Where Does Anxiety Fit in the Behavior-Communication Connection?

Where Does Anxiety Fit in the Behavior-Communication Connection

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Communication doesn’t explain all challenging behavior in students with autism. What if behavior related to anxiety or sensory input gets reinforced inside the body? Those students who function in the average to above-average range still face hurdles, and one of them is an increased rate of anxiety and depression. In this episode, I discuss how you can address those with communication responses in your functional behavior assessment.

5:12​ – The conversation with an Academy member that got me thinking

8:28 – The tricky nature of proper behavior analysis for students with anxiety disorders

11:14 – Keep this in mind when attempting to fit anxiety into the functional behavior analysis process

13:46 – An example of a behavior hypothesis for the FBA that takes anxiety into account

17:14 – Further illustrating why behavior and communication aren’t always necessarily the same

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Welcome to the Autism Classroom Resources Podcast, the podcast for special educators who are looking for personal and professional development.

Christine Reeve: I’m your host, Dr. Christine Reeve. For more than 20 years, I’ve worn lots of hats in special education but my real love is helping special educators like you. This podcast will give you tips and ways to implement research-based practices in a practical way in your classroom to make your job easier and more effective.

Hello, there. I am so glad you’re here today for the Autism Classroom Resources Podcast. I’m Christine Reeve. This month, we are talking all about the relationship between communication and behavior. It’s interesting, I was visiting the other day with my co-author, longtime co-worker, and friend, Susan Kabot. I’ve had to—on the podcast, a couple of times—to talk about communication. She’s a speech pathologist. She came on and talked about students who are functioning in the average or above average range of cognitive abilities who have autism.

In those episodes, we talked about some of the hurdles that those students face. One of which is specifically, increased rates of anxiety and depression, how that impacts both their communication and their behavior. You can hear those interviews about teaching pragmatic communication skills and some of those other challenges in Episodes 70 and 71. If you just go to autismclassroomresources.com/episode70 or /episode71, I’ll make sure those links are in the show notes as well.

Anyway, we were talking about this this weekend, working with behaviors with the students that we noted in those episodes. It’s really complex. One of the reasons for that is because their behavior functions just aren’t as clear cut as we’re often led to believe when we are taught about how to do a Functional Behavior Assessment. We believe that all behavior is communication. I hear people say that all the time. When I put it out on Facebook, almost everyone said that it was. Certainly you know—if you’ve listened to the podcast for the last couple of weeks—that I believe that communication plays a huge role in challenging behavior. 

I think that our research shows that there’s no denying that, but is it really the explanation for all challenging behavior? Because what about behavior that’s related to anxiety or sensory input and automatic reinforcement where the behavior is reinforced by something inside the body? Can we really address those with just communication responses? What about things like depression? Where did they come in when we’re dealing with a Functional Behavior Assessment? That is what I’m going to talk about today. I’ve got a free download for you on the blog. I will share that with you later in the episode as well. Stay tuned for that. Grab a cup of coffee, or your beverage of choice, or get comfortable in the seat of your car. Let’s get started.  

Most of our research literature on Functional Behavior Assessments was completed with individuals who had severe disabilities, severe developmental disabilities, and individuals who had severe communication difficulties or disabilities. Many of the participants in the research studies were nonverbal and couldn’t tell us what they were thinking or what they were feeling. Yes, as a behavior analyst, I do think that people have thoughts and feelings that play a role in their behavior. Yet, when IDEA started the mandate to use Functional Behavior Assessments in schools around 1997, it required an FBA for every single special education student who needed behavioral support in the classroom, not just for students with developmental disabilities, even that those were the individuals where most of our research related.

Our functional research really focused on that group but we didn’t really have a lot of research on groups outside of that. That was great for those of us that are working in autism and ID but what about the students who had Attention Deficit Disorder? Well, we do have some literature on that but not necessarily FBA literature, or students who had depression, or students with obsessive compulsive disorder, or other anxiety related disorders. We still have very little research literature about those types of needs when we think about doing functional assessments.

