FAB (Functionally Alert Behavior Strategies) to Improve Self-Control.

This paper describes the FAB (Functionally Alert Behavior) Strategies approach to improve behavior in children and adolescents with complex behavioral challenges. FAB Strategies include evidence-based environmental adaptations, sensory modulation, positive behavioral support, and physical selfregulation strategies. FAB Strategies can be used by teachers, parents, as well as occupational, physical, speech and mental health therapists to improve the behavior of students with developmental, sensory processing and mental health challenges. FAB (Functionally Alert Behavior) Strategies to Improve Self-Control Copyright © 2015 by John Pagano, Ph.D., OTR/L <www.fabstrategies. org> Teachers and therapists face the challenge of helping students develop appropriate behavioral skills that support learning. This challenge has become more difficult given the increasing demands of the common core curriculum and numbers of students with complex behavioral challenges. It is important to address students with complex behavioral challenges because their behaviors interfere with these students’ and their classmates learning. FAB (Functionally Alert Behavior) Strategies can improve self-control in students with complex behavioral challenges. FAB Strategies are individualized to help students with complex behavioral challenges including behavioral, social, developmental and sensory processing skill challenges. FAB Strategies were specifically developed to address the neuropsychological needs of complex behavioral problems related to Autism Spectrum Disorder (Reynalds & Lane, 2011; Tomcheck & Dunn, 2007), intellectual disabilities (Chapman et al., 2006), psychiatric disorders (Ben-Sasson et al., 2009; Carter et al., 2009; Gouze et al., 2009; Green & Ben-Sasson, 2010; Van Hulle et al., 2012), and PTSD Blaustein & Kinniburgh, 2010; Hanson et al., 2010; Henry et al., 2007). Actively learning self-control through strategies like the "turtle technique in a sensory coping area" helps children with complex behavioral challenges reduce aggression by developing attention, self-control and functional communication skills (Raaijmakers et al., 2008; Riggs et al., 2006; Sweeney-Kerwin, 2007). In addition to helping students with complex behavioral challenges FAB Strategies facilitates attention, learning, and parental involvement in typical students. Given the increasing use of mainstreaming in schools, FAB Strategies simultaneously addresses special needs students and their typical classmates. Many typical students lack adequate seated attention, self-control, and sensory-motor skills to master their academic learning requirements. FAB Strategies are fun activities that engage student’s musical, visual-spatial, and bodily-kinesthetic intelligence to improve learning (Brand, 2006). FAB Strategies further promote the learning environment for typical students by providing opportunities for active learning. The FAB Strategies form lists activities that promote learning and address students’ behavioral, self-control, developmental, and sensory processing challenges. The FAB Strategies form can be used as a checklist of behavioral interventions and a practical way of developing coping strategies. A student’s individualized FAB Strategies form can be used across settings then transferred to the next teachers and therapists. Strategies are developed by using a check mark in the blank at the beginning of the line, then underlining the specific strategies to be used. The checked strategies are for use by teachers, therapists and families. A few FAB Strategies options (listed in bold type) can be marked with an X for use by trained occupational, physical, speech, and mental health therapists. Two blank lines on the bottom of the form enable teachers and therapists to add strategies not listed. Below this is a line for the parents or guardians signature indicating that they understand and agree with the goal, adaptive equipment, and adaptive techniques listed on the form. Beneath the signature line is a list of helpful resources that can be underlined for use. The FAB Strategies form is organized into four sections addressing: environmental adaptations, sensory modulation, positive behavioral support, and physical self-regulation strategies. The teacher and/or therapist lists objective educational goals at the top of the FAB Strategies form, and selects at least one strategy from each section for goal attainment. Strategies chosen are checked and underlined for use across disciplines. The FAB Strategies form enables teachers and therapists to individualize the strategies to the student's developmental level and individual needs (Suveg et al., 2007). Section A Environmental Adaptations is the foundation for improving behavior, social skills, development and sensory processing. Although often neglected environmental adaptations enable teachers and therapists to prevent rather than react to inappropriate behavior (Machalicek