Introduction
Behavioural challenges in children and adolescents can disrupt learning, strain relationships, and impede emotional development. This case study highlights how the Positive Systems Approach (PSA), as described by Dr. Bob Carey and Terry Kirkpatrick, was applied to support Liam.
Liam was a vibrant 14-year-old boy with a love for animals, a fascination with animals and nature. He had an extraordinary ability to recall facts about his favorite topics. Diagnosed with Autism Spectrum Disorder (ASD) and Attention Deficit Hyperactivity Disorder (ADHD) at an early age, Liam’s life had always been a blend of challenges and unique strengths. His parents, Rachel and Mark, adored him, but they often found themselves struggling to understand and meet his complex needs.
From a young age, Liam displayed behaviours that set him apart. He spoke in an advanced vocabulary about topics he loved but found it difficult to sustain conversations about everyday matters. His energy seemed boundless, and his curiosity endless, but transitions—moving from one task to another—were especially hard for him. He would scream or throw objects when his favorite activities ended abruptly. By the time he reached middle school, Liam's challenges became more pronounced. He began exhibiting frequent outbursts in the classroom, which included yelling, throwing books, and even hitting his head against the wall when overwhelmed. These moments often occurred when he didn’t understand instructions, felt unfairly treated, or was interrupted during a deep focus session on a topic he loved. Teachers described him as defiant, but his parents knew it was frustration and anxiety driving these behaviours.
Academically, Liam had a sharp mind, but his difficulty in following multi-step instructions and his tendency to hyperfocus on unrelated topics made it hard for him to keep up with his peers. Math lessons were derailed by his detailed monologues about ecology and animal behaviour, while group projects often ended in tears when he couldn’t compromise or communicate effectively. Despite this, Liam excelled in science, especially when studying ecosystems—a topic he loved because it related to his dream of becoming a wildlife conservationist.
Liam’s behaviour strained relationships with his peers, who didn’t understand why he often refused to share materials or play by the rules in games. Over time, many classmates began avoiding him, leaving Liam isolated. At home, his outbursts and self-injury left his parents emotionally drained and worried about his future. They were also concerned about his younger sister, Emily, who often felt overshadowed by the intensity of Liam’s needs.
One day, during an English class, Liam’s frustration boiled over when he was asked to write an essay on a topic he didn’t enjoy. After tearing up his paper and screaming at his teacher, he stormed out of the classroom. This incident led to a meeting with school administrators, who were considering moving Liam to a specialized behavioural program. It came to the point where his now frequent outbursts, self-injury, and defiance, disrupted classroom routines and hindered his academic progress. These behaviours strained his relationships with peers, teachers, and family, presenting a complex situation that demanded a comprehensive, evidence-based intervention. PSA offered a framework that addressed both Individual Factors and System Factors to create a sustainable solution tailored to Liam’s unique needs.
Individual Factors
The Individual Factors component of PSA focuses on identifying and addressing the personal, environmental, and behavioural triggers that contribute to problematic behaviours. For Liam, tackling all seven individual factors was critical to understanding and mitigating his challenges.
1. Identification
The first step was a Functional Behaviour Assessment (FBA), a comprehensive process designed to identify triggers, root causes, and patterns of Liam’s behaviours. The FBA revealed several key insights:
Interviews: Engaging Liam’s parents, teachers, and behaviour therapist provided a detailed history of his behaviours. His parents highlighted sensory sensitivities and struggles with transitions, while his teachers noted increased defiance during unstructured activities.
Medical Assessment: A medical evaluation ruled out physical health concerns but confirmed sensory sensitivities, such as aversion to loud noises and bright lights, which were likely exacerbating his stress.
Environmental Analysis: Observations at school revealed that noisy hallways, sudden schedule changes, and social challenges with peers often preceded Liam’s outbursts.
Behavioural Triggers: Common triggers included sensory overstimulation, disruptions to routine, and feelings of social rejection. For example, an unexpected fire drill once led to a significant meltdown.
This step underscored the importance of understanding Liam’s environment, medical context, and daily experiences to create an effective intervention.
