bitten a hole in the interior of my car door.

Question:

My son is 8 and has recently been diagnosed with ADHD and ODD. He often explodes over silly little things. He was mad about not being able to ride his bike. He kept banging his head on the roof of m car. He chews on my car door and actually has bitten a hole in the interior of my car door. He also chews on his shirts and other clothes all the time. Is this normal behavior for a child of this nature????? I am STUMPED!

THANKS MELISSA


Answer:

O my, Melissa. This is NOT normal for any child and you need help! Who gave him these diagnoses? Ask this person to direct you to a child psychiatrist familiar with psychotropic medications and to a behavior specialist. Or, if your son has been prescribed and is taking medication, inform the physician of his behavior. That could be a problem too.

You don't say what is happening in school with your son. It is not likely that all is sunny there, given the behaviors you describe. School staff may be able to help you by sharing what techniques they use which they find effective, and by letting you know what resources are available in your community and which specialists have good reputations.

  • Some of the information I have found online also refers to a connection between SOD and autism. Is this something to pursue?

This month's Behavior Question is shared with our Behavioral Peditrician

Question:

Dear Dru, I am working on a behavior plan for a 13-year-old male who has been diagnosed with Septo-Optic Dysplasia (SOD). In addition to his many medical issues, this young man also has a number of behavioral concerns in the area of social skills and impulse control. The problem behaviors center around bizarre comments made by the young man, verbally and physically aggressive behaviors towards specific peers, and what appears to be self-stim behaviors (head rolling, playing with hairs on arm, rolling knuckles together, also picking nose and /or scabs on arm.)

This young man has also been diagnosed as ADHD. He is currently taking Ritalin and a number of other medications (hormone replacements). How much of the behavioral issues might be due to drug interaction or improper dosage of drugs? His mother is in the process of scheduling an appointment with a psychiatrist to determine the medicine issues.

Some of the information I have found online also refers to a connection between SOD and autism. Is this something to pursue? Once again, I would appreciate any help or guidance you could provide to help me help the parents and teachers, as well as the young man

I have found some limited information on-line regarding his condition, but I would greatly appreciate any information you could provide, or resources you could point me to regarding Septo-Optic Dysplasia. I would appreciate any sources that could address behaviors and strategies for addressing these behaviors.

Thank you,
Pat Judd Behavior Intervention Case Manager


Answer:

 From the Behavioral Pediatrician

Dear Pat, Septo-Optic Dysplasia is a rare disorder characterized by abnormal development of the optic disk, pituitary deficiencies (hormones) and often absence of the septum pellucidum (a central part of brain that separates the two ventricles, fluid filled spaces). Because the degree of abnormality varies the disorder can encompass a variety of neurological abnormalities and consequently a variety of symptoms. This sort of "spectrum" of abnormalities is common with any brain malformations or developmental abnormalities. One cannot predict form the diagnosis the degree of cognitive delay (if any), the amount of hormonal abnormalities, or whether there will be other developmental brain symptoms and diagnosis such as Autism or epilepsy.

These children consequently require a full assessment including in depth cognitive testing as well as endocrine assessment (hormones) and neurological assessment looking for symptoms compatible with seizures or physical problems such as cerebral palsy or abnormalities of the cranial nerves which involve facial movements, hearing and vision. Of course, many of these difficulties should have become obvious and already have been diagnosed.

One cannot form a behavioral plan with only knowledge of "Septo-Optic Dysplasia". The behavioral interventions need to be created only after detailed evaluation of the spectrum of symptoms displayed by a particular child. You are right to be concerned about medication interactions. Also, frequently psychiatrists are not trained to evaluate such a spectrum of Neurodevelopmental abnormalities and the situation can be further compromised by use of medications that can worsen neurological difficulties and therefore worsen the behavioral difficulties. Such an example might be that Ritalin can cause "picking behavior" or worsen anxiety.