I was talking to a member of the Special Educator Academy the other day. In the academy when you finish your trial and decide to stay on with us, you can book a quick Zoom meeting with me to help make sure that you’re getting the most out of your time in the academy. We’ll talk about your situation at work and what you’re looking for in the academy. I’ll help you make a personal path through all of our material in the academy so that you are making the most of your time there; because we have so much content now that it’s really hard to really navigate through all of it at times.

This particular member was a behavior analyst who recently started working in schools. She noted that it was difficult at times to fit the behavior analysis mold for FBAs into the need for writing behavior analysis hypothesis statements for students who had more internalizing types of disorders like anxiety where the trigger for the behavior wasn’t always related to the external environment and available for us to observe. It got me thinking again about the role of communication and behavior issues, again about whether behavior was always communication. I promise I am coming back to that. Just hold on to that for a minute. 

When we train—as behavior analysts, I’m speaking for myself—when we train about how to do an FBA, we don’t get nearly close enough to talking about how complex behavior really is. It’s more than even just a training issue. For a long time, our literature and our training had a habit of just talking about the four functions of behavior, as if four little words could sum up the complexity of human behavior. Is it an escape behavior, attention behavior, an automatic or sensory reinforcement behavior, or a tangible behavior, which basically means that they got something that they want?

But really, if we just name the function of the behavior, what does that really mean? Imagine if I dropped Reggie off in your classroom. I said to you, “Oh, he has an escape behavior and left.” Would you have any idea what to do with him? You’ll probably would have a lot more questions. Escape from what? Escape from the room? Escape from the teacher? Escape from work? Escape from groups? Escape from social demands? Escape from specific work demands? What does he escape from? Who does he escape from? Does he escape from being around girls with hairbows? Yes, I have seen escape related behaviors that is that specific.

Just knowing that the behavior is a escape related doesn’t necessarily give us the information that we need to be successful. That’s because obviously, human behavior is pretty complex. Our description and our understanding needs to match the complexity. It can’t be one word. It can’t be simplistic. Let me go back to the question of a student who presents with something like anxiety; How does that fit into the common focus of an FBA? A traditional FBA looks at the antecedents behavior and consequences.

Let’s take Anaya who has anxiety. Anaya’s data is all over the place. When we look at her ABC data, it shows that sometimes in a work situation, she has no issues whatsoever. Then two hours later in the exact same work situation, same people, same work, she becomes a puddle of tears, she starts tearing things up, and then she starts throwing them. What happened? What changed ? All the outward elements seem to be exactly the same. Well, maybe it’s the time of day. You take some more data.

You set up the same situation on a different day. Same materials, same work, same people, same time. She becomes a puddle, she starts tearing things up, and throwing things. You do the same thing two hours later, and she’s fine. Okay, that’s the opposite of what happened last time. That makes no sense as far as it being a time oriented component. You did this a couple more times and it becomes just as confusing as you look at the data. Then you sit with the team, you ask them what they saw, and what they observed that maybe wasn’t in the data that you took. Someone says that they noticed that Anaya was chewing her fingernails before the work each time she had a come apart, for lack of a better term for the behavior, when you presented the work.

Okay, now I’m making it really easy for you. In reality, there might be no behavior seen at all. No sign of anxiety. Maybe you start to see signs of some sort of internal setting then like anxiety, or maybe you don’t. Maybe you don’t even see it. Maybe when you go back and look at her record, you see something that clues you into this. Maybe Anaya is able to tell you that she feels anxious. Maybe you find a previous anxiety diagnosis. Maybe you guess if you have nothing else to go by. Then maybe you test it out by teaching her some relaxation strategies, to perhaps bring her anxiety down before doing that specific task to see if that prevents the behaviors, and it works. That’s one way to test it out to see if your hypothesis is correct.

