High Functioning Autism Conference

by Kim Stevens, OTR/L

What are public displays of behavior in children?  Answer: Embarrassing for parents…disruptive for teachers…a long-term goal for therapists.  Public displays of behaviors are the activities, noises, and/or movements children engage in when they are bored, overstimulated, or even extremely happy.  The problem lies in the public image of what is appropriate behavior.

Children (and adults) who have Autism often engage in undesirable public displays of behavior because public situations are most uncomfortable for them.  People who do not understand this gawk, make comments, even laugh at these behaviors, which often include hand flapping, hitting oneself, masturbation, making unusual noises, and biting oneself.

Trying to extinguish a behavior can be risky as the function of the behavior has to be understood prior to attempting to end it.  Ask yourself, is the behavior performed for social attention, avoidance of something else, an attempt to get a tangible activity/item, or for sensory feedback?  If a child is performing a behavior that serves as sensory feedback, it needs to be replaced by something equally stimulating.  If the replacement offered is not equally stimulating for the child, the child may choose an even worse behavior to replace the original behavior.

One tried and true method to replace an undesirable behavior (UB) is ignoring/replacing it while simultaneously reinforcing a positive behavior.   Finding a motivator to diminish the UB comes in many forms: food, technology, movement, etc.  Often times a piece of candy or a token is provided when the UB is stopped.  This begins the process of reinforcing positive behavior and diminishing the UB.

How to diminish an undesirable behavior with examples:

  1. Identify the undesirable behavior’s function: Child is biting arm when anxious (when someone enters the room).
  1. Find a suitable replacement behavior or motivational item: Say “arm down” while providing a squeeze to the arm for sensory input and giving a piece of crunchy candy for oral sensory input.
  1. Utilize the motivation EVERY time the child stops themselves or is stopped by an adult: Child typically bites when a new person enters room, provide a squeeze to the arm and piece of candy EVERY time a new person enters the room regardless of a biting attempt.
  1. Persevere through the extinction burst (time when the behavior worsens before getting better): If the biting seems to escalate, continue to provide the verbal (arm down) cue, sensory feedback (arm squeeze), and motivator (candy) EVERY time a bite is stopped.
  1. Provide the motivator until the child completely stops the undesirable behavior: Record throughout process any attempts at biting arm when someone enters room to document when the biting has stopped.
  1. Begin to reduce the frequency of the motivator (earning 3 tokens before getting the motivator): First, Then board with 3 tokens plus arm squeeze (for not biting), then candy.
  1. Phase out the motivator completely as the child has continued to not perform the UB: Slowly stop candy and adult squeezing arm, instead use child’s other hand to squeeze arm.

It takes a team working together to diminish an undesirable behavior.  It is important to note that all team members working with the child must be educated on the strategies utilized in this process.  Even more emphasis needs to be placed upon the importance of using the motivator or replacement behavior every time the undesirable behavior is displayed for success.