In treating behavior with medications it is important to clearly define the "symptoms" that one wants to improve with the medication. This defining process should also lead one to the type of medication that one might use. Similarly, one intervention should be done at a time… i.e. medication change first and then when behavior has stabilized, behavioral intervention. If two "treatments" are begun at the same time then it is unlikely to be unclear which is responsible for any noted improvement (or worsening) in behavior.

Sometimes it is helpful in a child like this to utilize a pediatrician or psychiatrist who is skilled in working with neuro-developmentally challenged children. This individual could communicate with the treating pediatric sub specialists (in this case endocrinologists+) and the family and the school. It is helpful to have such a physician contribute to making a list of those behaviors that might be targeted by either medication or a behavioral plan. It sounds to me like, in this case, that the Ritalin might be reconsidered in face of his aggression and "picking behavior".

From the Behavior Specialist

Pat, 
Thanks so much for your question. As you see, it was so complex, it took two of us! I heartily second Kay's recommendation that you attempt only one intervention at a time. So, if medication changes are occurring, hold off on making any significant changes in the environment. Also, I understand Kay to be saying that "autistic-like" behavior is not uncommon in individuals whose brain formation is different, as this student's certainly is.

That being said, what would I recommend for the presenting behaviors? Not knowing what his cognition or placement is, I'm going to assume that his cognition is normal and that he has special education services (because you are involved)

Looking at the list of behaviors:

1. Making bizarre comments 
2. Verbal aggression 
3. Physical aggression 
4. Self-stimulatory behaviors:

· Head rolling 
· Playing with hair on arms
· Rolling knuckles 
· Picking nose 
· Picking scabs

I'm going to prioritize. The aggressive behaviors are the ones that concern me most, and I'm going to include the "bizarre comments" in this group. The other behaviors may not increase his social status but they are not getting him BICM intervention (Note to Non Californians: Behavior Intervention Case Managers [BICMs] are mandated when students in special education exhibit significant maladaptive behavior.) Moreover, these are more likely to be related to the medication issue.

Next, I'm going to hypothesize that this student has stood out in some way for a long time. (Otherwise, he would not likely to have gotten this diagnosis.) Thus, I'm wondering about his history of peer interaction. I'm also thinking that at 13, he is dealing both with the onset of puberty and with the dramatic increase in the importance of social acceptance.

I don't have any way of guessing what the predictors are for these aggressive behaviors, though experience tells me that we often see this type of behavior when the student feels stressed, either because he finds assignments frustrating or his social interactions unsatisfying.

From these hypotheses, I'm going to take some data, both anecdotal and (a little) recorded, to get more information about the predictors but let's assume that this behavior is the boy's best attempt to interact with his peers. In other words, I am assuming that he wants to be liked but doesn't know how to go about making and keeping friends. Seeing this as a severe skill deficit, I'm going to explore ways that social skill training can be provided in this school. I may also include some self-management techniques to increase appropriate comments to peers and some problem solving strategies (see below) to teach him to consider better strategies.

I'm also going to see what in the environment is supporting his aggressive behaviors and attempt to minimize them. For example, since he is more aggressive with certain peers, can I a) involve him in a supervised social group (e.g., Lunch Bunch) with these students? b) decrease the time he is with these students? c) work with these students on increasing their tolerance of him? d) work with the whole class on community-building activities and appreciating everyone for their various strengths and weaknesses ([dis]ability awareness).

Find a reinforcement for this student and include in your plan how you will communicate progress to all team members.

I hope this is helpful. The boy you describe is the kind of student we see here at the Diagnostic Center. Please feel free to mention us at your IEP Team meeting as a resource to enlist if the plan you devise is not working and/or our pediatrician could help sort out some of the medical issues involved.

Best of luck!

Dru

Below are 4 Problem Solving techniques. Choose one (or make one up) and use the pneumonic to aid in memory. There are simpler ones if the student's cognition is impaired.

 

What am I going to do? stop-plot-go-so

 

SIDES SOLVE