13.30 – 15.00 Understanding Behaviour Dr Helen Downie

1. 13.30 – 15.00Understanding BehaviourDr Helen Downie

2. Practical Strategies for Positive Outcomes Dr Helen Downie Chartered Clinical Psychologist NHS Lothian/NHS Fife

3. Functions of Behaviour “The purpose of our behaviour is to have our needs met”

4. Functions of Behaviour This is the need the child is trying meet or have met by doing the particular behaviour. Working out what the function of the behaviour is, is necessary so that we can teach the child a more appropriate way of getting this need met. If we want to stop a particular behaviour we need to replace it with one that serves the same function for the child.

5. Some possible functions of behaviour Expressing a need/want Expressing that the child does not want something Wanting adult attention To get out of a frightening/confusing situation To make requests To make sense of a confusing situation/environment To try to have some control over a situation Communication!

6. The Iceberg Metaphor(TEACCH) BEHAVIOUR Sensory processing Memory Coping with change Time perception Comprehension Attention Expression Social communication

7. What is Attention? Attention is the ability to tune into and concentrate on things in the world around us-sights, sounds and other sensations. Part of this ability is being able to recognise what is the most important thing at that time and then to tune into it.

8. Attention Practical Activity: In groups of 3 One person sit in the middle and try to listen to the people either side talking to you. Imagine you will have to make these recipes later. You can’t write things down. The people on either side, read the recipe you have been given to the person in the middle.

9. Practical Activity • Comment on: • how this made you feel • what was difficult • What would you do if this happened for the rest of the day….

10. What can help with Attention Cut down on the number of distractions Look at the person Use their name to attract their attention Emphasise what they need to attend to Use visual and other cues to help them stay focused

11. What is short term auditory memory? The ability to hold things that are said to you in your mind To be able to recall things that are said verbally Most people can remember 7 +/- 2 bits of information People with LD often only between 1-3

12. Short term auditory memory Practical Activity: Listen to the story Write down everything you can remember, as accurately as possible What do you notice?

13. What can help with memory Give limited amounts of information Give it in small chunks Use visual prompts and clues Give information in more than one way, words and gestures Place cues like objects or pictures to “jog” the person’s memory

14. What is communication? “Communication is a two-way process involving the giving and receiving of information” Communication requires a speaker and a listener. Communication requires a need, a motivation and an opportunity. Communication requires the speaker and listener to have a shared language.

15. Practical Activity We need volunteers! Listen carefully Follow the instructions you are given How did you feel? What if you felt like that much of the time?

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18. How is your Hebrew?

19. Text is good…… îùøã ÷éåñ÷ ùéøåúéí

20. …… but symbols are better! îùøã ùéøåúéí ÷éåñ÷

21. Practical Activity • In pairs decide who is going to draw and who will gesture. • The person who is going to draw must turn their back to the screen. • Their partner will look at a picture and then using only gesture will communicate what you should draw.

23. Practical Activity • Comment on: • how this made you feel • what was difficult • how you overcame barriers • was this satisfying communication

24. What can help with expression Observation: how do they express themselves? Motivation: do they have a reason to communicate? Augmentation: encourage the use of signs, gesture, symbols, photos, pictures Be aware: fatigue can reduce the amount a person expresses themselves

25. What can help with comprehension Repeating or rephrasing Using cues such as: Gestures Objects Pictures Signs symbols

26. What can help with comprehension Slower speech Small chunks of information Modifying vocabulary Clarifying complex ideas such as : time, past/present/future tenses, negatives, numbers Avoiding or checking people understand, sarcasm, irony and jokes

27. So what can I do?

28. Why do we need positive strategies? We are often asked to help with “Challenging Behaviour” The behaviour we find challenging is serving a function for the person doing it If we want to reduce or change the behaviour we find challenging we need to teach a new behaviour the does the same job. We want that behaviour to be positive!

29. To teach and learn we need to interact • Difficult behaviours can mean potential teachers are reluctant to interact. • Interactions with others can be confusing for people with Learning Disabilities or ASD. • We need to find a way to interact with people who are anxious or unsure about how to interact with us. • Once we are able to have an interaction we can teach more new skills & use more new strategies.

30. Be what you want to see • Positive, trusting relationships are what we want people to experience. • One of the most important parts of any intervention is the person delivering it. • Our thoughts, values and feelings about a person come through when we interact • We have to find a way to show that we want to have an interaction with a person even if their behaviour is challenging to us.

31. Be honest & genuine • It isn’t possible to “pretend” to have a positive interaction with someone. • Think about how it feels when someone you know doesn’t like you is polite to you. • Do you feel valued? Do you trust them? • Sometimes we have to question our ideals and values before we can have a truly positive interaction.

32. How can we make interaction easier? Interactions can be anxiety provoking if you don’t know how long they’re going to last or what’s going to happen. We can use a structured approach to have a positive, trusting interaction. Keeping interactions short, structured and task focussed makes for more positive interactions.

33. So what can you do? • Don’t respond to or comment on the behaviour, but DO NOT IGNORE THE PERSON • Remaining calm defuses behaviour • Turn attention to something else – a structured activity • Activities become openings for rewards, you value being with them • But how do we do it?

34. As easy as 1,2,3 Pick a task you can structure into manageable chunks. Try to pick something that will allow the person to see how many times they will have to do something. If you can’t do it visually use “1,2,3, finished” If the person is reluctant to take part, touch the object to their arm or hand and complete the task for them. Give loads of praise and do the same for 2 more pieces/turns. Repeat (a lot!)

35. What does it work with? Absolutely everything! Not “which activities can they be involved in?” but “how can I help involve them in this right now?” Find parts of activities person can do Fill in the gaps with your help to ensure they succeed

36. What does it work with? To start with, the task is not that important as it’s all about engagement. Lots of simple tasks can turn into lots of other more functional tasks later. It’s not all about “education”. This is a great way to teach daily living skills.

37. Why do it? • This isn’t just a strategy for helping with difficult behaviours. • It also: • Increases trust & builds relationships. • Allows you to teach how timetables work. • Helps people to take part in the things that happen in their lives. • Improves self esteem • Helps give people a sense of purpose.

38. Thanks to Dr Gill Kidd & Nicola Murray

39. Finding out more • Gentle Teaching • Gentle Teaching: A Non-Aversive Approach to Helping Persons with Mental Retardation  by McGee, Menolascino, Hobbs  & Menousek (out of print) • Aylott J, Sell I. (1997) British Journal of Nursing, Apr 24-May 7;6(8):442-6 • Cullen C, Mappin R. (1998) British Journal of Clinical Psychology, May;37 ( Pt 2):199-211 • Gates B, Newell R, & Wray J (2001) Journal of Advanced Nursing, Volume 34 Issue 1 Page 86 - April 2001 • Gentle Teaching: A Positive Approach for Challenges of Behavior AND Learning (2000) – DVD available from http://www4.nau.edu/ihd/