2. Reinforcement
To address Liam’s behaviours, a robust reinforcement strategy was developed to increase positive interactions and reduce stress. This included:
Positive Reinforcement: Liam’s teachers introduced a points-based reward system where he earned privileges, such as extra art time or choosing a book to read, for demonstrating positive behaviours. This motivated him to engage in socially appropriate actions.
Non-Contingent Reinforcement: Recognizing Liam’s need for frequent sensory breaks, the team scheduled short, predictable breaks where he could use sensory tools like noise-canceling headphones or calming tactile objects. These breaks reduced baseline anxiety and created a safer emotional environment.
Building Rapport: Teachers and staff consciously worked on strengthening their relationships with Liam. For instance, one teacher incorporated Liam’s love for animals into lessons, which helped him feel valued and understood.
The reinforcement plan emphasized consistency and created opportunities for Liam to experience success, which boosted his confidence and willingness to engage.
3. Re-Direction
Preventing escalation was a cornerstone of Liam’s intervention. Redirection strategies allowed staff to intervene at early stages of distress:
Engagement in Preferred Activities: Liam was provided with calming tasks, such as drawing or listening to music, when signs of agitation appeared. These activities redirected his focus and allowed him to reset emotionally.
Physical Redirection: Staff were trained to guide Liam to a designated quiet space if he exhibited signs of frustration. This gave him a safe place to decompress and avoid full-blown outbursts.
Crisis Interruption Techniques: Simple verbal cues like, “Liam, let’s take a deep breath together,” or offering alternative actions helped interrupt negative thought cycles before they escalated.
These redirection techniques relied on careful observation and early intervention to mitigate challenging behaviours.
4. Coping
Many of Liam’s problematic behaviours stemmed from skill deficits in coping with stress and change. Addressing these deficits involved teaching him specific coping strategies:
Stress-Management Skills: Liam learned deep-breathing techniques and mindfulness exercises to manage overwhelming situations. For example, he practiced counting to 10 and imagining a calm environment when he felt angry or frustrated.
Visual Schedules: To reduce anxiety during transitions, Liam was given a visual schedule that broke his day into manageable chunks. Knowing what to expect reduced his stress and increased his ability to participate in activities.
Role-Playing: Liam participated in role-playing exercises where he practiced expressing his feelings verbally, asking for help, and handling unexpected changes.
By teaching these skills, the team empowered Liam to take greater control of his emotions and responses.
5. Communication
Understanding that behaviour is often a form of communication was pivotal in Liam’s case. Efforts to enhance communication included:
Identifying Functional Needs: Staff analyzed Liam’s outbursts and discovered they often served specific purposes, such as avoiding tasks he found difficult or gaining attention from peers. Recognizing these patterns helped staff respond proactively.
Augmentative Communication Tools: Liam was given a communication board that enabled him to express needs like “I need a break” or “I’m feeling upset.” This alternative reduced his reliance on physical outbursts to convey frustration.
Teaching Replacement Behaviours: Liam was taught to use specific phrases or gestures to communicate his needs. For example, he practiced raising his hand to request help rather than storming out of the room.
These communication strategies not only reduced negative behaviours but also strengthened Liam’s ability to interact meaningfully with others.
6. Relationship/Rapport
A core principle of PSA is fostering relationships based on mutual respect and trust. Liam’s team prioritized this through:
Unconditional Positive Regard: Teachers used warmth, patience, and positive reinforcement to build a foundation of trust with Liam. This approach emphasized interdependence and mutual care.
Daily Check-Ins: Regular one-on-one time allowed staff to connect with Liam, celebrate his progress, and discuss any challenges.
Peer Relationships: Efforts were made to involve Liam in group activities where he could experience positive peer interactions, helping him feel more connected to his classmates.
These relationships created a supportive environment where Liam felt safe and valued.
7. Stimulation
Recognizing Liam’s need for stimulation, structured yet enjoyable activities were incorporated into his daily routine:
Incorporating Interests: Activities like art, storytelling, and hands-on science experiments engaged Liam and reduced boredom, which often triggered disruptive behaviours.
Enhanced Staffing: To ensure Liam had sufficient support during high-risk times, additional staff were allocated. This allowed for more individualized attention.
Community Engagement: Weekly visits to a local animal shelter provided Liam with an opportunity to connect with his love for animals. These outings became a highlight of his week and significantly reduced his overall stress.
