Provocative Language - A Misunderstood Behavior - Autism, ADHD, TBI, and Tourette Syndrome

Provocative Language provides information on the interface between psychological practice, applied behavioral analysis, and social cognition training in an area that affects the education and welfare of children with specific disabilities like Autism, ADHD, TBI, and Tourette Syndrome. It provides insights on working with schools, mental health providers, and the criminal justice system. It describes principles for best practices and recommends procedures to be followed in IEP and goal development.

THE ANSWERS ARE OUT THERE

WE ARE JUST ASKING THE WRONG QUESTIONS!

“I don’t know what your destiny will be, but one thing I know; the only ones among you who will be really happy are those who have sought and have found how to serve.” Albert Schweitzer

Provocative language is one of many symptoms exhibited by those with
Autism Spectrum Disorder (ASD), Attention Deficit Hyperactive Disorder
(ADHD), Traumatic Brain Injuries (TBIs) and Tourette Syndrome. The use of provocative language (disrespectful, abusive, or unsafe language), provokes a reaction, and the user is viewed as an out of control child violating boundaries, being confrontational, anti-social, or acting out to gain attention or escape a demand. Symptoms of these disabilities are frequently misunderstood, and often result in removal from classrooms, detentions, suspensions, or unwarranted police interaction.

It is not unusual for peers, adults or agencies to misinterpret the neurological symptoms associated with a child or adolescent’s disability and label them as just behavioral problems. Because these children may not behave in socially acceptable ways, they are viewed as purposefully disruptive, bad, delinquent, attention-seeking or manipulative. There are many factors that may contribute to the manifestation of this type of behavior. They may suffer from anxiety, overwhelm and fear of failing due to academic skills deficits, cognitive or sensory processing delays, brain damage, pragmatic language deficits, social communication disorders, obsessive-compulsive behaviors, or PTSD from trauma or abuse. They are not delinquents.

The setting event or antecedent to the behaviors is different than for a
neuro-typical child who might have this behavior. Those with impaired
sensory, pragmatic language processing or social cognition deficits will not always recognize or be able to independently manage their transitions from calm to discomfort, upset, anger, or rage. Nor will they be able to deescalate and return or recover to calm easily or independently. These
behaviors may be manifestations of a disability that needs treatment, not
discipline.

It is well recognized that there is an over-representation of learning and
social skill deficits among youth offenders and drop-outs. All of which
should have been identified and remediated by schools, under IDEA. in a
2015 study of individuals in a juvenile justice system, 60% of students
accessed presented with speech, language and communication difficulties, 52% met the criteria for having a language disorder not previously recognized. Language difficulty and social skill deficits are significant risk factors for illiteracy, emotional difficulties, educational failure and entry into the school to prison pipeline. Competent language skills are required to form positive interpersonal relationships and maintain appropriate personal, social, educational, literacy, employment and business interactions that are necessary across all environments.

The use of provocative language significantly increases the risk of student
engagement with Child Protective Services and the Criminal Justice System. Traditional interventions like Cognitive Behavior Therapy and Anger Management programs in residential or segregated therapy settings require language modifications, which are not provided, in order to be delivered appropriately and result in positive outcomes.

It should be noted that inappropriate or unlawful behavior is not particularly high for those with disabilities but they are disproportionally represented within school expulsions, suspensions, as well as the justice system, and child protective services.

For juveniles, treatment should be aimed at reforming and preventing further inappropriate or criminal behavior in both school and the justice system.

This is mandated by IDEA and the juvenile justice system. Currently
interventions used are not research-based for children with language and
socially-based disabilities.

PREVALENCE: JUSTICE SYSTEM POPULATION
Childhood ADHD            63.00%      5.00%
ADHD in adulthood       43.00%      4.40%
Autism                             10.00%      1.50%
Tourette Syndrome        6.00%       0.03%
Intellectual Disability      1.00%      1.00%

This is difficult for those who are socially delayed (naively, requiring rigid
routines, having social miscues, perseverative behaviors, lack of understanding of behavioral impact, empathy, consistent emotional control, social communication, social cognition, and imagination skills), to explain their behaviors and their lack of intent to do something wrong.

Some students have not been diagnosed prior to demonstrating
significant behaviors.
Some do not volunteer their diagnosis prior to an interview or
interrogation
Some appear willful during an interview due to changes in their
routine, and stress
Poor social cognition and problem-solving skills make them
susceptible to bullying and coercive tactics
Communicating their recall of events may be compromised due to
their language deficits (Woodbury-Smith & Dein, 2014).
Students may not fully comprehend what they have done wrong or even know that they may get in trouble for their behavior (Berryessa, 2014).

Schools and courts need to understand that there does not appear to be a uniform understanding of how these students might demonstrate their intent, frame of mind or knowledge of wrongdoing (mens rea—which is a necessary element to making some behaviors a crime). Yet, they are seven times more likely to intersect with the criminal justice system than individuals without these disabilities (Berryessa, 2014). Additionally, officials at school and in court may not immediately recognize that certain behaviors are a manifestation of a student’s disability vs. an intent to do wrong because assumptions are made when a student appears high-functioning.

A transition goal for safe and appropriate behavior and language in the
community is necessary. The most successful students, academically and
functionally, have a team that approaches their programming collaboratively and where everyone is trained, and fidelity checks assure consistent application of interventions across environments. It is essential to collect and analyze meaningful data and use it to modify programming
appropriately, so as to achieve functional outcomes, commensurate with the child’s circumstances, and in the least restrictive environment. Teaching, reinforcement, generalization and mastery of replacement behaviors must occur throughout the day in both isolations and then across environments, with supports and prompting and then fading to independence.

This book is a manual for interagency practice related to the understanding of behaviors that are misinterpreted and thus result in inappropriate interventions. It also addresses the disability cultural realities and insights related to working with unique behavioral presentations specific to disabilities. This book includes a wide range of expertise necessary for psychology, community psychology, mental health, neuropsychology, family and parents, educational psychology, behavioral analysis, as well as child, adolescent and school psychology. Dr. Lewis addresses the shared responsibilities and accountability that are lost through system gaps, due to agencies being under-supported and not provided adequate training. The following areas and resources are offered:

Defense System Activation Triggers
The Dysregulation Process
Behavioral Interventions
Socially Inappropriate Language
Steps to Social Competence
Language Deficits Need to be Identified
What Does it Look Like?
Punishments Are Counterproductive
Feelings of Parents
Causes of Dysregulation
Support Program Quality Indicators
IEP Development
Social Cognition Goal Samples
Suspensions are not Research Based
Alternatives to Suspension and Expulsion
What to do Next

This information has prevented inappropriate CYS and Police involvement with children, by accurately identifying certain behaviors as a manifestation of their disability. This book will assist educational professionals, parents, and education advocates in providing appropriate and individualized services based on accurate identification of the student’s social, emotional, functional and behavioral needs. It is the hope that this will assist those involved with the student’s school evaluations and IEP development in addressing and implementing a Free Appropriate Public Education (FAPE), in the Least Restrictive Environment (LRE), as required under the Individuals with Disabilities Education Act (IDEA), the nation's special education law that provides protections and rights for children with disabilities.