How to Reduce Maladaptive Behavior in Children with Disabilities

Extinguishing a behavior in a child, normally with a disability, is done only when the behavior puts the child or others at risk of injury, or the behavior is so maladaptive that it will severely impact the child's life in a negative manner if left unchecked. Like all behavior modification, it is done with great care, with a well thought out plan with input from all adult participants in the child's life.

Method 1

Method 1 of 3:

Understanding

Understanding the behavior is important for deciding whether and how to stop it. If you don't understand it, you may end up wasting time on an ineffective strategy, or even doing harm.

1
Know the difference between maladaptive behavior and healthy but odd behavior. Behavior is maladaptive if it hurts or endangers someone, destroys property, encroaches on personal space without consent, and/or is extremely disruptive (e.g. screaming in a classroom). If it's odd-looking but harmless, it isn't worth the energy of redirecting.^{[1]XResearch source} Don't try to interfere with stimming or harmless behavior. It's best to let a child engage in behavior like:
- Hand-flapping
- Finger flicking
- Harmless fidgeting
- Lining up objects
- Avoiding eye contact^{[2]XResearch source}
Tip: Just because behavior seems meaningless to you doesn't mean it's meaningless to the child. The behavior may be helping them in a way you don't understand. You don't want to accidentally interfere with an important coping mechanism unless you have a very good reason.
2
Keep in mind that there are many possible reasons for behavior. While behavior therapists often categorize reasons for behavior into only 4 groups, there are many more possible reasons behind a child's behavior.
- Coping with pain or distress
- Self calming/emotion regulation
- Expressing frustration
- Alleviating boredom
- Dealing with discomfort (sensory, hunger, thirst, etc.)
- Meeting sensory needs (either seeking or blocking out)
- Seeking attention or comfort
- Seeking something concrete (food, water, toy, etc.)
- Involuntary tics
- Learned behavior from peers or adults
- Trauma response
- Asking for help
3
Try to figure out what the function of the behavior. There's always a reason. Figure out why the disabled child acts in an unhealthy way. Determine what happens before each incident, and how that makes the child feel. You cannot help a child with maladaptive behavior until you understand how it works.
- If possible, ask the child directly why they do that. During or after the episode, ask the child what went wrong and why they acted the way they did. Usually they have specific needs that are not being met.
- Disabled adults have written checklists to help determine the reason behind maladaptive behaviors.^{[3]XResearch source}
- Talk to a doctor if they self-injure in a specific area. For example, head-banging may be caused by pain from lice or a toothache.^{[4]XResearch source}
Tip: Be cautious about assuming that a child acts a certain way because they are "difficult" or "stubborn." They may be acting this way because they're dealing with a very real problem. Don't give up on them.^{[5]XResearch source}
4
Try removing a stressor if it tends to trigger dramatic behavior in the child. Stress can cause kids to act in ways that they otherwise wouldn't. Protecting the child from pain or panic may cause the behavior to stop.
- A child who hits her head only in ABA therapy may be experiencing mistreatment. Find a better therapist and her head-banging may stop.
- A child who screams and throws himself to the ground when the blender runs may stop engaging in this behavior if he's warned and allowed to go to his room before the noise starts.
- A child who acts out when the teacher yells at them could use either to have the teacher stop yelling or to be transferred to a different class with a teacher who doesn't yell.
5
Reach out to disabled adults online or in person for advice if you're struggling to understand the reason for a behavior. People with neurological disabilities think and experience the world differently, so the reason for what they do might be completely different from what you expect. Adults with the same disability can better understand and may be able to offer insights you wouldn't have considered otherwise.
- Sometimes, well-intentioned people will extinguish a behavior, only to find out that their actions are robbing the disabled person of an important coping mechanism.^{[6]XResearch source}^{[7]XResearch source} This can harm the person.^{[8]XResearch source}
- The disabled community has hashtags online such as #AskingAutistics.
Advertisement

Method 2

Method 2 of 3:

Talking to the Child

Older and/or more mature disabled children may need only emotional support in order to quit a maladaptive behavior. No matter the child's maturity, talking with them is an important step in helping them recognize that you're going to help them cope better.