Stimulation provided both an outlet for Liam’s energy and a framework for meaningful, positive experiences.
System Factors
While addressing individual factors is essential, long-term success requires systemic changes to support the individual effectively. In Liam’s case, all seven system factors were addressed to ensure a holistic approach.
1. Flexibility
The system demonstrated adaptability in several ways:
Tailored Schedules: A predictable yet flexible routine was developed to accommodate Liam’s needs.
Staff Training: Ongoing training sessions equipped staff with the skills and confidence to implement Liam’s intervention plan effectively.
Environmental Modifications: A quiet, sensory-friendly space was established at the school, giving Liam a designated area to decompress when overwhelmed.
These changes made the environment more responsive to Liam’s needs, fostering stability and reducing triggers.
2. Perseverance/Tolerance
Liam’s behaviours were deeply ingrained and required significant perseverance:
Long-Term Commitment: The team understood that progress would be incremental and committed to supporting Liam through setbacks.
Avoiding Punitive Responses: Instead of resorting to restrictive measures like suspension or medication, the team sought proactive solutions and viewed challenges as opportunities for growth.
This commitment to perseverance ensured that Liam received consistent support over time.
3. Consistency
Consistency across all caregivers and settings was paramount:
Unified Strategies: Staff, substitutes, and family members adhered to Liam’s behaviour plan to maintain predictable responses.
Frequent Communication: Weekly team meetings allowed staff to share insights, address challenges, and refine strategies collaboratively.
Consistency reduced confusion and reinforced Liam’s sense of security.
4. Portability
Efforts to make PSA strategies portable ensured continuity across environments:
Home-School Coordination: Liam’s parents were involved in implementing strategies like visual schedules and communication boards at home.
Therapist Involvement: Liam’s external therapists were included in discussions to align approaches.
Portability bridged the gap between settings, ensuring Liam experienced consistent support.
5. Intensity
Intensive support was provided during critical moments:
Additional Resources: Staffing levels were increased during transitions and other high-risk times.
Focused Interventions: High levels of engagement were prioritized during challenging activities, reducing the likelihood of escalation.
This intensity allowed the team to address Liam’s needs proactively during vulnerable periods.
6. Change
Advocating for changes in Liam’s environment played a critical role:
Stimulus Change: Noise-reduction measures, such as staggering hallway transitions, were implemented to minimize sensory triggers.
Resource Advocacy: The school secured funding for additional sensory tools and staff training.
These changes reduced environmental stressors and improved Liam’s overall experience.
7. Team Health
A healthy, cohesive team ensured the intervention’s success:
Core Team Formation: A dedicated group of staff members met weekly to coordinate efforts and provide mutual support.
Broader Support Circles: Liam’s therapist, extended family, and community members worked together to create a network of care.
Team cohesion maximized the effectiveness of the intervention and ensured sustainability.
Results
After six months of implementing PSA, Liam’s progress was substantial:
Outbursts decreased by 75%, as Liam became more skilled at managing transitions and expressing his needs.
Engagement in learning improved, with Liam actively participating in lessons and completing assignments.
Relationships flourished, as Liam’s positive interactions with peers and teachers increased his sense of belonging.
Conclusion
Over time, Liam’s behaviour began to improve. He still faced challenges, but the frequency and intensity of his outbursts diminished. His teachers noted that he was more willing to participate in class and showed increased pride in his accomplishments. He formed a bond with a fellow classmate who shared his love for animals, and together they created a poster about endangered species for a school project.
At home, Rachel and Mark noticed Liam smiling more and engaging in family activities, such as game nights. He even started teaching Emily about the different habitats of rainforest animals.
Looking ahead, Liam’s journey was far from over, but his story became a testament to the power of understanding, patience, and individualized care. With continued support, his parents hoped he would not only succeed academically but also grow into a confident, compassionate young man ready to leave his unique mark on the world.
The Positive Systems Approach demonstrates that addressing both individual and systemic factors can lead to meaningful, lasting change for individuals with complex behavioural challenges. For Liam, this approach not only reduced problematic behaviours but also enhanced his quality of life, relationships, and academic success. PSA serves as a powerful framework for creating supportive, inclusive environments for individuals facing similar challenges.
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