Using a Bio-Psycho-Social Approach for Students With Severe Challenging Behaviours

Abstract

What teachers learn about classroom management in education classes often results in behaviour strategies that do not account for the individuality of each student. Teachers would benefit greatly from a common formula for effective problem solving and decision making with regard to choosing when to use the strategies in their "tool box." The solution proposed is the building of an individual biopsychosocial, multimodal profile for each student with chronic challenging behaviours.

Full text

LEARNing Landscapes | Vol. 7, No. 2, Spring 2014 | 259
Using a Bio-Psycho-Social Approach for Students
With Severe Challenging Behaviours
Lisa Reisinger, West Montreal Readaptation Centre
ABSTRACT
What teachers learn about classroom management in education classes often results in
behaviour strategies that do not account for the individuality of each student. Teachers
would benet greatly from a common formula for eective problem solving and
decision making with regard to choosing when to use the strategies in their “tool box.”
The solution proposed is the building of an individual biopsychosocial, multimodal
prole for each student with chronic challenging behaviours.
A Flexible Strategy for
Successful Classroom Management
Imagine for a moment that a classroom can be compared to the creation of a salt-
water sh tank, with all of the delicate needs of the dierent salt-water sh in a
single tank. Preserving and maintaining this fragile environment would require
specic knowledge of the individual needs of the various types of sh, along with an
understanding of the required elements or resources that each sh, such as coral reefs,
crustaceans, saltwater plants, anemones, specic kinds of water ltration, and carefully
considered water chemistry. After all of the environmental “engineering,” a marine
ecosystem would be created that would require constant monitoring for problems
and a quick response time for modications in order for the sh to remain alive. Only
a devoted aquarist, who considered the individual needs of each sh, could manage
a salt-water tank that includes both hardy sh as well as delicate sh with special
aquarium needs.

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Keeping that example in mind, today’s classrooms are replete with learners whose
diverse nature is reected by dierences in their cultural, cognitive, developmental,
linguistic, preexisting knowledge, and learning preferences needs. Implementing
dierentiated instruction can seem near impossible because addressing learning
needs is often overshadowed by problem behaviour in the classroom. With the wrong
classroom dynamics, challenging behaviours can often take up the majority of teachers’
time. Eective teaching practices must include using eective classroom management
procedures that respect students’ diverse needs, while concurrently promoting
student engagement and motivation. This kind of outstanding expectancy of teachers
requires a solid plan that can withstand even the most dicult of students. The formula
described below is set within the framework of dierentiated instruction but uses a
biopsychosocial, multimodal approach leading to a precise functional behaviour
analysis that can, in turn, be relied on by teachers and specialized educators alike.
The Components
• Implementation of a biopsychosocial multimodal plan (Griths, Gardner, & Nugent,
1998) for all chronically inexible children
• Individualized problem solving for solutions to dicult behaviour by using a
functional behaviour analysis that is based on the multimodal plan. Decisions
are made based on why the behaviour is occurring or what is maintaining
thebehaviour
• The continued pursuit of professional development opportunities to maintain
a “tool box” of currently advised, evidence-based strategies for diverse and
dicultstudents
The Biopsychosocial Multimodal Plan Adapted for Teachers
The biopsychosocial model was coined by Roy Grinker in the 1950s (a neurologist
and psychiatrist; see also Grinker, 1964) and later applied to general medicine by Dr.
George Engel, a specialist of func tional gastrointestinal disorders. Engel was considered
to be the founder of this approach. The biopsychosocial approach (Engel, 1977, 1980)
was designed to consolidate interacting components from three elds into the
assessment and treatment of medical health problems by emphasizing the importance
of understanding human health in a holistic context. Using a biopsychosocial
perspective, complex behaviour can be considered as a result of multiple causes. This
model was intended as a general health care delivery model but is used most often

