Dealing with escape behaviour: how one therapist rose to the occasion wonderfully

As we work with children on the autism spectrum and their families, we frequently talk about negative reinforcement and how it can cause difficult behaviours to persist.

Here is an example: S is a child who can read and write very well but does not like to work. You ask him to read something and answer a question, he starts whining. Since he whines, you leave him alone, thus removing the demand on him. Next time you ask him to read, he whines more and eventually, every time anyone asks him to work, he whines.

This is ‘negative’ as the demand was removed in response to the child’s behaviour and ‘reinforcement’ as the whining behaviour has increased. Oh, by the way, I never said the child has any difficulties. Also, remember this has nothing to do with the nature of the behaviour.

Now, replace ‘reading and writing’ with any other demand like asking the child to point instead of pulling your hand. And then, replace ‘whining’ with self injurious behaviour like head banging, biting/scratching self, or aggressive behaviour like hitting others. Now you see how big the negative reinforcement problem can become.

The other day, one of our therapists was working with K, an impulsive child diagnosed with ADHD. When she asked him to write nicely, he strikes out with his pencil hand, kind of stabbing her on the thigh. It starts to bleed. Another therapist takes over, this one changes clothes and comes back to sit with him. The child himself is shocked at what happened.

Despite our request to leave, go see a doctor and take the day off, the therapist refuses to do so and continues to work with the child. Her thinking was that leaving the child to work with someone else can have a negative reinforcement effect, where the child starts to learn that if I don’t like something, I can hurt people and then the demands on me are removed. Much as we would have liked her to go to a doctor immediately, we could not disagree with her. And thankfully, the wound was not that serious and she is back at work today, though she is on pain killers and has a little limp.

The next time you see a child who seems to show escape behaviours, self injurious behaviours or aggression, think of this story and think of the child’s experiences that would have reinforced such behaviour. And ask, “is it really the child’s fault?” Our guess: this line of thinking will help you empathize more and suggest a better course of helping the child.

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