Question:

I am a teacher in a preschool special day class for severely handicapped children. I have one girl who gets extremely upset when any other children in the class cry. Her behavior consists of a vigorous shaking/flapping of her hands while getting in very close proximity to the crying child. Occasionally, the child who is crying gets accidentally hit by this girl while she is flapping. At the same time she is flapping she is getting more and more worked up, losing her ability to speak making an oooooo sound or uhuhuh sounds as she builds in intensity.

We try to get the upset child away from the girl for both safety reasons as well as attempting to remove the stimulus, but that sometimes is not enough and the child has a tantrum. i feel that the tantrum may be anger at her inability to speak and/or comfort her classmate. When she is upset, we go to the quiet area (the bathroom located in the classroom) to calmly talk to her and eventually calm her down. The quiet area is necessary to remove all the stimuli from the girl and at the same time help restore order to the rest of the class who can get upset by the girl's extremely loud crying and shouting.

Calming the girl down can take up to 15 minutes on some occasions. I can give greater detail on the behaviors if you need them. What advice would you have for dealing with this?

Thanks

GWS

Answer:

Hi George,

Thanks for the question. I would focus some more on the function of her (I’ll call her Amy) behavior. Your hypothesis is that Amy is protesting her inability to comfort her classmate. That may be so, but even typically developing preschoolers are quite egocentric, so a delayed preschooler is even less likely to be so altruistic. My hypotheses about her crying are that it might be:

• A protest because she finds the noise annoying, or
• A protest because she finds the noise scary, or
• A request for attention because she knows the child who is crying will be getting a lot of attention

I’d bet on the first one (she is annoyed) and so I would look at what changes can I make in the environment and what new skills can I teach Amy.

Here are some ideas for changing the environment (time, space, materials, or interactions):

• I would have a plan with my instructional assistant: one of us goes to the crying child and one of us goes to Amy immediately (interactions)
• I would have some voice output communication device (VOCA), like a BIGmack™ (http://my.execpc.com/~labres/able_big.html), already programmed in Amy’s (or another child’s) voice to say. “I don’t like that noise.” I would model using it for Amy when things are calm. (materials)
• I might place the VOCA in the quiet area and lead her to it as soon as crying starts. (space)
• I would emphasize (reinforce) Amy’s use of the VOCA (“Good using words, Amy.”) and not comforting her (interactions).

• Teach Amy to use headphones for a favorite book on tape or computer. Have it set up and ready for immediate use.
• If the VOCA is not a good idea for Amy, teach her to cover her ears, make a face and say “I don’t like that noise.” Practice doing this when things are quiet.

• Depending on Amy’s level of understanding, create a social story (with pictures) such as:
• Sometimes my friends cry.
• This hurts my ears (makes me sad; makes me scared; whatever)
• When this happens, I can:
• Go to the quiet area
• Listen to books on the headphones
• Use my words
• I can take care of myself (picture of smiling Amy).

Another key element to changing Amy’s behavior lies in the reinforcement piece. At this time, it sounds as though she receives a lot of reinforcement (in the form of special attention) for getting upset. The reinforcement needs to be heaped on when she makes any progress towards, what I would name for her, “taking care of yourself.” The behavior I would reinforce heavily and consistently looks like:

• expressing distress with words,
• doing something to distract herself from the noise,
• removing herself from the area,
• not requiring direct staff attention