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Using a Bio-Psycho-Social Approach for Students With Severe Challenging Behaviours
by psychiatrists and developmental psychologists because of its humanistic approach.
This model takes into consideration the complex nature of individuals and, with minor
modication, is a perfect tool for teachers who are on the front lines of behaviour
interpretation in the classroom. The biopsychosocial approach provides the foundation
for accurate functional behaviour analysis—the only evidence-based method of
analyzing dicultbehaviour.
The bio-psycho-social approach systematically considers biological, psychological,
and social/environmental factors, alongside their complex interactions. Biological/
medical type factors include medical, psychiatric, and neurological states that can cause
behaviour. Psychological factors include current psychological features (i.e., emotional,
cognitive, developmental) as well as skill decits that can inuence how a student
behaves. The social/environmental factors include family, cultural, interpersonal, school
program factors, and physical aspects of the environment that can aect behaviour
(Griths & Gardner, 2002). In order to predict behaviour outcomes and inuence future
behaviour, an understanding of the following is required: 1) the synthesis of instigating
conditions, such as the social/environmental causes of the behaviour, 2) the child’s
vulnerabilities (psychological/biological /medic al factors inherent in the child), and 3) the
reinforcing (maintaining) factors that can inuence challenging behaviour. Gaining this
complex understanding of behaviour is a multif aceted t ask, which requires a purposeful
multimodal approach to the assessment and treatment of dicult behaviours.
Using an integrated biopsychosocial approach for mapping a child’s behaviour
prole is referred to as the multimodal prole (Griths et al., 1998). The multimodal
prole is based on the assumptions that not only are the individual contributions of each
component signicant (i.e., the biological, psychological, and social/environmental
components), but the interaction between components also plays a critical role in
understanding why behaviour occurs. A comprehensive treatment plan is based upon
what is known about the component interactions, and is the result of completing a
multimodal prole grid for an individual. (Refer to Tables 1, 2, and 3 for a sample prole).
The discussion below posits that teachers would benet greatly from an understanding
and the use of a modied multimodal approach for dicult-to-manage students.

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Components of the Multimodal Prole
for a Student With Challenging Behaviours
Instigating conditions or precipitating factors. These factors, which result in the
occurrence of challenging behaviour, may include aspects of the school, social, or
physical environment (social/environmental factors) (Griths & Gardner, 2002). These
conditions may act as triggering factors (antecedents) in that they precede the challenging
behaviour. For example, let’s hypothetically consider Adam* (*pseudonym), a student
who is highly sensitive to sound. Adam may always react with challenging behaviours if
the classroom is too noisy. Alternatively, other factors may act as contributing conditions
in that they would not trigger the behaviour in isolation. Instead, they will increase the
likelihood of the behaviour when several of the conditions have been combined. For
example, Adam may also be aected by contributing factors. He may appear irritable
or uncomfortable when these contributing conditions occur in isolation, but will only
display challenging behaviours if several of the contributing conditions are combined.
Specically, if Adam is requested to complete a visually “busy” worksheet while he is
fatigued and is sitting too close to another student, he may ac t out by hitting the student.
If Adam arrives at school tired (his prole in Table 2 indicates periodic insomnia) but
no other contributing conditions are present, Adam may work more slowly or appear
uncomfortable, but will not display the hitting behaviours.
Other social/environmental features may include mismatches between the
individual and the physical environment, (e.g., sensitivity to temperature, light, or
seating conditions), the social environment (e.g., sensitivity to personality types or
working in groups) or related to the school program (e.g., sensitivity to the amount
of work requested, presentation of work, or level of diculty of work). Refer to Table1
as follows for a full description of Adam’s instigating conditions related to social/
environmental factors.

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Using a Bio-Psycho-Social Approach for Students With Severe Challenging Behaviours
Tab le 1
Sample Multimodal Prole for Instigating Conditions
(Triggering and Contributing Factors)
Name of Student: Adam
Behaviours Targeted:
1) Hitting
2) Screaming
3) Throwing objects
Instigating Conditions
Triggering Factors
(Always an antecedent)
Contributing Factor
(Antecedents when combined)
Social/Environment Factors
Physical Environment
• Not having a work break
every 10 minutes during
seated work
• Classroom too noisy
• Having to concentrate
while being physically
close to another student
(other student becomes
a distraction)
Social Environment
• Working with loud or
forceful students
• Working in groups of more
than two
• Tolerating other students
when fatigued
School Program
• Work is too dicult
• If he perceives that he will
not do well on a test or an
assignment, he will act out
• Worksheet is too visually
busy
• Not having a calculator
during math period
Modied from the Multimodal Contextual Behavior Analytic Worksheet: D.M Griths, W.I Gardner,
& J.A. Nugent (1998). Behavioral supports: Individual centered interventions — A multimodal functional
approach. Kingston, NY: NADD Press.
Vulnerability conditions, or risk factors. These conditions may include features of
the individual (psychological or biological/medical factors) that place the individual
at risk for problem behaviour. Vulnerability conditions may include skill decits (e.g.,
poor expressive language or rote memory), cognitive decits, psychological features
(e.g., social anxiety, fear of failure), biological abnormalities (e.g., sensory sensitivities
or diculty sleeping), or medical/mental health diagnoses (e.g., epilepsy, ADHD, or
autism). Vulnerability conditions increase the likelihood of challenging behaviour in
theclassroom.

