Setting the Stage for Cooperative Behavior

Helping someone change their behavior is not an easy feat. Throw in the characteristics of Prader-Willi syndrome (PWS), and the situation really gets complicated.  As parents, caregivers, teachers, therapists, we are constantly tasked with helping someone change their behavior. We may be focusing on something as simple as teaching someone to put their shoes in the shoe bin upon entering the house or as complex as remaining calm when they cannot have something they want. Unless you are lucky enough to have received formal training, you probably are relying on good intentions and basic problem-solving skills to address these situations. Sometimes this works! But other times, which honestly may feel like most of the time, you keep trying one unsuccessful strategy after another. When this happens, or to prevent it from happening, here are a few tips that can help (future blog posts will elaborate on these tips):

Rule Out a Medical Cause

When the behavior of an individual who has PWS suddenly changes without an obvious reason, this could be a sign of an internal change in their body. If the behavior is their way of coping with or reacting to this change, the behavior will not stop until the change is addressed. A visit to a medical professional is a good first step. At the appointment, let the medical professional know that the individual’s behavior has changed and you would like an exam to rule out any medical causes for this change. If the medical professional is not familiar with PWS or your loved one, it also can be helpful to show that person the Prader-Willi Syndrome Medical Alerts booklet created by PWSA-USA.  Speaking from personal experience, even something as simple as swimmers ear can present as increased fatigue, irritability, and perseverative behaviors. The most effective behavior intervention strategies will not be successful if their behavior is acting as a way to relieve some sort of physical discomfort.  

Figure Out the Why

All behavior serves a purpose. In the world of Applied Behavior Analysis (ABA), this is called the function of the behavior. Individuals engage in a behavior when they like the result it produces. There are four functions of behavior. People do things to gain access to something, escape something, gain attention (pleasurable or corrective), or for some kind of automatic (sensory) reinforcement. 

So, if you thought that your child was throwing things to escape cleaning their room, but when you stopped asking them to clean their room they did not stop throwing,  there is likely another function or purpose. For example, the behavior may be serving the purpose of gaining attention. They may like or want the attention they receive that comes in the form of you correcting their behavior. So, to meet their need of attention, the next time they have to clean their room, you could try staying in the room and talking with them while they clean. Or you could tell them that as soon as they are done you will play their favorite game with them. Trying these exercises could help you identify the function of the behavior.

Assess if You Set a Reasonable Expectation

Sometimes, what we want an individual to do right now and what they are capable of doing right now are not same thing. If a behavior persists despite making changes based on the believed function, it is possible the challenging behavior is that person’s way of saying that, right now, what they are being asked to do is too hard. After the situation calms, take some time to consider all aspects of the expectation and the current environment. Is there something that you can remove or alter to make it easier for the person to cooperate? 

If so, try to remove or accommodate it before presenting the expectation next time. For example, if asking your child to clean their room, they may not know what “clean” really means. So, you could help them clean their room to learn where things go, label drawers or bins, and take a picture of their clean room for them to reference next time. If it’s successful, over time, you can slowly increase the expectation until you are presenting the original expectation (or as close to the original as the person can tolerate). It is important to remember that what is a reasonable expectation under one condition may not be a reasonable expectation under another condition. For example, in the morning when rested and fed, your child may be able to tolerate an unexpected schedule change; however, in the afternoon, when tired and before snack time, they may not.  

Focus on Teaching Skills

When assessing the function and if the expectation is reasonable, consider if there are any skills the individual needs to learn so that they can participate in the presented situation. Being able to quickly and easily ask for a variety of things, wait for brief periods of time, stop  something they are doing, or ask for something they do not like to be removed are just a few examples of skills that may prevent an individual from having to engage in challenging behavior to get their needs met. 

Helping someone change their behavior can be a slow process. Don’t give up! Take time to assess the various aspects of the situation and the behavior, and then try again. Most importantly, assess if this is something that is reasonable for the individual to do right now and if there are any lagging skills the person would benefit from.