Proactive Engagement of Aggressive or Confrontational Events – P.E.A.C.E. Techniques Michael J. Weiss, Ph.D. Giant Steps School – Connecticut Fairfield University Level 4: Inconsolable and/or in danger Level 3: Upset & Refusing Participation Level 2: Distressed, in Disagreement, but communicative & Compromising Level 1: Calm & Collaborative Level 4: Reactive Safety Level 3: Requiring Participation Level 2: Read Emotions & Acknowledge Distress (READ) Level 1: Proactive Growth Factors

Systems developed for managing aggressive or confrontational events The various systems that have been developed for safely managing aggressive or confrontational actions – SUPPORT – CALM – Prevention and Management of Aggressive Behavior (PMAB) – Prevention and Management Techniques (PMT) – Prevention of Aggressive Behavior and De-escalation Techniques – Behavior Management Techniques Common intervention techniques include: – Proactive methods – Verbal redirections – Physical supports & escorts – Physical "containment" – Methods of restraint – Keeping everyone safe

Emotional Self-Regulation

Emotional self-regulation – the process of initiating, inhibiting, or modulating internal feeling-states, emotion- related physiological processes, and emotion-related cognitions or behaviors in the service of accomplishing ones goals (Siegler, DeLoache, & Eisenberg, 2006)

Regulation of Emotions Walter Mischel and the marshmellow test Pre-schooler (4-years old) taken to a room where they see favorite treats Given 2 choices: 1. wait for a long time for 2 treats 2. ring bell to end the waiting for 1 treat

Regulation of Emotions Correlates with the outcomes 10-years later & adulthood: Social competence Academic achievement Verbal fluency Rational thinking Attentiveness Planfulness Ability to deal with frustration Further ability to delay gratification Performance on SATs Self-esteem Drug use

Maccoby & Martin (1983) -- Influence of "Responsiveness" and "Demandingness" on children's self-regulation

Baumrind (1977): Parenting Dimensions Authoritarian ("Dictatorship") "Shape, control, evaluate behavior in accordance with an absolute set of standards; values obedience, respect for authority, work, tradition, and preservation of order; discourage verbal give and take. These parents sometime reject their children if they don't live up to the parents standards."

Baumrind (1977): Parenting Dimensions Permissive ("Anarchy") "Attempt to behave in an accepting, positive way toward child's impulses, desires, actions; use little punishment; consult the child; makes few demands for household responsibility or order; allow child to regulate their own activities and avoid control; attempt to use reasoning, but not overt power to achieve objectives."

Baumrind (1977): Parenting Dimensions Authoritative ("Democratic Dictatorship") "Direct children in rational, issue-oriented manner; encourage verbal give and take, explain reasons behind demands and discipline; use power when necessary; expect child to conform to adult requirements and to be independent and self-directed; child is expected to recognize the rights of others; parents set standards and enforce them firmly; listens to child, but do not base decisions primarily on child's desires."

Why we behavior the way we behavior? Applied Behavior Analysis (ABA) "explanations" Avoidance/escape Attention seeking Automatic (inherently reinforcing) Social Communication, Emotional Regulation & Transactional Support (SCERTS) -- Prizant, Wetherby, et al. Emotional regulation and "dysregulation" "Internal" and "external" factors

Why we behavior the way we behavior? Communication issues o Cant say what you are thinking-feeling o The only communication opportunities that are "created" are: labels requests responses to directions but nobody wants to talk about my thoughts or feelings o Millais of frustration around communication

Why we behavior the way we behavior? Physical factors: Discomfort in your skin o Hungry, thirsty, tired, state of desire or need o Difficulties in regulating sensory processes and/or movement "differences" o Underlying medical factors that leaves you feeling awful and/or in pain GI – headaches – Seizures – Toothaches -- allergies

Why we behavior the way we behavior? Environmental factors o Over/under stimulating overcrowding; noise; lighting; tastes; smells, etc. o Activities/staff are too predictable or not predictable enough o Inaccessibility -- missing needed adaptations

