When engaging with a new client, I’m excited to jump in and begin working toward our speech and language goals. However, before we begin working on specific skills, I need to make sure that the child is emotionally regulated, focused and ready to learn. How can we best ensure that children stay attentive, positive and engaged during sessions?
Having worked in public schools and private practice settings for over ten years, I know that children with speech and language impairments, as well as those with neurodevelopment disorders such as autism and ADHD, often present with behavioral challenges and difficulties with emotional regulation. Examples of challenging behaviors include elopement (i.e., running away from a situation or task), aggression, tantrums, an inability to stay seated and refusals to participate.
Understanding Behavioral Challenges
When faced with these behavioral challenges, I’ve noticed that parents and teachers sometimes fail to consider the impact of the child’s disability on their behavior. Caregivers may assume that children are making specific, conscious choices in refusing to comply or participate but, in fact, the choices children make are often influenced by a variety of factors, such as sensory processing challenges, inability to understand information and expectations, or difficulty with focus and attention. It’s natural for parents and teachers to feel frustrated when it seems as though a child is making a deliberate choice not to participate.
When we look at the specific profile of each child, we can gather clues as to why children are exhibiting these challenging behaviors. For example, I worked with a young girl who had autism with severe language impairment and a sensory processing disorder. While doing therapy at her desk, she suddenly started pulling at her clothes, burst into tears and threw the therapy materials on the floor. I later learned that, because of issues with sensory processing, sometimes the tags on her clothes made her extremely uncomfortable. Because of her language impairment, she wasn’t able to tell me what was happening and ask for help. Although her outburst was baffling at the time, on further reflection her distress made perfect sense.
Clarity
As a speech pathologist, I’m attuned to the fact that children with special needs shouldn’t be expected to follow instructions as readily as kids without disabilities. For a child with language impairments, the vocabulary in the instruction may not be clear, or perhaps the sentence is too long and complex. A child with an attention deficit might not be able to retain the information due to competing bids for her attention.
In my view, the first step toward effective behavior management involves providing clarity for the child. What is the child expected to do? For a child with autism who struggles to process auditory information, I provide pictures or other visual representations of the information to improve clarity. Children with ADHD also benefit from visual representations to help understand new information and follow directions. For a client with attention deficits, I make sure that the child is in close proximity to me and makes eye contact with me before giving instructions.
For children with language impairment, I break down the instructions into concrete steps and provide modeling and gestural cues as needed. I also supply additional modes of communication (e.g., augmentative communication devices, picture boards) to reduce frustration for children who are nonverbal or have limited verbal abilities.
Consistency
Children also benefit when provided with clear expectations. These are another avenue to clarity and consistency in our communications with children, and the use of structured routines will further support our efforts. When a child enters the classroom, what are our expectations? If we expect her to hang up her bag and coat, sit at her desk and start a morning work activity, then we need to repeat and reinforce the routine every day. If she is sometimes expected to follow this routine, but on other days the routine is different, it may cause her some confusion and distress because she does not know what is expected of her, and we may see some challenging behaviors that result from this confusion.
Managing challenging behaviors is crucial. If children aren’t ready to learn because of emotional dysregulation, we won’t be able to teach new skills. It can be difficult to determine which factors are impacting a child’s ability to participate, but once we’ve investigated and resolved possible causes, provided clear instructions and implemented a consistent routine, we are much more likely to succeed.