Assessing and Treating Physical Aggression

Written by:  Ed Littleton, M.S., BCBA

When looking at the problem behaviors that children with developmental disabilities sometimes display, one of the most common and difficult to deal with is physical aggression.  Physical aggression is a type of aggressive behavior that could lead to the injury of another person.  It often displays as hitting, kicking, biting, scratching, hair-pulling or a combination of several of these behaviors. 

One of the reasons it is so common is because of its effectiveness.  Using physical aggression is the quickest way to make somebody back off and also gain the attention of everybody in that area. 

Before we look at any type of intervention to treat physical aggression, we first have to analyze the function of the behavior.  This is done through careful observation of the antecedent (whatever happens before the behavior) and the consequence (whatever happens after the behavior).  There may also need to be a more formal functional analysis conducted, which should be done by a Board Certified Behavior Analyst (BCBA). 

Physical aggression that serves the function of “escape” means that the child is using the aggression to get away from doing whatever it is that you are asking them to do or something unpleasant.  So, if the antecedent of the aggression always seems to be task demands, we can hypothesize that the behavior is being used to escape those demands.  In this case an intervention that results in the removal of these demands (i.e. time-out) would not be effective and would only serve to reinforce the behavior making it more likely to occur in the future.  A more effective intervention would include only removing the demands following appropriate behaviors and may also include some sort of reinforcement plan for completion of the demand/task.  We could also look at working on some functional communication training that would give the child a more appropriate way to ask for a break.  This could be done with either signs/gestures or vocalizations. 

When the antecedent involves the child being ignored and the consequence includes people coming over to intervene or the child receiving a verbal reprimand, attention may be hypothesized as the function.  In this case, any intervention that involves physical restraints or verbal reprimands would be ineffective.  Your intervention would want to include withholding attention (i.e. time-out, planned ignoring) following the aggression.  You would also want to include a component that provides the child with additional attention following any appropriate behaviors, so they do not need to use the aggression in order to gain the desired attention.

When the aggression occurs following an item being removed or the child being told “no” when asking for access to an item, the access to that item may be the function of the behavior.  We often see this in a store when the child will see something they want and the parent tells them they are not allowed to have it.  The child will then engage in aggression and the parent, in order to avoid further aggression in public while others look on, will give the child the item they wanted.  This, in turn, reinforces the behavior and makes it more likely to occur again in all settings.  Your intervention may involved teaching the child to accept “no” and include gaining access to preferred items only following the occurrence of appropriate behaviors rather than aggressive behaviors (eg. “if you walk nicely in the store, you can choose a candy at the end of the trip”).

It should also be noted that sometimes the aggression may be based on internal factors (i.e. physical pain, confused thoughts).  These covert circumstances are unable to be observed and are typically harder to treat.  However, if the behavior seems cyclical (occurring at high rates and the fading) a medical exam may be in order to look for any medical ailments that may need treating.  Also, part of the problem is that often children and adults with developmental disabilities are unable to communicate effectively.  Thus, when they have a physical pain they are unable to tell anyone.  Having a good verbal behavior program in place and working on teaching body parts can help give the person an outlet to communicate what is occurring. 

While these are some guidelines on how to assess and treat physical aggression, if you have any questions or are interested in services in order to help reduce such behaviors, please leave a comment below or contact Behavioral Consulting of Tampa Bay at 813-814-2000.