How would anxiety fit into an FBA, ABC letter alphabet that is our FBA process? Well, there are three things that I would say we need to consider with this that are important. First, it’s important to remember that human behavior is anything but simple. The idea that a three-term contingency of Antecedent Behavior Consequence is going to completely and adequately sum up every behavior is probably not going to work. Think about how many times your consequence ended up being an antecedent to the next behavior, and the behavior ended up being an antecedent to the next behavior before the environment even responded with an outcome or consequence.

We know that what we’re going for in understanding the ABCs is the context of the behavior, not a straight linear relationship. We’re trying to capture the overall context of the individual’s behavior and the environment actions around that behavior to find the different connections and overlaps between them. It’s not really a three-term contingency though, is it? Because it also needs to include things like setting events.

I’ve talked about setting events during Episode 11 and in other places on my blog. If you’re not familiar with setting events, they’re essentially something that sets the occasion for the antecedent to trigger the challenging behavior. They make it more likely that the challenging behavior is going to happen. Typically, they’re more global than just a single event. They can be something that’s internal that we can’t see. We have research literature that includes focusing on pain and discomfort, good and bad mood.

Yes, you can actually do things to change someone’s mood from bad to good, and get better behavior. Rapport with staff in a group home which shown to impact behavior. If you think about it, that makes sense. People are more likely to comply with individuals that they have a good relationship with. McLaughlin and Carr also implemented ways to increase the report to improve behavior. I would contend that anxiety is a setting of it. It’s something that when it’s present, it sets the occasion for the work in Anaya’s case, to trigger the problem behavior. But when she isn’t anxious, the behavior isn’t an issue. The work doesn’t set it off the way it does when the anxiety is there.

How does that factor into the hypothesis statement? Coming back to my academy member who is grappling with how to do this and how to put it into the FBA. Well, I believe that hypothesis statements need to be really detailed and focused on what we’ve observed over time with the individual. They need to lead directly to what our behavior plan is going to implement. Rather than saying that Anaya’s behavior serves to escape from situations when she’s anxious, or that Anaya engages in challenging behavior to escape work situations, her behavior hypothesis might be when an Anaya is showing signs of anxiety such as biting her fingernails, or expresses anxiety to an adult, depending on what an Anaya is actually doing, then is presented with a math task requiring writing, she begins to cry and tear papers.

This behavior escalates until she’s throwing items off the table. The staff typically removes her from the area to a quiet area until she calms down. There’s your consequence. When Anaya does not exhibit signs of anxiety, state she is not anxious or engages in relaxation exercises before the math work, she completes the work without incident, much more specific, right? But it also tells me exactly what I plan to do for intervention.

Replacement behaviors might be teaching her to initiate the relaxation strategies on her own, possibly teaching self regulation skills to know when she needs them. Teaching her to ask for a break or a calming period before starting difficult tasks independently if she is feeling anxious. You can see the preventive strategies within the work that’s already been done. By writing it factually, we have the “anxiety” there which, granted, is a mental construct instead of a behavioral one. But I don’t think that anybody could deny that it exists, or would say that they’ve never felt anxiety at some point in their lives.

We’ve tied it to some behaviors that we can either observe, or she can report based on who she is and what she does. You can also tie it to self regulation tools, like a five point scale that she rates herself on. I’ve got a post on that and I’ll share that in the show notes. Because don’t forget that for students who are able to report their own behavior, they can often accurately report their internal thoughts and feelings. We can’t always rely on them 100% but we can rely on them to some degree, depending on the situation and the student.

I’ll never forget a talk that I listened to with Rob Horner once who made the statement that it was so amazing when he started working on school wide Positive Behavioral Support when he realized that with typical students, you could just ask them why they did things. Sometimes they would tell you. After so many years of working with students who are nonverbal, that was just amazing. Sometimes we really do make things harder than they have to be.

