In a previous blog, I discussed the first step to tackle any problem behavior and that was to fully assess the whole child and accurately describe the problem behavior. If you haven’t watched that video blog, you may want to do that first.

After assessment and a really good description of what the problem behavior looks like when it occurs, we need to determine when and where the problem behavior usually happens. Is it always with mom? Does it usually occur with a particular teacher? Is it usually within an inclusion or community setting or does it occur at home or in the autism classroom?

Also, it’s just as important to find out if there is a location or situation where the behavior never or rarely occurs. Would the behavior never or rarely occur in a pool or would it never occur with free access to videos or if the child is in bed?   If you let your child play on the computer all day or line up cars or eat unlimited snacks, would he not engage in problem behaviors? These are all important clues.

Next we need to look at what happens right before the problem behavior occurs.  This is called the antecedent. When Johnny is alone in the crib, he tends to bang his head. When Sarah is called to the kitchen table to eat, she whines. When Faith is told “no,” she screams and flops. When TJ is watching movies, he scripts the lines from the movies.

The consequences are the next thing to determine…. what happens right after the problem behavior occurs? What does the parent or teacher usually do when the problem behavior occurs to stop it if anything? If Faith flops and she’s at home, do they just walk away? Do they walk away for 5 minutes, then if Faith doesn’t get up from flopping does her mom go back and pick her up? Does Faith ever flop in the grocery store or outside? Also what happens if Faith flops and mom needs to go to an appointment?  In that case, what happens when she flops?

That’s usually the problem. There are probably a lot of different consequences based on the location and how much time the parent or the teacher has to ignore the behavior or to intervene.

While we’re assessing the actual problem behavior, ideally, you want to take frequency and ABC, and/or a partial interval data over a few days at least to get an accurate baseline. But in a lot of situations this simply can’t be done.

For example, getting a true baseline of how often a problem behavior is occurring is not possible for kids who are having severe problem behaviors that could cause injury.

For instance, I had a client who banged his head on hard surfaces to the point where he got an open lesion on the back of his head.  He was only 2 years old. When I first assessed him, I said to the caregiver “How much of the 9 hours that he’s here at the child care setting does he bang his head?” The person that was watching him said about 3 hours a day.  I can’t wait for 3-5 days to establish a baseline. I mean, 3 hours a day of banging his head on hard surfaces, I need to intervene quickly.

If you can’t take a full baseline, I would interview the person that is with the child, preferably, the parent and the teacher if they’re in school. Get an estimate of the frequency and magnitude and ask questions like does it happen 3 hours per day, 10 times per day (for 5 minutes each episode) or 2 times per week.

Finally, take a video of the problem behavior when it occurs and/or take a picture if there are any open wounds, scabs, or indent marks. If you are a professional make sure to obtain video and photograph permission early on.  This will help you document the severity of the issues and will provide a nice “before and after” view of the situation after you implement successful interventions.

To wrap up, the first step to tackling any problem behavior is an accurate assessment of the whole child, including a thorough description of the problem behaviors and the second step is to understand when, where, and how often the behavior occurs and what usually comes before and after each occurrence.