Setting Events – Figuring out Difficult Behaviors

When I was the Program Director at a Care Center for people with disabilities, I worked a lot with managing difficult behaviors.  I was usually called in to work with someone after the staff had already been working with that person for a while, and they needed help. Sometimes figuring out why someone is doing something is difficult, especially if that person does not talk.  Their behavior is how they communicate, and our responsibility is to figure out how to interpret their behavior. You may be familiar with the Antecedent-Behavior-Consequence form that is used a lot when parents/professionals are faced with difficult behaviors.  If not, I will definitely blog about it another time.  With that form, you look at what happened right before the behavior, what the behavior looked like, and what happened immediately following the behavior.  This is a good way to start noticing patterns, and how to help an individual. One thing that sometimes is missing is the Setting Events.  These are things that may have happened previous to the antecedent, and could be anything from medication changes to going to bed late or even having a bad dream.  We’ve all had it happen to us, where our day is thrown off because of something that may have happened the night before, or maybe we got a phone call that made us upset, but we don’t erupt until hours later when everything appears to be unrelated.  Those are Setting Events. Here is an example of why understanding Setting Events can be important.  There was one day that one of the residents (I’ll call him Simon) was refusing to eat.  The staff did everything they could think of to get him to eat, but he would not eat.  The dining hall was almost empty, and Simon had not even started eating.  This was a concern because of health issues, so it was important that Simon ate his breakfast.  It wasn’t uncommon for Simon to refuse to eat, but generally the staff could get him to eat without involving me. For some reason today was different.
I’m not totally sure everything that the staff tried before they asked me to come assist, but I know they had been trying for probably about an hour.
When they came to me to ask for help, I immediately asked them if Simon had a belt on.  Now, to an outsider, that probably seems like a very odd question to ask in this situation.  What does a belt have to do with eating breakfast?  The staff said that he did not have a belt on, so I asked them to get him his belt and if he is still refusing to eat then I would come in and help.  I’m sure that they thought I was crazy, but a few minutes later the staff reported that Simon was eating.
So what does a belt have to do with eating breakfast and how did I know that that was the reason why Simon wasn’t eating before I even went to check on him?  I had worked with Simon for a couple years, and I knew that he had a very rigid routine that he would follow every day.  If that routine was interrupted, he wouldn’t complain, but he would start over.  Simon usually moved at a very slow pace which was opposite the pace that the staff was working at, and oftentimes Simon would be rushed.  Usually rushing Simon had the opposite effect because he would have to start over, so in essence he took even longer.  I had noticed a few days/weeks prior to this incident that Simon had become very attached to his belts, and he always had to be wearing a belt.  If he did not have a belt, then his day would be ruined.
So one of the Setting Events was that Simon was rushed and he did not have a belt on.  The Antecedent was that he was given breakfast, the Behavior was that he was refusing to eat, and the Consequence was that the staff did everything they could do to try to convince him to eat.  You can see why Setting Events can be important, and why being aware of routines, environment, etc., can be key to your observations.  Without the setting events, our conclusion could have been he was avoiding eating, maybe it was a sensory thing with the food, or maybe he wanted something else.  It could have been that he was doing it for attention.  Those would have been good guesses, but they were wrong that particular day.
Sometimes it’s the obvious, but when what you’re doing isn’t working, it might be something less obvious.  This is also a reason why communication is important between parents and teachers.  I was always so grateful when parents would call me (when I was teaching) to let me know that something happened at home, or the child missed breakfast, or that they changed medications.  That information can be very useful when you are trying to decipher why there may be a change in behavior, or why what you used to do doesn’t work any more.

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