Positive Behavioral Intervention Strategies for Children With Challenging Behavior & Hearing Loss

A significant body of research has shown that children with hearing loss commonly exhibit behavioral problems,[1,2,5,7] but there is limited evidence on positive behavioral intervention strategies to address such behavioral issues among these children.[2] In this article, we’ll share evidence-based responses and strategies to prevent such behavior.

Behaviors such as tantrums and not following directions are some examples of the challenges many parents and educators face daily. It’s understandable to be unsure how best to approach such behavior, especially when working with children with hearing loss who may also have delayed communication skills.

All children need nurturing, responsive relationships, and supportive environments. But for some that is not enough. If a child does not respond, they may require more intensive intervention. Children with severe and persistent challenging behavior can require the use of individualized positive behavior supports with targeted social-emotional supports.[3,4] Whether in the classroom, a clinical setting, or at home, some strategies can be used to help promote a child’s social-emotional growth.

Positive Behavioral Intervention Strategies for Children

We recommend working toward preventing problematic behaviors from occurring. To do so, teach children social-emotional skills and allow them to practice the skills by giving them the tools needed to be more successful. Creating make believe situations and acting how to solve a problem is a great way to be proactive in addressing challenging behavior. This may include role playing, using puppets, or playing games during which you prompt the child to practice their new skills. You may need to do this several times with a variety of situations.

The most important thing to remember is that if a child is escalated, this is not the correct time to teach. Your goal in those instances should be to help the child de-escalate and keep everyone safe. To help the child de-escalate, we recommend using positive behavioral intervention strategies.

How to Promote Children’s Social-Emotional Skills

The soil needs to be rich for a garden to grow. Similarly, all children need high-quality supportive environments and nurturing, responsive relationships. To provide a high-quality supportive environment, ask yourself the following questions:

• Is there a predictable schedule?
• Are clear expectations provided?
• Do you tell the children what TO do (rather than what NOT to do)?
• Are your activities and materials engaging?
• Do you provide clear directions?
• Do you offer choices to the children?

Research has shown that when children with hearing loss do not understand what is going on around them, they are more likely to behave inappropriately.[6] Therefore, if you have answered “no” or “yes, but with room for improvement” to any of the above questions, these are areas in which improvements should be made.

By creating a more structured and supportive environment, what is expected becomes more accessible to all children, especially those with hearing loss.[8] In addition, don’t forget to use language that the children understand and move close and gain their attention before speaking.

The relationships built with children, their families, and among colleagues can lay the foundation for positive behavior. It is important to build these relationships early on rather than waiting until there is a problem. Children learn and develop social emotional competence in the context of relationships that are responsive, consistent, and nurturing.

Growth via Self-Regulation & Co-Regulation

Teaching self-regulation can also have a huge positive impact on emotions and behavior for young children. Self-regulation is a complex process that allows children to control their attention, thoughts, emotions, and behaviors. Infants and toddlers have a limited ability to self-regulate, but this skill can be strengthened and taught. Because disruptive behavior can make it even more difficult for children with hearing loss to develop language and communication skills,[2] learning how to self-regulate is particularly important for children with hearing loss.

Before self-regulation comes co-regulation. According to David Belford, co-regulation is when an adult caregiver teaches a child how to calm down by making eye contact, talking softly (but loud enough for a child with hearing loss to understand), giving gentle touches, etc. Through co-regulation, children begin to develop self-regulation, which requires higher level thinking. Both co-regulation and self-regulation are important for growth and development throughout our lives.

Ensure a Child’s Hearing Device Is Working Properly

Be sure children are ready to listen every day. In planting the seeds for positive behavior, we must also ensure children using hearing devices such as hearing aids or cochlear implants are able to receive these messages through listening. It is best to assess listening devices and complete the Ling Six Sound Test daily with children.

Be sure to visit the Evidence-Based Practices website on ChallengingBehavior.org, which provides many resources and printable materials in 12 different languages. There you can find more information on adopting, implementing, and sustaining a systematic approach that promotes young children’s social competence and addresses challenging behavior, along with more on the extensive body of research behind the insights shared in this article.

Special thanks to Erin E. Sizemore, MA, Learning and Development Facilitator at the Department of Child & Family Studies in the College of Behavioral and Community Sciences at the University of South Florida as well as Lauren Beatty, Consumer Engagement Manager at MED-EL Corporation, USA for their contributions to this article.

References

1. Barker, D. H., Quittner, A. L., Fink, N. E., Eisenberg, L. S., Tobey, E. A., & Niparko, J. K. (2009). Predicting behavior problems in deaf and hearing children: The influences of language, attention, and parent–child communication. Development and Psychopathology, 21(2), 373–392. https://doi.org/10.1017/s0954579409000212
2. Bigler, D., Burke, K., Laureano, N., Alfonso, K., Jacobs, J., & Bush, M. L. (2018). Assessment and treatment of behavioral disorders in children with hearing loss: A systematic review. Otolaryngology–Head and Neck Surgery, 160(1), 36–48. https://doi.org/10.1177/0194599818797598
3. Dunlap, G., Strain, P. S., Lee, J. K., Joseph, J. D., Vatland, C., & Fox, L. (2017). Prevent, teach, reinforce for families: A model of individualized positive behavior support for home and community. Paul H. Brookes Publishing Co.
4. Dunlap, G., Wilson, K., Strain, P., & Lee, J. K. (2013). Prevent, teach, reinforce for young children: The early childhood model of individualized positive behavior support. Paul H. Brookes Publishing Co.
5. Hall, W. C., Li, D., & Dye, T. D. (2018). Influence of hearing loss on child behavioral and home experiences. American Journal of Public Health, 108(8), 1079–1081. https://doi.org/10.2105/ajph.2018.304498
6. Hogan, A., Shipley, M., Strazdins, L., Purcell, A., & Baker, E. (2011). Communication and behavioural disorders among children with hearing loss increases risk of mental health disorders. Australian and New Zealand Journal of Public Health, 35(4), 377–383. https://doi.org/10.1111/j.1753-6405.2011.00744.x
7. Stevenson, J., McCann, D., Watkin, P., Worsfold, S., & Kennedy, C. (2009). The relationship between language development and behaviour problems in children with hearing loss. Journal of Child Psychology and Psychiatry, 51(1), 77–83. https://doi.org/10.1111/j.1469-7610.2009.02124.x
8. University of South Florida Program-Wide Positive Behavior Support. (2022, August 17). Evidence-based practices. National Center for Pyramid Model Innovations. https://challengingbehavior.org/pyramid-model/evidence-based-practices/