Ever Had a Crisis Kind of Day?

Let’s presume that you have already completed a functional behavioral assessment (FBA) and are implementing a behavior intervention plan (BIP) because a student on the autism spectrum has continually displayed problematic behavior. Yet as you put the plan into place, the student’s behavior still rises to the crisis level. This article will describe behavior stages that any student in a crisis mode will escalate through when displaying extreme emotions. The stages described are anxiety, questioning, refusal, release, and building rapport. In addition, helpful hints, and proactive strategies in each of the stages will be described particularly when working with students on the autism spectrum.

When any student is in a crisis mode, his/her emotional state is high while one’s quality of judgment is very low, and the student is on overload. It is important to note that for some student’s behavior starts with anxiety and escalates through stages while others may come into your classroom already in a full-blown crisis mode. As a result, it is imperative that the one primary person that is trying to calm the student with ASD understands the individual’s characteristics and his/her baseline behavior to identify when the student is in crisis. For all involved, the goal is to maximize safety and minimize harm in the crisis situation (Crisis Intervention Institute, 2021). In addition, lessons should be learned to work towards a safe resolution, and ultimately teach the student new skills to be successful.

Anxiety Stage

Students on the autism spectrum may feel anxiety about social situations, changes in routines, overload of senses, and environment stressors. A warning sign may be that the individual displays a change in typical behavior. This may be an observable repetitive stimming behavior of increased pacing, rocking, hand flapping, or repeating scripts or movies to self. As staff, our job is to be supportive. This means acknowledging the change in behavior and offering the student with ASD assistance using positive behavioral support strategies. Some of the ways may be to:

• Allow more time to process information (e.g., may need 30 seconds to ten minutes). Make sure everyone is clear about the time needed for the student to receptively process information. Try giving one direction, then wait a designated time before restating the information. If the time needed is long, try walking away from the student to help another child in class. Be patient. Then watch to see if the student follows the direction given.
• Model ways to express the need for a break (e.g., visual supports, sign language). Many students with ASD need periodic breaks within the structure of their day to calm themselves. This time is essential and should not be thought of as a “reward time.”
• Often individuals with ASD display anxiety and frustration due to the curriculum not being at their level of learning and/or being expected to show their responses in the same manner as other classmates. Instead, acknowledge learning styles and try to implement the tools provided by Universal Designs for Learning (e.g., engagement, representation, action, and expression; CAST, 2018)
• Identify sensory needs or movement differences that exist. Then with the occupational therapist, plan strategies to accommodate and support the student across all settings.
• Allow time to review the daily schedule (i.e., using photographs, symbols and/or words) when the student first arrives at school to relieve their anxiety.
• Offer the student choices. For example, first take a sensory break, then go to the reading group at the round table. Or show me the order in which you want to do your math papers. Let’s put a number one on the first paper and so forth. Providing choice can help to minimize behavior challenges.
• Consider any setting events/precipitating factors the student with ASD may not have control over (e.g., health concerns, changes in medication, weather, lack of sleep, poor nourishment). Create an alternative schedule (e.g., Handle with Care Day) which would allow for adjustments for how individuals need support for just that day.

Questioning Stage

In the questioning stage the student may seek information to clarify what was heard or what is stated on the individual schedule, or the reason for a change in routine. Simply answer the question factually and honestly. If the staff member doesn’t know the answer, say, “let’s find out together.” If the student’s question is not addressed, the questioning can lead to challenging the authority of the adult. This may look like the student with ASD raising his/her voice or demanding answers. The best approach is to remain calm, listen to the student’s concerns and provide the answer(s).

