By Sarah DiGioia, BCBA, LBA, Director of Clinical Services 

Behavior can be defined as “any interaction between a person and their environment. Opening a door, walking up stairs, picking up a cell phone when it rings, these are all behaviors. Problem behavior can be defined as “Behavior that occurs at the wrong place at the wrong time, is too weak or too forceful” (Pyramid Educational Consultants, 2016). Common causes of problem behavior may or may not include organic factors such as ASD, ID, genetic disorders,  and certain medical conditions. They can also evolve from symptoms of those disorders such as communication impairments, stereotypy, rigidity, cognitive impairment, sensory deficits, chronic pain, and  immobility. They can also develop due to environmental and historical factors such as major transitions (move, divorce, etc), family issues and trauma. 

The key to reducing problem behaviors is identifying the function of the behavior, developing prevention strategies, teaching and rewarding more socially appropriate behavior. 

Crisis behaviors are behaviors that occur at a higher intensity, frequency, or duration of typical problem behaviors. Crisis behaviors are continuous behaviors that cause (or have the potential to cause) harm to the individuals, to others, and/or to the environment. These behaviors may include self-injurious behaviors, physical aggression, health threatening eating disorders, and other dangerous behaviors. Typically, crisis behaviors are caused by the same antecedent(s) as less intense problem behaviors, but there are several variables that may facor in:

1. Change in reinforcement (type or rate)
2. Change in demands (higher or lower)
3. New or sudden transition
4. Change in regular routine (new caregiver, teacher, aide, diet, etc.)
5. Medical (medication change, illness, allergic reaction or other medical condition such as a toothache, migraine or something more serious) 

The key to effective Crisis Management falls into four critical steps:

1. Crisis Prevention –Preventing the crisis from ever occurring in the first place
2. Crisis Minimization or De-escalation– Minimizing the effect or intensity of a crisis situation
3. Crisis Intervention– Knowing how to intervene when the crisis becomes dangerous
4. Post-Crisis Management and Debriefing– Safeguarding yourself and the student from legal ramifications and creating a plan for future crisis situations and prevention strategies

Crisis Prevention simply stated, means taking steps to avoid a crisis from ever occurring in the first place.

Strategies to prevent a crisis from occurring include:

1. Environmental engineering– Be aware of environmental triggers such as loud noises, tempting items (food items, toys, etc.), overstimulation such as bright lights, crowds, or high levels of movement. Be aware of environmental stimuli that are potential triggers for challenging behavior. 
2. Engaging in safe behaviors– Keep your child or  student(s) in close supervision at all times, avoid “vulnerable” positions (back turned to individual, head down, etc.), monitor your own behavior (body language, voice tone, proximity to student, excess language, etc.), protect yourself from temptation by wearing long hair up, avoid excessive jewelry, hoods, scarves, and other loose clothing. 
3. Creating a highly reinforcing environment– Deliver reinforcement (praise, rewards, motivating activities) often and non-contingently, make the child/student(s) see you as a reinforcer (this is often called “pairing). Continually observe your child/students to determine likely reinforcers and reinforcing activities. 

The goal of crisis minimization or de-escalation strategies is to minimize the effect or intensity of a crisis in order to reduce the overall impact of the situation. In order to minimize the intensity of a crisis behavior, it is important to be aware of what triggers problem behavior in the first place. Common triggers include:

• Loud noises
• Crowded spaces
• Unexpected changes in schedule/routine
• Difficult tasks or demands
• Delay or removal of a reinforcing item or activity

It is equally important to be aware of behavioral “signals”, observable behaviors that indicate a crisis behavior may be coming on. Common signals include:

• Pacing, rocking or other increased movement
• Certain facial expressions
• Fidgeting
• Staring
• Tapping or banging
• Increased vocal stim or self-talk

By developing intervention strategies when triggers and signals are first present, it is possible to reduce the impact of a crisis behavior. For example:

“When Paul is in the noisy lunchroom (trigger) and his French Fries are finished (trigger) his teacher notices he begins to rock (signal of possible aggression) and pick at his fingers (signal of possible aggression). She moves him to a quieter area away from the crowded part of the cafeteria (prevention strategy), and offers him a choice of something to drink or preferred book (prevention strategy). She asks her assistant to stay close by (intervention strategy) and praises Paul when he makes a choice without engaging in aggression (intervention strategy).  With Paul away from other students and her assistant nearby, if Paul does become aggressive, his teacher is able to intervene quickly with less potential of others becoming harmed or affected. “

Crisis Intervention involves knowing how to intervene when a crisis behavior becomes dangerous. When individuals exhibit crisis behaviors, it is important to respond to the crisis quickly while avoiding reinforcing the crisis behavior.  Make minimal eye contact with the individual and avoid any responses that might intensify the behavior. Call for assistance at the first signs of a crisis behavior and make sure the Individual  is away from dangerous items and at a safe distance from other people and potentially harmful objects. 

It may be necessary to physically intervene with an individual who is exhibiting crisis behavior. If your child or student engages in frequent crisis behaviors it is best to receive training in safe physical management procedures. These should ONLY be used as a last resort and if the child/student is at risk of harming themselves or others. Physical management should NEVER be used as a punishment or when the behavior being displayed is not dangerous to the child/student or others. 

Post-Crisis Management and Debriefing happens after a crisis occurs. This is a time to talk with all parties involved, including the individual who experienced the crisis if they are able. If a sibling was involved, talk with them separately from the individual. Debriefing is important for many reasons. One, it gives everyone involved an opportunity to process and reflect, and two a plan can be developed for a course of action to avoid future incidents. Some questions to ask: 

Can environmental antecedents or triggers be adjusted or avoided? 

What does the individual’s behavior tell you? 

Are they trying to get something or avoid something?  

What can the individual learn to do next time potential triggers occur? 

Did I/we handle this crisis effectively? 

In conclusion, the key to addressing crisis behavior is to prevent it from occurring in the first place, however that is not always going to be the case. For ongoing crisis behaviors it is best to seek professional guidance and support. 

For more information and resources: 

• https://www.autismspeaks.org/tool-kit/challenging-behaviors-tool-kit
• https://www.interventioncentral.org/behavioral-intervention-modification
• https://www.psychologytoday.com/us/blog/the-management-behavior-challenges