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Tab le 2
Sample Multimodal Prole for Vulnerability Conditions
(Psychological and Biological/Medical Factors)
Modied from the Multimodal Contextual Behavior Analytic Worksheet: D.M Griths, W.I Gardner,
& J.A. Nugent (1998). Behavioral supports: Individual centered interventions — A multimodal functional
approach. Kingston, NY: NADD Press.
Name of Student: Adam
Psychological Features
(includes cognitive, emotional,
and developmental features
and skill decits)
Vulnerability Conditions
Presenting Features
• Diculty paying attention for
periods longer than 10 minutes—
this is pronounced when fatigued
• Social anxiety
• Fear of failure
• Poor rote memory
• Cannot always communicate his
desires and needs eectively
Skill Decits • Missing social skills
• Missing problem-solving skills
(Biological) Medical or Mental Health
Diagnoses
• Language disorder
• ADHD, predominantly inattentive
type
• Epilepsy
• Periodic insomnia
• Sensor y impairments
Reinforcing conditions. The likelihood of the student displaying challenging
behaviour is further inuenced by the consequences that arise after the behaviour
has occurred. Consequences that increase the likelihood of the behaviour occurring
are described as reinforcing conditions. Consequences that increase the likelihood of
the behaviour occurring when something is added to the environment are positive
reinforcers. Consequences that increase the likelihood of the behaviour occurring when
something is removed from the environment are negative reinforcers. For example,
consider the planned consequence for Adam, the child discussed, if he were to be
removed from the classroom (sent to the oce) each time he hit another student.
This consequence may be reinforcing the hitting behaviour (if Adam is trying to avoid
having to complete his work), making the removal from class a negative reinforcer. On
the other hand, if an unplanned consequence is that the children in the class laugh at

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Using a Bio-Psycho-Social Approach for Students With Severe Challenging Behaviours
the situation (and Adam enjoys being the class clown), then this addition to the situation
(laughing) is a positive reinforcer. The teacher will have to manage these reinforcers
(both positive and negative) in order to extinguish the hitting behaviour.
Tab le 3
Sample Multimodal Prole for Reinforcing Conditions
(Positive and Negative)
Name of Student: Adam
Consequences: Reinforcing Conditions of Dicult Behaviour
(Occurring immediately after the challenging
behaviour is observed)
Positive (Something is
added/provided)
Negative (Something is taken
away/removed)
Social/Environment Factors
Physical Environment
No positive reinforcers
identied yet for the
physical environment
Adam is removed from the
group and permitted to work
individually, at his desk
Social Environment
• Students laugh at Adam’s
misbehaviour, a desired
response by Adam who
loves this attention
• Adam is immediately
provided with one-on-
one support and he is an
attention seeker
Adam is immediately removed
from the classroom and thus
from having to work
School Program
Adam is immediately
provided with a calculator or
other program supports
Work is removed or simplied
Modied from the Multimodal Contextual Behavior Analytic Worksheet: D.M Griths, W.I Gardner,
& J.A. Nugent (1998). Behavioral supports: Individual centered interventions — A multimodal functional
approach. Kingston, NY: NADD Press.
Challenging behaviour is inuenced by the dynamic interplay among instigating
factors (triggers and contributing), vulnerability factors (psychological and biological/
medical), and reinforcing factors. Let’s again consider the child, Adam who has challenging
behaviour (e.g., hitting) discussed throughout the text, and use his multimodal prole
grid (displayed in Tables 1-3) to examine how a teacher may proceed to engineer
this particular student’s environment and program his day-to-day schoolwork. The
multimodal grid, once complete, acts as a checklist of things for the teacher to do to
prevent the dicult-to-manage behaviour from occurring. Often teachers are aware of
some of the factors in the multimodal grid but have never completed a full multimodal
prole, which considers the interplay between each factor.

