Positive Behavior Support and Neurodiversity Affirming Approach for Self-Injurious Behavior in Ruben
(please note all names have been changed to protect privacy).
Introduction:
This case study explores the work one of our clinicians did to address self-injurious behavior in a participant named Ruben, who is a neurodivergent individual. PBS aims to understand the root causes of challenging behaviors and implement proactive strategies that focus on increasing positive and adaptive behaviors while reducing distress and harmful actions. At Transform Life we focus on building meaningful relationships and quality of life overall- using the PBS approach.
Participant Information: Name: Ruben Age: 16 years old Diagnosis: Autism Spectrum Disorder (ASD) and Intellectual Disability (ID) Self-Injurious Behavior: Head-banging, hitting self with objects, and biting fingers during moments of distress or frustration.
Background:
Ruben is a friendly and energetic teenager with ASD and ID who loves marvel movies and learning about all things AI. He communicates primarily through non-verbal means such as gestures and vocalizations. His self-injurious behaviors began to escalate during periods of heightened stress, changes in routines, or sensory overload. These actions not only caused physical harm but also raised concerns among his caregivers, family, and support team.
Neurodiversity Affirming Approach:
The Positive Behavior Support team, comprising caregivers, therapists, educators, and a positive behaviour support practitioner, took a neurodiversity affirming approach to address Ruben’s self-injurious behavior. This approach embraced and respected Ruben’s neurodivergent identity, recognizing that his behaviors were his unique ways of expressing distress and needs and that all behaviour is communication.
Proactive Strategies Implemented:
- Functional Behavior Assessment (FBA): An FBA was conducted to understand the triggers and functions of Ruben's self-injurious behavior. Observations, interviews with caregivers, and data collection were used to identify patterns and contexts in which the behaviors occurred. At Transform life we use data collection in conjunction with input from the individual to form a picture of the function that the behviour serves for them.
- Communication Support: As Ruben's primary mode of communication was non-verbal, alternative communication methods were introduced. The team used an AAC device, pictures, and a communication board with icons representing his needs and emotions. This facilitated better communication and reduced frustration. It was found that Ruben communicates best with his close friend Mike, so our team was sure to include Mike in the problem-solving process!
- Sensory Regulation: Recognizing that sensory overload contributed to Ruben's distress, a sensory-friendly environment was created. This involved adjusting lighting, noise levels, and providing sensory tools like stress balls or weighted blankets to help him self-regulate during overwhelming situations as well as giving him forms of communication that were accessible to him during heightened moments.
- Choice and Autonomy: Supporting autonomy and offering choices whenever possible helped reduce feelings of helplessness and frustration. For instance, Ruben was offered choices for activities, supports, and preferred objects, empowering him to make decisions about his experiences in ways that were meaningful to him.
- Teaching Coping Strategies: Ruben was taught alternative coping strategies to express his emotions constructively. This included introducing relaxation techniques like deep breathing exercises or redirecting his energy through types of exercise that he likes such as martial arts.
- Collaborative Teamwork: The Positive Behavior Support team collaborated closely with Ruben and his family, teachers, and support staff. Regular meetings were held to discuss progress, share insights, and ensure consistency in implementing strategies across various settings as well as making sure Ruben was on board with all strategies being implemented.
Outcome:
Over time, the implementation of Positive Behavior Support strategies positively impacted Ruben’s self-injurious behavior. He began using communication tools more effectively to express his needs and emotions, resulting in a reduction of frustration and distress. His self-injurious incidents significantly decreased, and he started engaging in more functional behaviors, fostering a sense of empowerment and improving his quality of life!
Conclusion:
The neurodiversity affirming approach, coupled with Positive Behavior Support strategies, proved to be effective in addressing Ruben’s self-injurious behavior. By understanding and respecting his unique neurodivergent identity, the support team could tailor proactive strategies that reduced distress and promoted positive behavior. Through collaboration and a person-centered approach, Ruben’s quality of life improved, and he made significant progress in managing his emotions and communicating his needs more effectively.
