Much of the early success using basic operant conditioning principles for reducing challenging behaviour came from single-case studies in which some sort of punishment contingency was imposed (Linscheid et al., 1990). These contingencies vary from relatively benign interventions, such as time out and overcorrection (Adams & Kelley, 1992), to much more aversive stimuli being used as the negative contingency (Larzelere & Kuhn, 2005). These included tabasco sauce in the mouth, slapping, electric shock with cattle prods, and electric shock with an automated device known as SIBIS (Self-injurious behaviour inhibiting system; Linscheid et al., 1990). While it was clear the use of aversive contingencies could be effective in controlling serious challenging behaviour such as aggression and self-injury, criticisms of the approach soon emerged, both from an ethical and from a practical stand-point (LaVigna & Donnellan 1986; Brown et al., 2008).
There were also a variety of concerns expressed by advocacy organisations, especially what was then known as The Association for People with Severe Handicaps (TASH). TASH, started in 1974, and developed a policy statement advocating the immediate cessation of all use of punitive interventions, or at least those based on highly aversive stimuli. Following this, various clinical researchers began to demonstrate that serious challenging behaviour could be addressed using positive intervention techniques (e.g.
Carr et al., 2002; Evans, Scotti, & Hawkins, 1999; Meyer & Evans, 2006; Harvey et al., 2009).
Very soon there was a widespread move within the field to eliminate punishment procedures and to focus on positive interventions. This move meant some separation from the traditional ABA approaches, even academic debates regarding the nature of scientific evidence. As identified, the key characteristics of the PBS movement involved a focus on addressing behavioural difficulties ecologically (Carr et al., 2002). This approach highlights the importance of challenging and changing contingencies and promoting alternative behaviours (Keen & Knox, 2004).
While PBS is now widely regarded as the appropriate strategy for managing challenging behaviour (Evans, Scotti, & Hawkins, 1999; Meyer & Evans, 2006; Harvey et al., 2009), there remain some limitations to this approach. In particular, Evans and Meyer (1989) questioned whether PBS’s focus on function of the challenging behaviour provided a sufficient understanding of the child’s emotional needs. The arguments were relatively simple: it might be established that the child’s negative behaviour had the function of obtaining social attention. The reasoning was then that the child should be taught a more appropriate way of obtaining social attention, such as a communication skill. However it remains unclear that this satisfies the child’s needs for love, acceptance, physical contact, emotional warmth, security, or any of the other features of typical children’s emotional development. Perhaps interventions, Meyer and others argued, needed to consider the child’s emotional and motivational needs, such as those outlined by Reiss (2000; Meyer & Evans, 2006).
Has this perspective been incorporated in positive behavioural designs as a general approach? To investigate this issue, recent articles within the positive behavioural tradition (and published in the Journal of Positive Behavior Intervention) were randomly selected and reviewed in order to ascertain the degree to which emotional development issues are specifically featured in the method or reported in the results (see Table 1 below).
Table 1. Positive behavioural interventions and emotion-based intervention techniques
Author, Design, N Emotions addressed in intervention (interventions used) Emotions (emotional needs) defined or communicative function specified.
Schneider & Goldstein (2010), Multiple-baseline case study, n = 3
Social stories (appropriate
behaviours in social
situations), visual schedule boards. No specific emotion-
based interventions
mentioned.
Information not provided.
Adolphson, Hawken, &
Carroll (2010), AB
experimental and survey design, N = 1049
Behavioural contracts, redirection/ prompting, assisting with on-track work completion. No specific emotion-based interventions mentioned.
Information not provided.
Simonsen, Britton, & Young (2010), Single- school case study, N = 53
Token economies (rewards systems), teaching social skills (through modelling, picture cues and board games – not described in detail), group skills sessions, problem solving skills, individual behavioural plans (details not disclosed). No specific emotion-based interventions mentioned.
Information not provided.
Kleeberger & Mirenda (2010), multiple baseline, case study, n = 1 (family)
Video modelling. Prompting/
fading and social
reinforcement. No specific emotion-based interventions mentioned.
Information not provided.
Binnendyk & Lucysyn, (2009), case study, n = 1 (family)
Parental implementation of a hierarchy of successful eating steps. Included stimulus fading, use of contingent praise, and escape extinction procedures. No specific emotion-based interventions mentioned.
Alluded too (e.g. food refusal included crying or protesting and function of behaviour as child engaging in challenging behaviour to avoid situation).
Carlson, Luiselli, Slyman & Markowski (2008), multiple- baseline, case study, n = 2
Choice-making –
opportunities provided for appropriate clothe changing at set intervals. Instructions to stop inappropriate behaviour. No specific emotion-based interventions mentioned. Outlined communication as a function of behaviour
Butler & Luiselli (2007), ABAB reversal design, case study, n = 1
Verbal direction, modelling, physical guidance. No specific emotion-based interventions mentioned.
Outlined communication as a function of behaviour
(e.g. to escape demands/ situation).