1
Take the child aside and explain why you're worried. Tell them that you see them doing a maladaptive behavior, that it upsets you to see them so upset, and that you'd like to help them find a way to cope better.
- Chances are, the child does not enjoy maladaptive behavior. For example, a boy who scratches his arms probably doesn't like the pain and injury that follows; he does it because he doesn't know how else to cope. He may be relieved if you offer to help him find alternatives.
2
Ask the child about the behavior if they are able to speak or communicate. See if they can tell you their side of the story. Even if they can't say much, they may be able to give you some important hints about their thoughts and feelings when they do this. They might not be able to tease out why they do things, but even asking what happened could help. Here are some examples:
- "Can you tell me what you were thinking yesterday when you got upset and pulled your hair out?"
- "I saw you biting your hand this morning. When you bite your hand, how do you feel?"
- "I noticed you struggle with going shopping sometimes. I want to help. Could you please tell me what is hard about shopping?"
- "I heard you cried in the classroom last Friday. It sounds like you had a hard day. What made you cry?"
3
Work together with the child to brainstorm potential solutions. Pull out a piece of paper and create a list of alternative behaviors. Encourage your child to come up with ideas. This will help them feel ownership over their treatment, and it makes them more likely to remember and implement the strategies. Consider...
- Ways to minimize triggers (e.g. bringing earplugs or headphones, taking breaks from stressful situations)
- Alternative actions (e.g. shaking the head instead of hitting it, fidgeting with a stim toy instead of ripping all the paper in the house)
- Creating an action plan (e.g. coming up with a hand signal that means "get me out of here" when the child notices stress building up, so she can calm down somewhere quiet instead of pushing herself to the point of explosion)
Tip: Try asking questions like "What would help you feel better when...?" or "What would you like me to do/know when...?" to help the child start thinking of solutions.
4
Work on emotional regulation skills if the behavior arises during a time of unavoidable stress. While some stressors can be easily removed (e.g. vacuuming the house while the child is at school or playing outdoors), some stressors are a part of life. In these cases, the child needs help learning healthy coping mechanisms.
- Try incorporating aspects of dialectical behavior therapy to help with stress tolerance and assertiveness skills.
- Examples of healthy skills include speaking up about how they're feeling, taking breaks when needed, healthy stimming, and doing calming activities.
5
Offer gentle reminders about replacement behavior when the child behaves maladaptively. Remember that the child may be forgetful or too upset to think clearly. For example, if your son screams when upset, calmly ask him to take deep breaths and tell you what's wrong, just like you brainstormed together.
- Remove them from a situation if it is too stressful.
- Be gentle and patient. Remember, they may be having a hard time right now and they are doing their best.
- Remind the child why the replacement behavior is good. For example, "It's hard for me to help you when you scream. If you can take a few deep breaths and talk or type to me, I'll understand better and I can help you with your problem."
6
Encourage the child when they begin to use the replacement behavior. Praise their efforts and tell them how proud you are of their skills.
- For example, "I noticed that you were getting mad, and that you started to take deep breaths and walked away. I'm really proud of how strong and mature you were. Good job!"
- Emphasize why they did a good thing. This helps them learn the distinction between people-pleasing and constructively taking advice. Never pressure the child or teach them to comply for compliance's sake, as this will hamper their social skills as an adult.
7
Consider a reward system for a younger child. For example, each time a girl successfully uses breathing techniques to calm herself, she gets a gold sticker to place on her chart. When she fills the chart, you bring home a treat from the grocery store or let her pick out a small toy.
- Reward them for trying, even if they still get upset or act out a bit. The reward is for making an effort to use the new technique, not for acting perfect.
- Avoid overusing reward systems, because the child may become too dependent on approval.^{[9]XResearch source}^{[10]XResearch source} Reward systems should be phased out as a child gets older. The child/teen should learn how to set boundaries and say no, so they can be safe.
8
Keep clear communication between yourself and the child. Treat the child's communication (verbal and nonverbal) with respect, and always presume competence. Talk regularly to the child so they know what's going on and what's in your mind. That way, the child will trust you and talk to you if a problem arises.
Advertisement

Method 3

Method 3 of 3:

Outside Intervention

Serious maladaptive behavior may require a coordinated effort and a reward-based plan. Only use an intervention plan for severe maladaptive issues, because this level of intervention can unravel a child's agency and self-esteem if used often.

