Managing Severe Challenging Behavior in the Home

Children and adults who routinely engage in severe challenging behavior typically require treatment and care from a team of professionals and trained caregivers. Unfortunately, due to a number of factors (service availability, staff shortages, etc.), individuals may not be receiving the amount or quality of treatment that they need. Because of this reality, many families are on their own with little or no day-to-day assistance or guidance.

Safety First

When treatment is unavailable or currently ineffective, families should focus on the safety of their children and everyone else in the family while trying to minimize the chances of inadvertently reinforcing the challenging behavior. If you’re working with a behavior analyst and your child has a behavior plan but it is currently not effective, we suggest you revisit this with your behavior analyst to create a safer environment in the home while the plan is being modified.

Proactive Strategies

Here are some proactive strategies that can be used to prevent challenging behavior from occurring:

• Reinforcers – If your child has reinforcers, be sure to have them with you. Keep an adequate supply at home at all times. You may also want to increase the frequency of the current reinforcement schedule or deliver the reinforcers non-contingently throughout the day at a higher frequency.
• Preferred activities – Do not add any additional or unfamiliar demands to your child’s schedule. Consider modifying your child’s schedule to increase the number of preferred activities throughout the day while maintaining variation.
• Home modifications – Consider making some modifications within your home to create more space in existing rooms, removing or taking down items that can easily break, and situating furniture in front of windows. These temporary changes can prevent a behavioral outburst from becoming a medical incident.
• Create a safe/calm space – Designating a room or a space within a room for your child to deescalate can prevent an outburst from becoming a full-blown crisis. Design this space so that your child can be there without the need of someone right by their side while also decreasing the chance of them hurting themselves.

Safety Strategies

Here are some additional safety strategies to consider in case the challenging behavior does occur:

• Protective equipment – Protective equipment is a key component of increasing the odds of keeping everyone safe during a behavioral outburst or crisis. Martial arts blocking pads and body protection are probably the most effective, but couch cushions, pillows, gardening kneeling pads, and other soft, cushiony items will also work well. Whatever protective equipment you have, make sure that you spread it out across the house so that it is always readily available.
• Personal apparel – Give some thought to the clothes and accessories that you and your family members wear each day. Avoid wearing jewelry, clothing, or any accessories that have loose and hanging pieces that can easily be grabbed. If you have long hair, you may want to consider wearing it up or having a hair band easily accessible. Durable and comfortable clothing like sweatpants, sweatshirts, and denim are good options along with having hats available to protect against hair pulling.
• Location and Movement – When a challenging behavior occurs, it may be your natural reaction to rush in to physically prevent or block it. Depending on the behavior and the space around you, it may be best to keep some space between you and your child. Even if you do need to be physically close to or touching your child during these times, always remain mindful of your balance and location. Try your best not to place yourself into unsafe spaces such as having your arm near your child’s mouth or standing right in front of them where you could be kicked or pushed off balance.
• Safety plan – Your family should create a safety plan that outlines some steps that everyone can follow in the case of a behavioral crisis. This plan should incorporate many of the items listed above along with trying to ensure that there are always at least two family members in the home to support each other if a crisis occurs along with consideration given to keeping younger and older family members safe.

The primary goal for families during a time when behavioral services are not available is to keep everyone as safe as possible. Of course, if 911 needs to be called, do not hesitate. Hopefully, the suggestions above can help families prepare for and potentially avoid a behavioral crisis and allow everyone to feel safe.

Experience Our Power of Connection

For additional information about behavioral crisis management and prevention or for assistance with accessing resources, contact Autism New Jersey at 800.4.AUTISM or email information@autismnj.org.

Originally posted 4/10/2020
Updated 6/7/2022