Question

Case: Susan is a five-year old girl who is attending preschool with approximately thirteen kids in her class. She has been in preschool for three years now. Teachers are concerned that Susan has been “acting out” in class a lot and seems to be in appropriate. For example, there were quite a few incidents that Susan hugs and kisses boys and girls. She pulls up and down her dresses. On the playground underneath the slides she has been found lying on another boy. Susan likes to go into the bathroom while others are going to the bathroom. The bathroom is unisex without stalls. Susan sometimes comes into her parent’s bedroom and sleeps with them. She tries to come into the bathroom while her dad is using the bathroom. She has come in on dad while he is getting dress. Her dad admits that he is not always very careful about modesty around the house. She is also inattentive and somewhat hyperactive in class. Teachers report that Susan is behind in her pre-kindergarden skills but everyone seems to think that she is intelligent and could learn them. Susan sometimes place herself in “harmful” ways to get attention from others; she will stand in front of a swing or sit at the bottom of a slide only to get hurt and have to go to the nurse’s office. Parents tell Susan to go to her room as punishment for her outside of circle time since she does not know how to act appropriately in circle. Teachers have taught other students to assert themselves and to hold up their hands and say, “Stay back,” when Susan intrudes their places.

1 As a teacher, what do you want to know about the child?

2 What interventions should be conducted with Susan to get her “behaviors” under control?

3 How will you evaluate Susan’s response to your intervention? Please be specific about what behavior changes you will be looking for and how you will evaluate those changes

4 What criteria will you use to determine the success of your behavioral intervention?

Answer 1

1. The family dynamics and home environment is something that needs to be understood in detail. A brief case history and understanding the child from a bio-psycho-sociocultural perspective is a must before any work can be begun with her. Also, a hypothesis related to probable sexual/physical abuse is something that needs to be probed along in subtle ways from the family. Acting out behaviour and bizarre actions at this stage could be culminating from such violence.
2. Behavioural management needs to be carried out with Susan in order to keep her ‘acting out’ in check. There has to be immediate consequences to her behaviour. In fact every time she follows a rule/protocol successfully immediate positive reinforcement in the form of good feedback and encouragement needs to follow. The key is to being proactive with her instead of reacting upon her behaviours. The behaviour is the outer surface of what may be culminating at a psychological level. It needs to be understood that this impulsive behaviour may also be a neurological condition such as ADHD and therefore the appropriate intervention plan needs to be created and implemented with the help of a professional team. Rating scales used to identify ADHD in a child such as Conner’s Parent Rating Scale can be used for the same. Structuring their routine and trying to channelize the excess energy by allowing a lot of physical activity is something that may help too. The expected behaviour needs to be out there in front of the child, concrete enough for them to have it handy, till it becomes an automated way of being. Visual rewards and appreciation cards can be used to reinforce correct actions.
3. In order to evaluate her responsiveness to the intervention plan, her improvement in classroom behaviour needs to be monitored. Number of times she has followed other people into washrooms, intruded other people’s space, hurt herself or others intentionally. Any decrease in the number of times she has engaged in these behaviours means that the intervention plan has led to improvement in the behaviour. The same then needs to be implemented furthermore, until the behaviours are completely in check.
4. The success of the implementation can thus be acquired from her environmental settings such as school, family, neighbourhood, peer group. A positive feedback and sign of improvement means that the plan has led to change and needs to be implemented furthermore until the behaviours are in check. However, if a change has not occurred more planning and re-structuring of the program will be required.