1
Call a meeting of caregivers. Bring every person (parents, therapists, teachers) who will be involved in replacing the maladaptive behavior. It is best if everyone meets at the same time and place so that no misunderstandings can exist.
- One team member should take notes or record the meeting.
- Describe and define the unhealthy behavior so that there is no confusion as to exactly what the problem is.
2
Plan to use praise and/or tertiary reinforcers to encourage the child. A tertiary reinforcer is something above and beyond what the child normally has as a part of daily living. (Things they already have shouldn't be restricted because this is punitive and upsetting.) Think about things the child likes and figure out what new things could tie into that interest.
- Buying them a small toy, puzzle, game, or collectible item
- Earning money to buy a bigger toy, book, movie, or item
- Playing a favorite game with you
- A trip to a special place
- 15 extra minutes of TV/phone/game time
- A dessert they don't normally get (rarely!)
Tip: Choose reinforcers wisely. Too many food rewards could lead to unhealthy emotional eating habits, so don't use those every day or even necessarily every week.^{[11]XResearch source} Also, if something helps them stay calm and balanced, then access to it shouldn't be a reinforcer. Instead, they should be able to use it to help them whenever they need it.
3
Develop a BIP (Behavior Intervention Plan) also. Plan beforehand if the child is likely to act out or even hurt themselves if they don't get a reward. Emotionally fragile kids will need more help coping with the disappointment of not getting a reward. They also may need reassurance that even though they didn't get the reward, nobody is upset with them.
- Talk about how to de-escalate and calm the child if they tend to cry or self-injure if they don't get a reward. Discuss calming phrases like "remember, you can try again later" or "I know you're doing your best."
4
Encourage everyone to follow the plan, even when it's not easy. Those involved must agree to stick to the plan, and not give in even if the child acts out. When the unhealthy behavior arises, remind the child, and don't offer a reward if they continue the unhealthy behavior instead of the replacement.
- Encourage fellow caregivers to be empathetic without giving in if the child gets upset or throws a tantrum. Examples of things to do include validating their feelings, sitting with them and listening, and offering reassuring physical affection if the child likes it (e.g. a hand on the shoulder or an arm around them). Giving in will make things worse in the long run, but empathy can help.
5
Talk to the child and then implement the plan. In the beginning, clearly explain to the child that it upsets them to see you struggling, and that you want to help them cope with it. If possible, talk to them about ways that they could cope with the trigger.
- Present a clear coping mechanism that they can use in place of the maladaptive behavior. Simply telling the child "stop biting your arms" will leave them confused about how to deal with overwhelming emotions. Telling them "instead, you can bite on these chewy bracelets and take a break if you need to" will help them envision how they can act constructively.
- Don't feel discouraged if the child doesn't start improving right away. Learning new coping behaviors takes time, and there may be a delay before the child understands what to do.
Did You Know? Even if the child doesn't speak or make eye contact, they may be able to understand most or all of what you say. Offering an explanation shows that you care and that you believe in them.
6
Check in with members of the child's team about how they're doing. Meet with the implementation team regularly to determine the effectiveness of the plan. If you see a spike in the target behavior, don't worry, because it is almost always temporary. Continue encouraging the child to adapt and it will eventually happen.
- Check in with the child if possible. Ask what they think, what they don't like about it, and what they like about it. This may give you some good ideas.
7
Fade out the rewards as the child gets used to the healthy behavior. After a certain amount of time in which the child hasn't engaged in unhealthy behavior, modify any rewards. Make longer stretches in between rewards, or increase the number of points to be earned. The plan can be faded out gradually until you no longer need it.
8
Take action if the child relapses into the unhealthy behavior. Relapses are possible during times of stress or overwhelm. Check in with the child and see what's going on. Consider re-implementing the plan for a time if needed.
Advertisement

Expert Q&A

Search

Add New Question

Ask a Question

200 characters left

Include your email address to get a message when this question is answered.

Submit

Tips

Do not use primary rewards (like access to food or water) or secondary rewards (things that the child is used to, like nightly dessert or a favorite stuffed animal). This is harmful.^{[12]XResearch source} The reward should be something that the child likes but does not need (physically or emotionally).
Thanks
Helpful0 Not Helpful0
Make sure that everyone involved in the BIP (Behavior Intervention Plan) is emotionally prepared to say no. Some children may deliberately throw a tantrum in the hopes that the adult will give in. Giving in will hurt the child in the long run.
Thanks
Helpful0 Not Helpful0
Check up with other caregivers regularly and read their records.
Thanks
Helpful0 Not Helpful0

Warnings

If a caregiver raises concerns about the ethics of an intervention plan, listen closely.
Thanks
Helpful2 Not Helpful0
If the target behavior continues for over a month, chances are the plan is not working. Someone may be mishandling the program (giving in or forgetting to reward), or the child may not be developmentally ready to let go of the maladaptive behavior. Or perhaps you're misunderstanding the reason for the behavior and need to keep brainstorming.
Thanks
Helpful0 Not Helpful0
Don't use behavior intervention plans frequently, as this can lead to an abuse of power. The child may become angry and defiant, or overly compliant and unable to refuse or ask for help when necessary.^{[13]XResearch source}^{[14]XResearch source} Make sure that the child is able to preserve their own identity and communicate when they dislike something a caregiver does.^{[15]XTrustworthy SourceAustistic Self Advocacy NetworkNonprofit organization run by and for individuals on the autism spectrum that empowers autistic people through education and public advocacyGo to source}
- Never attempt to extinguish stimming. If the child stims in a harmful way (e.g. hitting themselves or biting their arms), teach them an alternative stim to fulfill their needs, rather than discouraging stimming. If a stim looks strange but is ultimately harmless, then leave it be, because you'll do more harm than good by stopping it.^{[16]XResearch source}
Thanks
Helpful0 Not Helpful0

Things You'll Need

Tracking sheets to track the target behavior and to record whenever a BIP must be used. They may be done in a large, poster manner so the child can be aware of it as well. Keep a pen handy next to it.
A stable supply of rewards. If you run out, the child will become confused and distressed, and may stop responding to the plan.
A quiet, accessible place for the team to meet, as well as a babysitter or activity to occupy the child during the meeting.
Kind and understanding caregivers.