Refusal Stage

When positive behavioral supports fail or are not implemented consistently and correctly, the behavior may start to escalate. During the refusal stage, the student is unwilling/unable to cooperate, follow instructions, or do the task. His/her voice may get louder to the point of screaming, verbally yelling, “no”, or walking away to the point of running out of the classroom. The student with ASD may also hide under a desk, sit with arms folded or refuse to talk. The staff needs to respond calmly by setting limits. Staff members need to make sure the limits are:

• Clear and simple – Many students with ASD learn best by being given short phrases that are concrete (e.g., the bell to start class just rang, sit down at your desk). Don’t keep rephrasing directions in a short amount of time. Ask yourself, “Am I using too many words?” “Could I say what I want to say in a few sentences?” Individuals with ASD can process short phrases of information best compared to a full explanation. Often the difficulty lies in our need to express a lot of information. Other students work better with choices or options. Always state the positive choice last so that if the student with ASD perseverates it will be on the positive option. Also, try to replace one’s words with visuals (Gray, 2015).
• Reasonable – Remember that all behavior communicates a need and serves a purpose from the student’s point of view. Make sure limitations stated are within the individual’s capabilities. The limit that is set may need to be flexible. For example, staff requests the student to return to a specific location after running out of the room. The student may move closer to the designated location but need additional space. Ask the student if you can approach him/her. If he/she says “No,” respect their wishes by allowing some space. Then try again after a period based on their processing time when agitated. Try to write a note to use fewer verbal requests. This process may take some time. It is important to wait. Listening to the student’s needs is an important part of setting reasonable limits.
• Enforceable/Consistent – When setting a limit, make sure that staff can consistently follow through with the expectations. Do not overreact by grabbing or running after the student. The appropriate response by staff should only include verbal or visual redirection.

Release Stage

If time is not allowed or a solution has not been discovered for the student to calm down, then the behavior may escalate to releasing their anger. This can be a verbal or emotional outburst. This may look like screaming, swearing, or high-energy output. Also, the student may cause harm to themselves (e.g., head banging, biting, slapping self) or others (e.g., hitting, kicking, pinching, pulling hair, throwing objects).

The student with ASD may also be aggressive or intimidate staff or others verbally or nonverbally. It is critical to realize that our behaviors may further escalate the situation. Below are some reactions to avoid:

• Do not start setting firm limits after the student is calm.
• Do not bring up past incidents that may have occurred on another day.
• Do not judge the student or compare him/her to other students in class.
• Do not lecture the student.
• Do not make up consequences as the crisis escalates. State clearly the boundary or rule that the student needs to learn from the crisis experience. If a consequence must be applied, make sure it matches the function of the original behavior. The consequence needs to be immediate, relevant, and natural if possible.

Below are solutions to follow when students with ASD are at the release stage:

• Take all threats seriously. Seek assistance.
• Calm the student. Use a soft voice and talk slowly. For the student to be emotionally regulated, adults must make sure we are not agitated and unregulated.
• Get other students in the classroom out of the area. Have another staff member take the class to an alternative setting (e.g., library, another classroom) or stay with the class if the student runs out of the room. This process should be pre-planned.
• Radio or call the administrator or liaison in the building to be involved in all levels of the crisis.
• Make sure that everyone in the situation is safe. Students that are apt to harm themselves when they are frustrated or scared will continue this behavior until they are taught another solution, and/or until the environment is altered correctly for their needs.
• If the student is harming him or herself, be sure to include in the crisis plan safety procedures to implement (e.g., when hitting head against a cement wall, block using your hand or a soft object). Discuss how you will redirect, ignore, or support the individual at this crisis point. Be sure everyone knows the plan.
• Being aware of how you handle crisis. Ask yourself: Am I overreacting? Under reacting? There are some interventions that should be done cautiously. Make sure you:
  
  • DO NOT physically intervene unless the student is being aggressive towards others in an uncontrolled manner. This must be used only as a last resort. Remember some students with ASD crave deep pressure. As a result, physically holding a student who needs deep pressure will reinforce the inappropriate behavior.
  • DO NOT use any type of physical intervention or restraint unless the school policy allows, school procedures have been followed, staff have been trained with specific instructions in these techniques, and the entire case conference team (including family members) have been informed. Also, consider the size and age of the student. The student should never be taller or stronger than the staff member. If physical intervention is essential, make sure that there are more than two people in the area helping the staff member.
  • Ultimately the focus should still be on helping the student regain control of their behavior. Be sure to set realistic expectations for the specific individual with ASD.

Building Rapport Stage

Once the student is in a safe environment, the staff member(s) involved should take a short break to get a drink, take a walk, go to the restroom, regroup and/or seek medical attention if needed. Once the student and staff are calm, time is needed to start building trust and communication again. The best time to process with the student isn’t always immediately after the crisis event. It may be hours or a day later. However, it is imperative to process together before the student returns to the specific class or situation to have a proactive plan in place.