Lucyshyn, Albin, Horner, Mann, Mann & Wadsworth (2007), Longitudinal, single-case, multiple- baseline experimental design, n = 1 (family)
Parent training. No specific emotion-based interventions mentioned.
Outlined communication as a function of behaviour
(e.g. attention-seeking).
These studies illustrate that although positive interventions are developing and are beginning to address the communicative function of behaviour the emotional needs underlying these have not yet begun to be addressed specifically. Even when functional analyses were undertaken the emotional needs related to any of the disruptive behaviours indentified were either not identified or reported by the researchers.
Summary
Following from behavioural approaches and a long-held dominance in the field, the approach to working with children who have developmental disabilities and/or challenging behaviour has begun to change (Evans, Meyer & Buckley, 2008). There are, as identified, newly emerging holistic approaches which address functions (emotions/motivations, why does the child want attention? e.g., jealousy, hunger, pain) that underlie the overt and often focussed upon function of the behaviour itself (e.g., attention).
As late as the 1970s, the principles of behaviourism dominated the practice of psychology. Influential behaviourists working with children who have developmental disabilities and behavioural difficulties, such as Lovaas (1987), utilised applied behaviour analysis techniques. At this time, it was thought that one could only ‘observe’ and measure behaviour, and therefore, behaviour was the focus of study. However, the contribution of studying the environment with a focus on behaviour is as useful to this day as it was when the behaviourists focussed on it many years ago. Alongside this, a small but growing body of literature is starting to demonstrate the importance of incorporating emotional elements into intervention for challenging behaviour.
Although these researched approaches are useful in many respects, and groups within behavioural approaches are changing their views in-line with new research, they are not without their deficits (Brown et al., 2008; Evans, Meyer & Buckley, 2008). Emotions and their inextricably intertwined interplay with behaviour are neglected in traditional behavioural interventions (Brown et al., 2008). Without addressing all factors that an individual presents with (developmental disability and challenging behaviour), and the factors which are evident in creating and maintaining these behaviours (emotions), challenging behaviour cannot be expected to be corrected entirely through traditional behavioural programmes. In circumstances where it has been successful in reducing behaviour, it may be likely that a replacement behaviour driven by the same underlying emotions would be developed (Keen & Knox, 2004).
Research examples identify some success and efficacy in the use of these designs, however, the consideration of other developmentally appropriate and emotionally-based factors are becoming increasingly researched beyond the dominant behavioural paradigm. Research identifies that treatments based on principles of behaviour modification are effective in reducing challenging behaviour in individuals who have an intellectual disability (Bodfish, 2007; Chambless et al., 1996; Evans, Meyer & Buckley, 2008; Roberts, Mazzucchelli, Taylor, & Reid, 2003). However, some children with developmental disabilities may require additional or unique treatment components tailored to suit their developmental level of functioning (Evans, Meyer & Buckley, 2008; Imray, 2008; Myles, 2005; Reiss & Havercamp, 1997). For example, if a child is non- verbal, other methods of communication may need to be explored in order to implement a useful therapeutic intervention (Gerenser & Forman, 2007; Myles, 2005). Similarly, awareness of the communicative intent of many challenging behaviours in children with intellectual and developmental disabilities should also influence treatment options (Keen & Knox, 2004). For example, this is how the current study is advancing knowledge by attempting to address emotional and/or communicative functions of behaviours not primarily addressed in behavioural models.
It is also important to recognise that, for some children exhibiting both a developmental disability and challenging behaviour, complete cessation of inappropriate and/or challenging behaviour may be extremely difficult. For some children it may be beyond their abilities to function independently and be aware of their behaviour (Imray, 2008). In
these cases, it is not acceptable or ethical to try and teach behavioural treatment techniques that serve to completely eliminate behaviour and, in some cases, behavioural treatments may not be appropriate at all. Therefore, there is a need to explore and understand the function of the behaviour and what purpose it is serving for the child (Berotti & Durand, 1999; Evans, Meyer & Buckley, 2008; Morris & Hawkins, 1999) and to consider other treatment options which address different factors of the challenging behaviour in this population. Whilst this critique is necessary and valid in terms of addressing the need for the current research it is also important to be mindful of the fact that this research stems from behavioural theory and as such still consider behavioural theory to be crucially important in both research and practise.
This introductory chapter has broadly outlined the key topics of emotional knowledge and needs, challenging behaviour, developmental disability, traditional treatment and theoretical models as well as the importance of new approaches to treatment. Although behavioural approaches for working with children who have developmental disability and challenging behaviour has merits, more recent arguments have arisen addressing the need to include and consider emotional aspects of behavioural problems and to address them more explicitly. The four component model as the model of choice for this thesis, addresses this need, and was outlined in detail. The importance of utilising a holistic approach to working with children who have both developmental disability and challenging behaviour/s was emphasised, evident also in the importance of respecting and including culture in practise. This growing literature leads to the need for the current study utilising this model.