et al., 2007). Environmental adaptations improve behavior and reduce arousal levels in all youngsters, but provide significantly greater effectiveness for students with developmental disabilities (Shapiro et al., 2008). Environmental adaptations include adaptive equipment, adaptive techniques, and visual supports that reduce anxiety (Brosnan & Healey, 2011). The student's goal guides the selection of environmental adaptations (Lieberman et al., 2011). Adaptive equipment significantly improves behavior in children with developmental disabilities (Ospina et al., 2008). Useful adaptive equipment includes disk-o-sit cushions (Pfeiffer et al., 2008), weighted vests (Buckle et al., 2011), and use of a sensory coping area (Hotz et al., 2006). Adaptive techniques include strategies such as limiting classroom noise levels, crowding, and transitions. Visual supports combine adaptive equipment and techniques. Visual supports help enable students with developmental challenges to meet social expectations (Jaime & Knowlton, 2007). Visual written and/or picture schedules can help children understand rules, schedules, routines, transitions, and how to earn rewards (Diamond & Lee, 2011). Schedules can be reviewed before environmental triggers (such as lunch time or assemblies where the child has previously been physically aggressive) as part of a comprehensive behavior plan. It is important to explain the rules for using environmental adaptations and to teach students to use them before environmental triggers (e.g., transition times, active movement activities, smells, high noise levels) and when they first notice their body triggers (e.g., increased heart rate, rapid breathing, crying, hand fisting) that precede misbehavior (Dunn et al., 2012). When developing environmental adaptations, it is important to consider the dynamic relationship between behavioral, social, sensory, cognitive, and environmental challenges (Henry et al., 2007). Environmental structure and behavioral demands are interacting variables, with greater sensory demands suggesting the need for more structure. When children show improved self-control or the demands are decreased, structure can be reduced to promote independence. It is helpful to assess the effect of adaptive equipment and techniques on goal achievement and anticipate possible problems before using adaptive equipment and techniques. Introducing environmental adaptations one at a time helps teachers and therapists judge their effectiveness on goal attainment. Adaptive equipment and techniques can be presented as "an experiment that will be continued only if it is found to help achieve the child's goal and respect others". Environmental adaptations are most helpful when they are individualized to achieve the child's goals. An understanding of the child's unique sensory processing style can help in developing adaptive equipment and techniques that match the sensory input of problematic behaviors (Dunn, 2007). For example, a child with developmental challenges who was a tactile sensory seeker grabbed items off the shelves whenever his mother took him shopping. The comfort bag strategy (access to a bag with fidget toys and a preferred video game) was selected to help this child improve self-control. The child is now allowed to use the coping bag while shopping with his mother as long as he does not touch grocery items with out permission. If the child grabs items off the shelf his mother simply takes away the comfort bag and leaves the store. In mainstream classes it is helpful to have a class rule that “students will be treated fairly but not equally”, with expectations and equipment guided by each student's needs. If extensive or detailed environmental adaptations are needed the FAB Environmental Adaptations form can be attached as a supplement to the FAB Strategies form. It is important that the parent or guardian understands and gives signed approval for all environmental adaptations on the FAB Strategies form before they are implemented. Section B Sensory Modulation strategies build on the foundation of environmental adaptations with activities that improve behavior (Tomcheck & Dunn, 2007). The sensory modulation strategies help children understand and manage their energy levels and feelings. Sensory modulation strategies include coaching e.g., guiding students, school staff, and family members in developing environmental adaptations (Dunn et al., 2012), promoting an understanding of feelings (Blaustein & Kinniburgh, 2010), basic yoga and mindfulness (Chambers et al., 2009; Kaiser-Greenland, 2010; Koenig et al., 2012; Flook et al., 2010), body awareness (Singh et al., 2008), and pressure touch strategies (Perry, 2009; Silva et al., 2011). The FAB event trigger, body trigger, energy level, energy level modulate, and coping strategies help students learn to recognize and understand their feelings (Blaustein & Kinniburgh, 2010). Students need to notice when they are beginning to lose control and use coping strategies to manag