The student may feel embarrassed, show no emotion, be remorseful or laugh inappropriately. Often students with ASD show inappropriate emotions in uncomfortable situations. The student may not know how they feel and be unaware of how the staff is feeling during or after the crisis. Be prepared, the student’s behavior could quickly re-escalate depending on the student’s interpretation while processing the situation. The focus should be on re-establishing rapport with the student by:

• Evaluating if the student can reason through the situation. It is important to know the student’s capabilities and respect how they process information even if it is different from the needs of the staff members.
• Understanding that all behavior serves a function. Talk to all the staff involved before the crisis occurred to understand the underlying conditions surrounding the behavior.
• Giving your undivided attention to the student by completely listening to the real message (e.g., using reflective listening, visuals). Allow the student to vent frustrations if possible.
• Returning the student to a familiar setting. The student may need reassurance from a specific staff member before returning to class.
• Asking the student what occurred from their perspective. Listen to the response. Be opened minded to the student’s perspective.
• Respecting the student’s personal space by asking if you can sit by him/her to talk.
• Implementing different strategies to support various students in a personalized manner.

Effective interventions for students with ASD must include the recognition that all behavior has a function and communicates a message. The staff must learn to interpret these behaviors and attempt to teach alternative strategies by acknowledging the individual’s language processing time, learning style, sensory needs, social capabilities, and cognitive ability. Any person working with individuals with ASD will need to communicate with a group of people to constantly investigate different patterns, antecedents (triggers), and messages of the students’ behavior. Here are some general rules to keep in mind:

• Students who engage in behavior that warrants a crisis approach, must have a behavioral support plan that is consistently followed.
• Minimize your verbalizations in a crisis. Use visual supports. Start with one word or picture written on a piece of paper. This can be as simple as a stick figure if the student understands the image. Do not lecture the student.
• If you continue to spend most of your efforts with a student in a crisis mode, then redo the FBA and reexamine the behavior support plan.
• Crisis management is a short-term intervention that has no long-term or educational outcomes.
• The outcome of a good behavior support plan is not that others can control the student in a crisis, but that the student can learn to self-manage or self-control. Controlling a student’s behavior will not prepare them for adulthood or for the time when staff are no longer present. 
• Remember as professionals that the way we frame our responses to the student impacts their behavior and attitudes and may add to the problem situation. Challenge yourself and your team members to be more proactive and positive. Follow the lead of the student by listening, watching, and waiting for the student with ASD to “show” their needs and address these before the crisis arises again.

Documenting and Debriefing

After the crisis, each team member needs to take time to document what occurred from their perspective before processing with another person or debriefing with the team. Document, document, document! If the incident is not in writing, technically it did not happen. Without written information, the school has nothing but hearsay evidence if there is a hearing, complaint or if additional action is warranted.

Debriefing is a time to process the crisis as a team. It is often done after school or the next morning. Everyone talks about the situation using their documentation report. This will allow everyone time to express concerns, provide feedback to one another, and become more aware of the student’s needs. A plan will need to be developed or tweaked if one is in place. Then shared with the student and family members so that everyone can work together to prevent crisis situations from occurring in the future. Revising the original FBA and BIP to re-identify the function of the behavior and the antecedents is suggested. An observation by an independent person (e.g., someone not involved with the student daily) may be helpful to give more insights to the behavior. Often when the original plan is created, it will need to be tweaked as more information is discovered.

References

CAST (2018). Universal Design for Learning Guidelines version 2.2. Retrieved from http://udlguidelines.cast.org

Crisis Prevention Institute (2021). CPI’s top 10 de-escalation tips. Institute Crisis Prevention: Milwaukee, WI.

Indiana Resource Center for Autism (2021). Behavior and emotions: Visual supports. Indiana Resource Center for Autism: Bloomington, IN.

Gray, Carol (2015). The new social story book: 15th anniversary edition. Arlington, TX: Future Horizons.

Dubie, M. (2021). Ever had a crisis kind of day? Retrieved from https://www.iidc.indiana.edu/irca/articles/ever-had-a-crisis-kind-of-day.html.