Why we behavior the way we behavior? Programmatic o Is there interest and relevance to what I am doing (or does anyone try to explain its relevance to me)? o Tasks too easy (bored) or too hard (confused) o Not appropriately individualized (i.e., "cookie cutter" programming) or too individualized (where is everyone else?) o Being grouped with others in activities that are not relevant to me

Why we behavior the way we behavior?: Temperament LARGE individual differences in emotional expression & regulation (mellow v. emotional; Timid v. outgoing) Temperament – constitutionally [biologically] based individual differences in emotional, motor, and attentional reactivity and self-regulation that demonstrate consistency across situations, as well as relative stability over time (Rothbart & Bates, 1998).

Temperament dimensions (Rothbart & Bates, 1998) : Fearful distress – distress and withdrawal in new situations and how long it takes a child to adjust Irritable distress – fussiness, anger, and frustration, especially if the child is not allowed to do what he or she wants Attention span and persistence – duration of orienting toward objects or events of interest Activity level – amount of movement (e.g., kicking, crawling) Positive affect – smiling and laughter, approach to people, degree of cooperativeness and manageability Rhythmicity – the regularity and predictability of the childs bodily functions such as eating and sleeping Why we behavior the way we behavior?

Psychological-affective-emotional reasons o Imbalance in autonomy, self-determination and others' agendas o Making me do something that I don't want to do (wanting to avoid something) o Not giving me what I want, when I want it (trying to get access to something) o Difficulties in generalizing, adapting, modulating and/or dealing with familiarity and/or novelty

Why we behavior the way we behavior? Psychological-affective-emotional reasons o Personal history related to my psychological status Thinking about something that happened a long time ago Sick of being treated in a certain way (i.e., no privacy in bathroom) Tired of listening to others talk as though I don't understand or have opinions/feelings Having to be around people that I don't like or not being with others that I do like Sick and tired of others' telling me how/why I feel and behavior the way I do It's more meaningful to me to stand my ground and make you upset, than it is for me to get that stupid reward!!

Why we behavior the way we behavior? What is my Developmental status and what does that imply about my... o Self-awareness o Other-awareness o Perspective taking and other aspects of "Theory of mind" o Other Social-Cognitive processes What is my chronological age and what does that imply about... o What my age peers are doing and interested in o My physical needs that may vary relative to my age o What the bridges may be which connect my developmental status to my chronological age

Why we behavior the way we behavior? Relationship factors o Parent relationships Need for high levels of warmth and high levels of enforced expectations (a.k.a. "Authoritative Parenting") o Sibling relationships o Extended family relationships o Teacher/therapist relationships o Do I have any friends? o Who talks to me like a person (and not a chair)? o Who can I engage in rough-n-tumble play with? o Who can I have an intimate relationship with?

What correlates with aggressive and/or confrontational events? Combined problems and permutations of the above o I just feel rotten o I can't tell you how rotten I feel o I wish people would just leave me alone o I hate what I'm doing at school, home or in the community o I'm stuck in thought and/or action patterns that I can't get out of o My relationships are lopsided, too few or too dependent o I struggle with self-awareness and awareness of others o I'm misunderstood and/or not respected o No privacy or confidentiality o Not enough in it for me o I'm Stressed!!

Baron, Groden, Groden & Lipsitt (2006) Hard to say where the chicken and the egg is on stress, but look at the prevalence of a "Fight or Flight" reaction

Why we behavior the way we behavior? There are many, many reasons why we act the ways we act!! Some of the reasons are obvious Some of the reasons are non-obvious Most of the time accommodations can be made to help a person "manage" the situation Some of the time, you have no choice -- you've got to learn to deal with life's ups and down

Levels of Emotional Regulation Level 4: Inconsolable and/or in danger Level 3: Upset & Refusing Participation Level 2: Distressed, in Disagreement, but Communicative & Compromising Level 1: Calm & Collaborative

