Question:

Dear Dru,

I am a high school teacher for students with severe disabilities. “Robby” is an 18 year old student in my class He is significantly retarded and essentially non-verbal. He has a long history of non-complaint behaviors. For example, sometimes he doesn’t’ want to get on the bus to go home and his family refuses to come and get him. Or instead of saying no, he’ll push things off tables and others could get hurt. He knows what he is supposed to do but he is very stubborn.

However, the most serious behaviors are trying to touch me (especially) and female classmates inappropriately. When I don’t allow this, he takes off all his clothes, and sometimes masterbates. I remove the other students and staff from the classroom and the male principal has to come in.

I have other students who are very high functioning and well behaved and Robby is really interfering with my teaching them. I think he should be moved to a more severe class but his family wants him to stay here. Any suggestions?

Thanks.

Frustrated HS Teacher

Answer:

Dear FHST,

Thanks for writing. I’m afraid that you are not going to get quite the response you want, but I must start by saying that in looking at the behavior of an individual like Robby, consider these grounding principles:

• Robby is not to blame for his inappropriate behaviors; he has learned to get his needs met as best he can. The staff, not just you, but the IEP team and other specialists as needed, is responsible for developing the proper conditions for him to acquire more acceptable behaviors.

• Behaviors are value-neutral. An adolescent removing his clothes hits many sensitive buttons but from a behavior analyst viewpoint, it is addressed the way any behavior is: look at function.

• Robby should have a Behavior Support Plan or Plans (BSP) and it should be reviewed regularly (as often as each grading period at the minimum) or more immediately if he demonstrates a few instances of the more severe behaviors.

• Robby’s family is not a part of enforcing his school behavior. If he is not successful, the team needs to look at all areas of the BSP to manipulate the parts that may not be working.

• Increase praise dramatically for all desired behaviors. Keep it specific and light-hearted. Do not delay reinforcing a desired behavior.

• Focus Robby’s communication goals on increasing the likelihood that he will communicate “No” (verbally, non-verbally, or with a Voice Output Communication device) and that he begin to make requests. Start by giving him choices to teach him to make requests.

Robby has two primary behaviors that interfere with his success. The most serious is touching others in unacceptable ways. The function of that behavior seems to meet sexual desires.

Behavior I – Inappropriate touching

This is a prime example of a behavior that cannot be treated in the usual way, which is looking for a functionally equivalent replacement behavior (FERB) for an inappropriate behavior. Sexual behavior is never appropriate at school and never appropriate if not mutually consensual. Since a FERB cannot be considered, the behavior needs to be eliminated from this setting.

Environmental change:

• Robby’s classroom should be a “No Touch” zone. Teachers should not hug or touch other students. It is not age-appropriate in high school. Teach students to ask each other for a non-sexual touch (not hugging) and teach them to honor “No”.

New Skill:

• Teach Robby to understand rule cards that say “Hands Down” and “Step Back”. Accompany the words with pictures and hand and feet movements. Review daily.

Reactive Strategies (what to do if he touches):

• Staff carries Rule Cards and uses them to prompt him if he begins to touch, using a neutral voice that sounds like you expect him to comply.

• Praise enthusiastically, “You put your hands down. GREAT!”; be specific and don’t say “Good boy.” He is a young man.

• If he doesn’t comply, go back to step 1 and use a sterner voice, making sure you have eye contact, but just say it once.

• If he still touches someone, wait a few moments and then have him sit down (not with the person he touched) and review the cards again.

• If it is deemed necessary to follow district policy that results in suspension, be aware that Robby will not connect his behavior to the consequence (staying home), so it has no teaching value.

• If he touches more than two or three times, review the plan and try changes to make it more successful. Look at the time and place it occurs and see if more interesting activities or less unstructured time could prevent the behavior.

Behavior II – Not following directions

Many students with severe disabilities wear tee shirts and sweat pants all the time. To avert his stripping, suggest that his family to take Robby shopping for jeans or other pants with a fly and for button-down shirts. Not only is it more like the clothing worn by peers, it is also much harder to remove. Stripping is another socially unacceptable behavior that can’t be replaced.

Why he uses this behavior : He does not yet have effective means to reject or protest and few ways to express his preferences.

What to do when he MUST COMPLY with a direction : Sometimes when Robby does not follow directions, the directions are imperative for him to follow (e.g., refusing to get on the bus). These times can be treated in one way:

MUST COMPLY

• Provide choices throughout the day to increase his feelings of efficacy.

• Teach him to follow a schedule.

• Give him advance notice when he will be transitioning to a less preferred activity and visual information about time passing (use a TimeTimer or an egg timer).

• For situations where a problem has frequently occurred, have an enticement waiting, such as a MP3 or Walkman with headphones on the bus.

• Praise compliance (“Awright, man. Good work. You followed the schedule.”)

What to do when compliance is more arbitrary: Directions should be followed because the skill of following directions will be useful for his future residential and employment options. However, the consequences of not following some directions (e.g., working at his desk) are not dire. This situation requires a different approach:

MORE OPTIONAL CIRCUMSTANCE

• His Speech and Language Pathologist (SLP) is the point person for deciding how best to teach Robby to “say” no. A variety of methods is possible.

• If he says no, honor his rejection.

• Tell him you are pleased that he used words (or a device) to tell you.

• That afternoon, examine the activity he rejected to try to understand why: did it come after similar work? Was it boring or hard? Did he not understand what was wanted? Did he need a break? Was it a task that really was important in increasing his independence? Try to make changes that will make him more likely to comply.

• If he uses behavior to refuse (throwing objects off the table), remind him that he can tell you “no”.

Reinforcement

• Increase frequency of praise and attention for desired behavior. You didn’t mention that Robby is autistic, so I can assume he likes attention, and when feeling appreciated he is less liable to be contrary.

• Increase general praise and warm comments for no reason at all.

• Use access to preferred activities such as computer programs and music.

Thanks for your question, and the opportunity to explore some interesting territory. First of all, what do you do if the function of a behavior is not an acceptable function? Secondly, as Skinner would say, the subject is blameless. We control the variables, hard as that is to hear. Good luck!