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Regarding reinforcing conditions. For preventive purposes, the teacher might rst
remove all negative and positive reinforcing conditions that are sustaining Adam’s
dicult-to-manage behaviours. She would likely begin by working to prevent the
children from laughing at the student’s hitting behaviour by applying unwanted
consequences. She might then apply planned consequences for the misbehaving child
within the classroom (instead of reinforcing the desire not to work by sending him out
of the class), and she would likely apply appropriate classroom supports as preventative
measures before the behaviour occurred. Her decisions would be made by examining
Adam’s multimodal prole, which outlines Adam’s needs and also what sustains the
hitting behaviour.
Next, Adam’s teacher might examine how the biological, psychological, and social/
environmental conditions are interacting with each other by again examining the
multimodal prole (refer to Tables 1-3). If necessary, the teacher could initially request
support from the resource teacher, psychologist, and/or school consultant, depending
on the severity of the challenging behaviours and the complexity of the multimodal
prole. For example, Adam’s multimodal prole indicates that he has a diagnosis of
ADHD and without frequent breaks, his challenging behaviour is triggered. His teacher
might choose to structure his day to include several planned work breaks. These breaks
could include handing out papers, collec ting work, and cleaning the board or delivering
notes to other teachers, in order to combat the child’s diculty paying attention for
long periods. Given other aspects of Adam’s prole (refer to Tables 1-3), his teacher
would need to ensure that any work requested was well matched to his cognitive level
and presented in a manner that is not visually overwhelming. Adam’s prole indicates
that he has a language disorder that aects his ability to communicate eectively. This
may be an additional reason why he does not enjoy working in groups. He may require
extra support in getting his ideas across to his classmates. The teaching of skills that
Adam is lacking (i.e., social skills and problem-solving skills) could also be based on the
multimodal prole, as these skill decits contribute to Adam’s misbehaviour.
Mathematic teaching objectives would likely be related to Adam’s problem-solving
skills decit. A calculator could be provided for individual work, based on Adam’s
diculty with rote memory, clearly outlined in his prole (Tables 2-3). It is clear the
child has social anxiety, which is related to a delay in social development, and thus
in his repertoire of social skills. This is not uncommon for children with signicant
diculties maintaining their attention. A plan for social skills learning should be made
in conjunction with Adam’s parents and the teaching team of the child. Within the
classroom, the teacher could facilitate Adam’s social-skills decit by managing how
group work is completed in class, perhaps by providing appropriate roles to students,

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Using a Bio-Psycho-Social Approach for Students With Severe Challenging Behaviours
based on their individual proles of strengths and weaknesses (also facilitating
dierentiated instruction).
Regarding social/environmental conditions (triggers and contributing factors).
The teacher would also have to act “on the spot” to change aspects of the environment,
if contributing factors were evident. We know that for Adam these factors include
being fatigued, having to work close to other students when concentration is required,
working in groups, using worksheets that are visually “busy,” and completing math
work without a calculator (indicated on Table 1). Therefore, if Adam arrived at school
looking fatigued (see Table 2; Vulnerability Factors, which indicates he has periodic
insomnia), all other contributing factors, such as having to work close to another
student during more dicult work assignments or participating in group work, would
not be possible that day. Knowing the contributing factors would signicantly reduce
behaviours: First, by knowing when the student is particularly vulnerable to having
challenging behaviour. Second, by knowing which factors must be eliminated when the
student is vulnerable. Removing all triggers (conditions that always lead to challenging
behaviour) in this case, working with students who have imposing personalities, would
imply a particular seating arrangement and avoiding group work with these types of
students on a dailybasis.
Regarding psychological conditions. Adam’s multimodal prole (Table 2;
Vulnerability Factors) indicates that he has, among other factors, social anxiety, poor
rote memory, and a fear of failure. In consideration of this psychological prole, once the
initial classroom engineering was completed, the teacher might choose to incorporate
a program wherein each classroom lesson ended with ve minutes devoted to the
teaching of how mistakes lead to better products and increased learning. The teacher
could discuss examples from the particular lesson to support the generalization of how
failure is not the result of making mistakes. Such a program (which would require only
minimal extra planning time) would benet all students and would be worth the eort
for this particular student whose fear of failure contributes to his challenging behaviour.
With time and, in some cases, initial support from a specialist or professional,
a teacher could provide an environment that is a “best t” for even the most challenging
of students. Realistically, this would not mean that the child, for whom the multimodal
prole was created, would no longer have dicult-to-manage behaviours. Instead, a
large number of the behaviours could be prevented. Remaining behaviours could be
explored in a functional behavioural analysis (FBA), an expected process for teachers to
follow when they are stumped by a behaviour that a student is exhibiting.

