CPI techniques can be used safely with a wide variety of people, including those on the autism spectrum. Due to the nature of autism and the unique characteristics of this part of our population, there are some special things to consider when employing CPI techniques with children who have autism. These eight strategies will help you help a child through a behavioral crisis. They’ll also help you prevent crisis situations from occurring in the future.
1. Learn about the way autism shows up in this particular child.
Everyone has heard the adage, “If you’ve met one child with autism, you’ve met one child with autism.”
Work closely with the child’s parent, teacher, or any familiar adult to learn which specific behaviors indicate that the child is experiencing anxiety.
For example, some children with autism flap their hands when they’re excited and happy. Others flap their hands when they’re beginning to feel stressed or anxious. How does the particular child you’re working with demonstrate that he’s anxious?
Also learn about ways that have worked to be supportive of this child in the past. Answer questions such as:
- Does the child like to be touched?
- Should you avoid touch?
- Has she responded well to schedules? If so, what kind?
- What are the child’s very favorite things? How often is she typically given access to these favorite things and under what conditions?
- What types of movement or activities have helped the child calm down in the past?
- Does talking help, or is it best to stay quiet?
Remember, if you can intervene with the right supports when low levels of anxiety are demonstrated, you might be able to help avoid escalation.
2. Teach the child clear communication skills for getting wants and needs met.
Find out how he’s communicating now, and as long as it’s functional (i.e., productively leading to what he wants), keep that, but also teach a way for the child to ask for specific things that may not be visible.
If the child is not yet verbal, figure out the best type of system for her to use. The Picture Exchange Communication System
and sign language are two options. Many children are also benefiting from apps
that allow voice output. Start with some favorite things and teach the child to request them using each to see which she responds to the fastest.
Avoid abstract language and words that are very general (“Yes,” “No,” “More,” “Please”), as they often result in anxiety and frustration because the listener has no way to know what the child wants.
Also be sure to include a way for the child to tell you to stop what you’re doing. Some people are concerned that if they teach a child a way to communicate this, the child will always use it. I’ve found that people with autism, just like the rest of us, will do whatever “works” in a situation. If the child with autism wants to escape a situation, I’d rather he use a word or sign to tell me than to physically aggress or run away.
If the child has escalated to the Defensive stage of the Crisis Development Model
℠, be aware that this could be because many children with autism are not able yet to ask for information in a typical way. For example, the child who requests “outside” multiple times may just be asking in her own way, “When do I get to go outside?” If the child is repeatedly asking for something, let her know clearly when it’s going to be available.
Also consider that asking questions is an important thing to teach the child to do. Important questions for any child to be able to ask include:
- “How many more?”
- “When can I _________?”
- “Where’s my _________?”
3. Avoid accidentally reinforcing behaviors you don’t want to see more of in the future.
Be sure to reinforce all verbal (vocal, voice output, signs) skills that are used to communicate what the child needs in the moment, but avoid accidentally reinforcing problem behaviors.
For example, if the child swipes things off the table to refuse a task, make sure you don’t immediately give him a break at that moment or he will likely use that behavior in the future in order to escape a task.
Instead, give a couple of easy instructions the child is likely to follow, and THEN prompt him to ask for a break or to stop the activity. Use that time to figure out what you need to change in the situation to increase the likelihood that the child will participate.
- Do you need to simplify the task?
- Do you need to allow more time for the child to process your request or do the task?
- Do you need to find a stronger reinforcer or provide it more frequently?
- Do you need to make the expectations clearer?
If the child begins to “release” or “let off steam,” make sure that once you’ve reached the Tension Reduction stage, you go back to the task.
This will help make sure you don’t accidentally reinforce the venting as a way to escape. Ways to be directive and set limits at this stage might be to:
- Use first/then statements.
- Remind the child what he’s working for.
- Take him back to his schedule if using one.
- Prompt an appropriate way for him to ask for a break.
While all children are different, for most children with autism, it’s best to avoid talking too much or getting too close at this stage.
4. Be aware of changes, and communicate regularly.
Ask questions daily to make sure you know if there have been changes in medications, sleep patterns, diet, if the child has had an illness, or if anything else has come up that could affect how she is being on a given day. Adjust your expectations accordingly to avoid escalation.
5. Use holds only as a last resort, and make sure they’re not reinforcing a problematic behavior.
As in all cases, physical intervention should only be used as a last resort, and only when the child’s behavior is posing more of a risk to his safety and well-being than any danger or risk of restraint
Another important thing to consider is that due to differences in the sensory system of the child with autism, some may find deep pressure reinforcing, so using holds could increase the likelihood that the child will aggress or become self-injurious in the future.
6. Make sure to record what happened right before a behavior occurred and what was done after it occurred.
At the Postvention stage, be sure to collect clear data about Precipitating Factors. Also document what you tried to do to de-escalate. Note a clear description of the behavior and a clear description of what you did right after the incident occurred.
This collection of ABC (Antecedent–Behavior–Consequence) data can be used to assist in determining the function of the child’s behavior, which is critical in order to make a plan to avoid the same thing happening in the future.
When collecting this data, think about being a reporter and just report the facts—no interpretations. For example, rather than say the child was hungry, you might put down that he hadn’t eaten.
7. Collaborate with other people in the child’s life.
This will help you assist in determining the function of a behavior, developing a plan, and making sure that everyone in the child’s life is responding consistently to the behavior plan developed.
The child’s doctor needs to be involved to determine the effects of different medications on her behavior. The child’s behavior analyst or psychologist can help with data collection or conduct a functional behavior analysis to determine the function of the behavior and develop a plan.
8. Make sure the child’s behavior plan is consistently implemented across settings.
The plan should always include a way to change what’s happening before
the behavior happens.
This helps decrease the likelihood that the child will escalate. The plan should also include a replacement behavior or a way for the child to communicate the SAME NEED that he was trying to communicate through the behavior.
For example, if it’s determined that the function of the behavior was to escape, the child needs to be taught a way to tell people when he wants to escape.
If the data shows that the behavior was to get attention, the child needs to be taught how to get attention in a more socially appropriate way.
Finally, the plan should clearly describe how adults should respond if the situation happens again. Parents, teachers, therapists, and everyone in the child’s environment must implement the plan consistently in order for it to be effective.
What works for you? Please share in the comments!
Tracy Vail, MS, CCC/SLP, is a speech language pathologist, an autism consultant, and a CPI Certified Instructor. As president of Let's Talk Speech and Language Services
, she works with children on the autism spectrum in a variety of settings including public schools, private schools, and private practice. In addition to her clinical work with kids, Tracy travels around the US and worldwide providing training and consultations for parents, teachers, organizations, and school systems to increase their effectiveness in helping children with autism. For more from Tracy, read 7 Tips to Help With Context Blindness and Autism