Your child shouts, hits, bites or throws themselves on the floor: can AAC help? Often, yes. In the vast majority of cases, a behaviour that challenges is a message: the person is trying to get something, escape a situation or signal discomfort, with the only means that works for them at that moment. AAC gives them another one, as long as it is at least as easy and as effective.
What is the behaviour trying to say?
More than 90% of autistic people show behaviours that challenge at some point (Jang et al., 2011, cited in Beukelman and Light, 2020). When you can’t say ‘I’ve had enough’, ‘it hurts’ or ‘look at me’, the body takes over. The most common messages are:
Asking for attention‘Come with me’, ‘look at me’
Asking for an object or activity‘I want that’, ‘more’
Escape or protest‘I don’t want to’, ‘it’s too much’, ‘stop’
Physical discomfortPain, hunger, tiredness, noise, a sensory need
Before talking about behaviour, always check that there is no medical cause. Someone who can’t say ‘I’ve got toothache’ may hit their head or refuse to eat. Words for the body and pain are covered in Body, pain, consent.
How do you replace the behaviour with a message?
Functional communication training (FCT) was described by Carr and Durand (1985) and is supported by several meta-analyses (Beukelman and Light, 2020). The principle: teach a message that gets the same result as the behaviour. The approach has six steps.
1. Find the function of the behaviour
Write down what happens before (the trigger), the behaviour itself, and what happens after (what the person gets or avoids). This is the ABC chart: antecedent, behaviour, consequence. Fill it in over several days, in several places: patterns reveal the function.
Example: every time he is given his writing exercises, Leo throws his exercise book. The adult then puts the book away and offers him a break. Likely function: escaping a difficult task. Leo needs an acceptable way to say ‘it’s too hard’ or ‘a break, please’.
2. Choose a message that is at least as easy and effective
The message must get the same result as the behaviour. If touching BREAK takes three pages of navigation while throwing the book works straight away, the behaviour wins (Horner and Day, 1991, cited in Beukelman and Light, 2020). So the message must be one touch away, on every page, in every place. In Pictalk Buddy, for example, the Essential 24 vocabulary keeps yes, no, more, all done, help me and stop in the same place on every page.
3. Teach the message before the behaviour
At the first signs of tension, before the behaviour appears, show the message on the tool (‘Do you want a break?’ while touching BREAK), then respond straight away. Prompt from most to least support: little by little, wait a bit longer before helping (see Model, wait, respond).
4. Respond to the message better than to the behaviour
At first, the message must work every time, straight away: communicating becomes more effective than shouting. The behaviour, on the other hand, should get less, or get it more slowly.
5. Make sure everyone responds the same way
Parents, teachers, teaching assistants, support workers, grandparents: if just one person ignores the BREAK message, the person learns that it doesn’t always work. Write the rules down on a shared sheet.
6. Reduce the triggers
Announce transitions, shorten tasks, offer choices, set up a quiet corner. To help the person know what is going to happen and when it will end, see Visual supports: schedule, sequences, timer.
Which replacement messages can you offer?
| Function of the behaviour | Possible replacement messages |
|---|---|
| Getting attention | Tapping a shoulder, waving; COME, PLEASE; LOOK AT ME; I WANT TO BE WITH YOU |
| Getting an object or activity | WANT, MORE, PLEASE + a choice; specific requests |
| Escaping or protesting | NO THANKS; ALL DONE; BREAK, PLEASE; STOP; shaking the head |
| Signalling discomfort | SOMETHING’S WRONG; IT HURTS + body part; TOO MUCH NOISE; I NEED TO CALM DOWN |
These messages are based on the examples in Beukelman and Light (2020). Choose them with the person and their team. The other functions of communication are covered in Beyond requests.
Should you teach NO, STOP and ALL DONE?
Yes, and early. People sometimes worry that the person will use them ‘all the time’: they probably will at first, and that’s normal. Being able to refuse in an acceptable way is a right, and it reduces behaviours that challenge. Words for protest and self-regulation (stop, not, all done, something else, enough) are among the first to offer.
When the person says STOP during a game, stop immediately: they learn that their word has power.
And when the refusal can’t be accepted?
Medicine, a blood test, a seatbelt: some refusals can’t be respected. Beukelman and Light (2020) then advise offering control within the constraint: which drink to take the medicine with, in what order to do the steps, which comforting object to keep, who helps. Acknowledge the message (‘I know, you don’t want to’) even if you can’t act on it.
Frequently asked questions
Is AAC enough to make behaviours that challenge go away?
It can help, when the message serves the same function as the behaviour. No tool guarantees a result: it is the overall approach that counts (function, message, consistent responses, environment).
Who can help me analyse a behaviour?
A psychologist, a speech and language therapist or the multidisciplinary team supporting the person can carry out a functional analysis with you.
Pictalk Buddy brings together AAC boards, a visual schedule, guided sequences and notebooks, with the same symbols, on Android, iOS, the web and the watch. A pay-what-you-want app, developed by a non-profit association. Discover Buddy
Sources
- Beukelman, D. R., & Light, J. C., 2020, Augmentative & Alternative Communication (5th ed.), Paul H. Brookes, chapters 3 and 10.
- Carr, E. G., & Durand, V. M., 1985, Reducing behavior problems through functional communication training, Journal of Applied Behavior Analysis, 18(2), 111-126.
- Studies cited from Beukelman & Light (2020): Jang et al. (2011); Horner & Day (1991).