Four levels of finding P.E.A.C.E. – adult responsiveness Level 1: Proactive growth factors –Need for meaningful education, therapy & relationships –Need to "push the envelop of growth" in emotional regulation Level 2: Read Emotions & Acknowledge Distress (READ ) –Need for recognition, acknowledgement and communication related to a person's distress, disagreement or other forms of refusal –Need to return to proactive growth factors through communication, collaboration & compromise Level 3: Adult insistence on participation –Interaction partners need to both recognize the difference between a request/choice and a "requirement –If the activity is a "requirement – adult must compel participation –Need to move past point of conflict and through the activity Level 4: Reactive strategies to extreme distress & actions –Need to keep everyone safe –Need to create calm & return to proactive growth factors

Level 4: danger to self or others Level 3: Upset & Refusing Participation Level 2: Distressed, in Disagreement, but communicative & Compromising Level 1: Calm & Collaborative Level 4: Reactive Safety Level 3: Requiring Participation Level 2: Read Emotions & Acknowledge Distress (READ) Level 1: Proactive Growth Factors A Developmental system for thinking about self-regulation and adult supports

Level 1: proactive factors & strategies that influence PEACE 1.Definitions & Data 2.Medical team evaluation 3.Relationships and finding my childs (and my) voice 4.Communication 5.Sensory & movement issues 6.Multimodal channels of information 7.Intensity, diversity, generalization 8.Assume competence: offering a wide academic window 9.Inclusion in the world 10.Make plans do-able 11.Understand your belief-systems 12.Dynamic behavior (parenting) plan 13.Medical management

Level 2: Recognize Emotions & Acknowledge Distress (READ your child) Recognize, acknowledge and communicate about what may be influencing signs of distress What are "signs of distress?" –For ever "reason" there is for distress, there are related signs. Do we recognize them? –Yes, things do "happen out of the blue" -- meaning "we don't know why." But, it is truly rare that an action occurs "for no reason." Level 4: Inconsolable and/or in danger Level 3: Upset & Refusing Participation Level 2: Distressed, in Disagreement, but communicative & Compromising Level 1: Calm & Collaborative Level 4: Reactive Safety Level 3: Requiring Participation Level 2: Read Emotions & Acknowledge Distress (READ) Level 1: Proactive Growth Factors

Level 2: How do we learn to READ the signs of a person's "state" Don't just ask about "the behavior." Describing the "antecedent" of a behavior may be quite misleading –Sometimes the immediate situation gives clues of why a behavior occurred (i.e., "avoidance behavior" to an undesired demand). –But, often times the immediate circumstances are not revealing (i.e., child has a headache)

Level 2: Do a "Functional Developmental Assessment" (FDA) Make sure you ask about the behavior Assess the situational factors surrounding a behavioral event... typically found in Functional Behavioral Assessment (FBA) The "A-B-C's" of behavior –Antecedents? location activities involved in people participating –What was the Behavior? frequency intensity duration –Consequences? returned to activity left location received some object

Level 2: Do a "Functional Developmental Assessment" (FDA) BUT, Don't just ask about "the behavior … … Make sure you ask about the person A FDA is a broad-ranging inventory of all those factors that may contribute to a person's actions. This should include factors that may not have an obvious relation to a specific event: –Medical/physiological presentations –Sensory, environmental & movement profiles –Temperament factors –Affective/emotional presentation –Communication needs and conditions –Social factors & relationship" inventories" –Curricular/instructional factors –Interest inventories & issues

Level 2: READ your child, student, client's "states of being:" What does this person look like when: –Having a head or stomach ache –After a seizure –Illness/infection –Hungry, thirsty, tired –Bowel/bladder irregularities –Responses to various sounds, visual inputs, smells, taste, tactile, kinesthetic, proprioceptive events –Over/under stimulated –Temperament-affective- emotional presentations (i.e., easy/hard to sooth; response to novelty; range of cries; fear reactions to what? etc.) –When frustrated or persistent –Making wants known successfully –Not being understood –Spoken to in a higher v. lower levels of sophistication –Highly active v. quiet –With favorite people vs. undesired people –In various groups v. alone –Curricular-instructional- attentional presentation (what does she look like when bored, interested, "following," confused, etc.) –Engaged with highest levels of fun –With dogs, cats or horses –In response to TV, computers, other electronics –Music, dance, material arts –Stuck in movement patterns –Given a high v. low level of self- determination & choice