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A functional behavioural analysis, developed in the eld of behavioural psychology,
employs fundamental principles of operant conditioning in order to determine the
reason why particular behaviour is persisting. The goal of such an analysis is to make
hypotheses about the purpose or motivation for a behaviour and then to test the
hypothesis. If the hypothesis is correct, the behaviour will cease once the motivation or
reason for the behaviour is removed.
Tab le 4
Functional Behavioural Analysis Grid for Targeted Behaviours
To establish the function of a behaviour, the following must be identied: any
triggers of the behaviour, any aspects of the student that inuence or feed into the
behaviour, and any consequences of the behaviour which are reinforcing the behaviour.
All of this information is available in the multimodal prole of the student. Not having
a multimodal prole for a student with persistent, dicult-to-manage behaviours
makes any attempt to reshape or eliminate behaviours more like a guessing game. Each
incorrect guess can have disastrous consequences for the teacher. Most teachers have
a large “tool box” of strategies to manage dicult behaviours. What they don’t have is
a method or formula for matching the strategies to the child or to the behaviour. Not
all strategies for ADHD, for example, will work for all children with ADHD. Success rates
for any strategy depend on the student’s individual multimodal prole. The reasons
Name:
Date:
Functional Behavioural Analysis Grid
for Targeted Behaviours
Describe Behaviour Targeted Trial # 1
Name Behaviour:
__________________
Trial # 2
Name Behaviour:
__________________
Desired Objective
Hypotheses (Reasons why
you think the behaviour
is occurring or is being
reinforced)
Trial Plan
(Description of the trial plan
and date of completion)
Person Responsible
Was the Plan a
Success?
Report Measureable Results

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Using a Bio-Psycho-Social Approach for Students With Severe Challenging Behaviours
why behaviours are occurring supersede any diagnostic label that the child may have
been given. A diagnostic label is just not enough information to build an individual
behavioural plan. This is well known in psychological circles, but the information has
not been uid between the disciplines.
There is strong theoretical and clinical support for the building of multimodal
proles that have a biopsychosocial approach for students with chronically challenging
behaviours. Using such a plan, a teacher would be more condent in making hypoth eses
about why challenging behaviour is occurring and thus could be more accurate in
solving behaviour problems. Additionally, any new causes of behaviour discovered
during a functional behavioural analysis could be added to the multimodal prole. The
idea is that the base prole is created only once, and only for students with chronic
behaviour problems. As the teacher gleans new information, the multimodal prole
is updated and continuously strengthens the ability of the teacher to manage the
student’s environment, and also to program his or her individual plan in a preventative
and holistic manner. The teacher is in a position to better use her well-developed “tool
box” of strategies for challenging behaviour, by having an improved ability to match
her strategies to the reasons why problem behaviour is occurring in her classroom.
Conclusion
Just as education borrowed from the eld of developmental psychology to support
curriculum development, and, in turn psychology borrowed from the eld of education
by incorporating Gardner’s (1983) proposed “intelligences” into the building of clinical
learning proles, we need to continue to keep knowledge bet ween the disciplines uid.
Both disciplines should continue to inuence each other and thus bring true meaning
to the development of educational psychology.

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Lisa Reisinger is a psychologist, educational speaker,
internationally published author, and former elementary school
teacher and university lecturer. She has been supporting
teachers and professionals for students with special needs
for over 20 years. Currently she is working at the West
Montreal Readaptation Centre where she is a clinical leader
and psychologist for children, teens, and adults with severe
challenging behaviours. She is a specialist for individuals with
autism spectrum disorder and intellectual disabilities.
LINK TO:
www.crom-wmrc.ca