To finish this off, because I’ve gone longer than I normally do in this podcast, let me come back to the question that I posed to my friend, Sue, about whether all behavior is communication. Her answer, and my answer is, well, we’re the same as they often are, is, “I don’t think that they are necessarily one and the same.” I don’t think that behavior that comes out of anxiety, for instance, is always communication based.

Could you make a leap and say that Anaya wants you to remove the work because she is anxious? Yes, you could, because in her case, there is an escape related component to it. But that behavior also likely has an automatic sensory function of relieving the anxiety. It’s two-piece. There’s an escape related piece, which is communication based, because she can ask you to remove the work, but there’s an automatic piece that isn’t communication based, that if we could make the anxiety go away, we wouldn’t need the communication piece.

Anxiety often reduces just with physical action, or deep breathing strategies. There’s anxiety related strategies that we can use to reduce the anxiety that are not necessarily communication based. It often reduces when someone’s crying. There’s also reactions to anxiety that can reduce behaviors that we consider problem behavior like crying or an outburst. There’s that component of it as well.

Let’s look at a more clear cut example. What about a student who has obsessive compulsive behaviors? A student who has to touch the doorframe seven times before he enters a room? The reinforcer for that behavior is the reduction of his internal anxiety or the prevention of the rise of the anxiety that happens if he doesn’t do it depending on how you want to look at it. When he does it, the anxiety doesn’t get worse. If he doesn’t do it, the anxiety will consume him. That happens if he’s in a room by himself. There is no social communicative context for that behavior. To me, that’s not communicative. It has an automatic function.

It’s an internal reinforcement to internal negative reinforcement, the removal. The same could be said for a student who pokes himself in the eye for an automatic reinforcement. The white light he sees when he does it, is he asking you to poke him in the eye to receive that visual feedback as a reinforcer? No. He’s gaining it on his own. To me, that’s not communication. Communication is delivering a message to somebody until someone responds to give you what that message was, to respond in a way of what you’re communicating for, or until you give up because you failed to deliver that message. That to me is the definition of communication based on Bates. That to me does not fit that definition.

To me, and to Sue so that I don’t feel like I’m alone, I don’t think that every behavior has a communicative function. Behavior is not always communication. However, in all of those cases, we might use communication as a replacement behavior. For instance, we might teach Anaya to ask for a break when she’s anxious. But we can also teach her self regulation strategies or self relaxation strategies that are not communicative to address the anxiety. Not all the interventions will be communicative either.

We might teach the student with obsessive compulsive symptoms to ask someone who typically prevents him from touching the doorframe—now, I’m talking about outside the context of therapeutic purposes where we might be working on that, but if there’s a kid in his class who always says stop doing that, makes him stop—we might teach him to ask them to not prevent him from doing this, to not prevent him from completing his ritual. That might help him avoid that anxiety spike and therefore avoid challenging behaviors.

We might teach the student who’s poking his eye to request a toy or something that provides that visual stimulation without the dangerous behavior, something like a white light kaleidoscope that we’ve taught him to use, and that might serve that same reinforcement function.  Later, we might teach them to request it. First, we might teach them just how to use it.

What about you? Do you struggle with trying to figure out how to integrate more complex information in the behavior plans and FBAs? You can grab a free template for writing hypothesis statements like the one I described in this episode on the website for this episode at autismclassroomresources.com/episode124. If you’d like more training in how to assess and integrate more complex information into FBAs and behavior plans for different students, definitely come join us in the Special Educator Academy, where we have a whole course on behavioral problem solving, and tons of other behavioral resources that address all these kinds of issues. Grab your seven-day free trial at specialeducatoracademy.com.

Stay past our trial and book a free consultation with me to plan out how to make the most of your time with us. Thanks for joining me today for this walkthrough making sense of the relationships between behavior and communication. I know it’s been a little longer than usual. Make sure you subscribe on the blog on your favorite app or wherever you get your podcasts and have an amazing week.

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