Level 2: READ your child, student, client What do you do when the "signs" indicate trouble in affective and emotional states? Review each "state" and arrive at a consensus about: – what the state signifies – How do we ask the person about "what is going on?" – Talk about how to get past the sign of distress What is the "path" to follow that takes a person from that particular state back to a place of proactive growth? – Headache..... lights out and rest – Hungry..... snack/food reinforcer – Too loud..... ear plugs, headphones, systematic desensitization – Over/under stimulated..... vary type, speed, intensity of activity – Difficulty with novelty..... "pick your battles," systematic desensitization – Indicating dislike of activity or person..... determine if you need to finish or can move on to something else

Level 2: READ your child, student, client What do you do when the "signs" indicate trouble in affective and emotional states? Review activities to determine what is optional v. what is a requirement – Can this individual work with you together to resolve the situation? By offering choices; attention to a need/want; by having a chance to talk things over; and much more. Prepare for the possibility of an escalation in "emotional expression" if mutual resolution cant be found.

Level 3: Reactive Strategies to refusals of a "required" activity The activity is a requirement – refusing to participate in therapeutic and/or educational activities is a non-starter; Certain actions are simply not tolerated – grab all of the candy in the grocery store isle; – property damage of endangering yourself or others An outburst occurs

Level 3: Reactive Safety -- escalation to aggressive or confrontational events The fact that an outburst occurs does not necessarily mean requiring the person to participate is wrong – We sometimes have to learn to do things that are hard – We sometimes have to do things that we would rather not do – We can't always get what we want (but, if you try sometimes, you might just find, you get what you need (M. Jagger)) Not all forms of distress are dysregulation It does not logically follow from Social Development data that – if you are dysregulated – that you cannot learn from the event

Level 3: Reactive Safety -- escalation to aggressive or confrontational events The fact that an outburst occurs does not necessarily mean we are causing a person to become more "dysregulated" in the long-term – Children need to learn to "internalize" emotional regulation across development and from repeated events and circumstances – Children need to have the opportunity to discover their unfolding autonomy, which is born from greater degrees of tolerating frustration

Level 4: Reactive Safety -- physically intervening with aggressive or confrontational events Receive training in one of the various systems that have been developed for safely managing aggressive or confrontational actions – SUPPORT – Prevention and Management of Aggressive Behavior (PMAB) – Prevention and Management Techniques (PMT) – Prevention of Aggressive Behavior and De-escalation Techniques – Behavior Management Techniques Common intervention techniques include: – Proactive methods – Simply and minimally intrusive physical supports & escorts – Intrusive physical supports & escorts – Physical "containment" – Methods of restraint – Keeping everyone safe

Level 4: Reactive Safety -- physically intervening with aggressive or confrontational events Escalation to potentially dangerous tantrum-like behaviors … … keep everyone safe! Level 4: Inconsolable and/or in danger Level 3: Upset & Refusing Participation Level 2: Distressed, in Disagreement, but communicative & Compromising Level 1: Calm & Collaborative Level 4: Reactive Safety Level 3: Requiring Participation Level 2: Read Emotions & Acknowledge Distress (READ) Level 1: Proactive Growth Factors

What every child needs: 1.A quality education in a climate of having their needs met, while being loved; 2.A voice that is heard, but not dictated with; 3.Being required to do important things that he/she may not want to do; 4.Keeping EVERYONE safe and feeling protected. Level 4: Inconsolable and/or in danger Level 3: Upset & Refusing Participation Level 2: Distressed, in Disagreement, but communicative & Compromising Level 1: Calm & Collaborative Level 4: Reactive Safety Level 3: Requiring Participation Level 2: Read Emotions & Acknowledge Distress (READ) Level 1: Proactive Growth Factors