After the dust has settled in a crisis situation, you find that you can breathe a bit easier. But, sometimes those easier breaths are soon followed by heavy sighs. You or your loved one are no longer in immediate crisis, but you may still be in a pretty tough situation. Now what do you do?
In a previous blog post, I discussed things to do in crisis and the final point included taking the time when you are stable to try and figure out what causes the crisis. The purpose of doing this is not to place blame, but for prevention of future crises. I like to use the A-B-C, or Antecedent-Behavior-Consequence method to try and get some clarity in situations. Below I have a rather complicated example as it takes a series of events leading up to a hospitalization and presents it as a root-cause analysis, or analysis of what was likely the main, or root, causes of the hospitalization.
Typically, when we talk about A-B-C data, there is one main Behavior that is being analyzed. But life is rarely neatly packaged, and neither is this example. J Hopefully it will help you understand how many different factors can be involved in these types of behaviors, especially when we are often only presented with the major consequence of the behavior. Often the behaviors that proceeded that outcome were the result of several previous, or antecedent, steps.
For example, a normally happy child wasn’t allowed to have his favorite toy on the bus. When he got to school, mands (demands, commands, etc) were placed on him by a substitute teacher and he began to rebel against her. When mands continued to be requested of him, he tore up a project of another student and was sent to the office. In route to the office, a bully teased the child, who began screaming and physically lashing out. Teachers tried to intervene by pulling the children away from each other, but the child, who has sensory processing issues, now has a major meltdown. He became aggressive and began indiscriminately biting and hitting teachers. One teacher got punched in the eye. The teacher, who had just returned from a leave from an assault by a different student, asked for the police to be called. The student had eventually calmed down, but the parents were called and told to meet their child at the hospital as he was a “danger to himself and others”. Police took him to the nearest hospital where he was admitted, and parents were told the child has now been suspended from school because of the assault on the teacher.
The initial Behavior was the child rebelling against the demands being placed on him and the Consequence was mands continued to be placed on him. The Antecedent was likely the toy being taken from him as well as some discomfort of having a substitute teacher. Now, if there was a different Consequence from the teacher, our story might have ended. What if the regular teacher had been there and known that the child was not his typical happy self and backed off on making requests of him? What if the substitute teacher had been given a synopsis of his IEP with a brief idea of how the child might respond if he was being pushed too far beyond his comfort level?
Unfortunately, without the initial intervention, mands continue to be placed and this is followed by another Behavior (the tearing of the project) with another Antecedent (bully’s teasing) that leads to still yet another Behavior (screaming and lashing out). On and on this cycle goes until we have the ultimate Consequence of the hospitalization and suspension. To get to the root of the problem you need to take each individual Behavior and look at its Consequence and try to figure out the Antecedent. This takes time and effort.
But, if you are the parent, staff, other student, and law enforcement officer, you have vested interests in making the effort to help prevent incidents like this from happening again. This can be a complicated task as there were many involved in this scenario but it does help get to the root of the problem and identify areas for real solution.
As a parent or patient, please do not try to figure this all out on your own. Again, when things are more stable, get the input of as many of those involved in the initial incident. If the incident is in school, as in this example, an emergency IEP meeting can be particularly useful. This can be done by phone or videoconference if needed. If the setting is in the community, mental health team meetings can be helpful. Getting to the root of the problem is a key to preventing future crises, and, as we all know an ounce of prevention is worth a pound of cure.
Here are some questions for you to consider:
- With the A-B-C method, it is usually much easier to identify the Behavior and the Consequence than it is to pinpoint the Antecedent(s). But practice makes us better at this. Think of an example Behavior of concern and write down the Consequence and possible Antecedent(s).
- If you or a loved one have been in crisis recently, were you able to get the input of those involved for the purpose of preventing a future crisis?
- Have you done a root-cause analysis of an unwanted series of behaviors before? If so, was it helpful for preventing future unwanted behaviors? If not, why do you think that is so?
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Bergina Isbell, MD is a Mayo Clinic trained and Board Certified Psychiatrist specializing in the clinical treatment of patients with history of Special Needs and Trauma. She is the mother of two children with special needs, including a son with a diagnosis of Autism. She serves as a consultant and Autism coach for those who want to transform their lives by developing a growth-promoting mindset. To join the Autism Alignment Movement and get access to free live interviews, click here https://bit.ly/autismstrategist.