#13. Behavioral approaches in early intervention

Behavioral approaches take the view that behaviors are learned and continue to be used because they are rewarding for a child. These approaches can inform early interventions and behavior modification strategies. Research suggests these approaches can be helpful for children with Down syndrome.

What educational research has shown

Behavioral approaches have been used to teach new knowledge and skills in early intervention programs since the 1970s, especially for children with autism, but only recently have begun to be systematically applied and evaluated for children with Down syndrome.[1 - 5] Behavioral principles can be applied effectively to change unwanted and challenging behaviors as well as for teaching new behaviors[7 - 9]

Kathleen Feeley, Emily Jones and their colleagues in the USA are leading this work. In a series of studies, they have focused on teaching infants and young children from 7 months of age communication skills including imitating verbal sounds, requesting a toy and question answering using behavioral approaches. The behavioral intervention approach defines the behavior to be learned very precisely (e.g. a specific sound), sets up multiple opportunities to learn the behavior (repeated practice), and uses shaping (rewarding approximate attempts as child is progressing towards goal behavior), prompting (helping child achieve target with full or partial help) and reinforcement for the child (rewarding attempts and successes with praise or toy). It also involves careful measurement of change. This team have chosen to teach imitation and requesting to infants and toddlers as these have been shown to be relative weaknesses compared to social interactive skills for children with Down syndrome. Recognizing that later development progresses by building on earlier acquired skills, they suggest that addressing verbal imitation and requesting at an early age may reduce some of the later communication delays (delayed expressive language and poor speech clarity) reported for children with Down syndrome. In a series of case studies the team has shown that their behavioral approach can successfully teach verbal imitation and requesting very early (7-15 months) and that infants and toddlers then generalize what they have learned (imitate new untaught sounds, request other objects) and may show improved problem solving.[1 - 5] The group have also proposed that a behavioral approach can be used to teach exploratory motor behavior[6]

A principle tenet of the behavioral approach is that behaviors are learned and continue to be used because they are rewarding for the child. This means that a behaviorist will start from the view that a child learns and repeats an unwanted, difficult or challenging behavior because they get a reward for doing it - for example; they gain attention, avoid something they do not want to do or provoke a reaction (control another person's behavior). In a series of case studies Kathleen Feeley and Emily Jones illustrate how effective a behavioral approach is to changing unwanted behaviors in young children (dropping to the floor, avoiding learning situations and throwing materials to floor, making noises, unwanted hugging).[7 - 9] Key to success is careful observation of the child and the behavior to identify when, where and how often it occurs so that the reasons (rewards) can be identified, planning a change program with everyone involved with the child and building new skills that may be needed so that the child does not have to resort to behaviors that are disruptive. Their work also makes clear that some behaviors are linked to background or setting events such as poor sleep and they identify ways that reducing demands on a child who is tired can avoid disruptive behaviors

The papers from this team demonstrate that change can take place quickly if behavioral approaches are used and that the change will last. More research studies and case studies are needed to extend the work that they report and the biggest challenge is to develop accessible training in behavioral methods for teachers and parents. However, there is a large body of knowledge on training parents and practitioners in the autism field which can be drawn on.

While it is important that parents and those working in early intervention and preschool services are trained in behavioral methods, they are equally important to delivering effective education through the school years.[10]

How this is helping

Parents and practitioners are using behavioral approaches to teach children new skills.

Parents and practitioners are using behavioral approaches to change and to prevent unwanted or challenging behaviors

Unanswered questions

Future research is needed to:

• establish if the positive findings of the small studies of behavioral teaching approaches to teach communication skills are replicated in studies with larger numbers of children with Down syndrome
• to evaluate the effects on later communication skills through longitudinal studies
• to explore how behavioral teaching strategies can be used to teach across all areas of development and learning

References

1. Bauer, S. M., & Jones, E. A. (2015). Requesting and verbal imitation intervention for infants with Down syndrome: generalization, intelligibility and problem solving. Journal Developmental and Physical Disabilities 27:37-66.
2. Jones, E. A., Feeley, K. M., & Blackburn, C. (2010). A preliminary study of intervention addressing early developing requesting behaviors in young infants with Down syndrome. Down Syndrome Research and Practice, 12, 98-102. https://library.down-syndrome.org/reports/2059/
3. Feeley, K. M., Jones, E. A., Blackburn, C., & Bauer, S. M. (2011). Advancing imitation and requesting skills in toddlers with Down syndrome. Research in Developmental Disabilities, 32, 2415-2430.
4. Feeley, K.M., & Jones, E. A. (2008). Teaching spontaneous responses to a young child with Down syndrome. Down Syndrome Research and Practice, 12, 148-152. doi:10.3104/case-studies.2007. https://library.down-syndrome.org/case-studies/2007/
5. Bauer, S. M., Jones, E. A., & Feeley, K. M. (2014). Teaching responses to questions to young children with Down syndrome. Behavior Interventions, 29, 36-49.
6. Bauer, S. M., & Jones, E. A. (2014). A behavior analytic approach to exploratory motor behavior: how can caregivers teach EM behavior to infants with Down syndrome? Infants and Young Children, 27, 162-173.
7. Feeley, K.M., & Jones, E. A. (2006). Addressing challenging behavior in children with Down syndrome: the use of applied behavior analysis for assessment and intervention. Down Syndrome Research and Practice, 11, 64-77. https://www.down-syndrome.org/perspectives/316/
8. Feeley KM, Jones EA. (2008) Strategies to address challenging behavior in young children with Down syndrome. Down Syndrome Research and Practice. 12(2);153-163. https://library.down-syndrome.org/case-studies/2008/
9. Feeley KM, Jones EA. (2008) Preventing challenging behaviors in children with Down syndrome: Attention to early developing repertoires. Down Syndrome Research and Practice. 12(1);11-14. https://library.down-syndrome.org/reviews/2076/
10. Jones, E.A., Neil, N. & Feeley, K. M. (2014) Enhancing learning for children with Down syndrome Chapter in R. Faragher and B. Clarke (Eds.), Educating Learners with Down Syndrome. (pp 83-116) Routledge Education.