A Narrative Review on Prevention and Early Intervention of Challenging Behaviors in Children with a Special Emphasis on COVID-19 Times

Figures & data

Figure 1 The Pyramid Model.

Table 1 Examples of ABC Observation for Challenging Behavior

Antecedent	Behavior	Consequences
Unstructured social situations (eg, free time, sports, games, family events)	Repetitive comments or questions, crying, dropping to the floor, hitting others	Avoids situations and social demands
Difficulty completing tasks with precision (eg, makes errors)	Crying, throwing, or destroying materials, refusing to complete activities	Obtains assistance or task is modified or delayed
Asked to do multiplication and long division problems, sitting next to Ahmed	Talking in class, arguing with Mr. Aaron (math teacher)	Gets sent to the principal’s (Mr. Michael’s) office

Table 2 Real Scenario Examples of ABC Observation

Antecedent	Behavior	Consequences	Function/Purpose
Noora does not enjoy/like group activities	Noora hits the person in the group sitting nearest to her	The teacher takes Noora to sit outside in the quiet corridor. Noora learns that when she wants to be taken out of a group activity, she hits someone and gets removed from the class	Escape
Father attempt to leave the house/go to work	Sarah screams every instance that her father walks away from her.	Her father returns to her and asks, “What’s wrong Sarah. Sarah learns whenever she wants her father to stay with her, she screams.	Attention
Khalid’s preferred toy is played by his brother	Become aggressive, hits his brother and scream	Mother gives Khalid back his toy and told his brother do not use this toy again. Khalid learns to not share his toys and hit his brother whenever he uses his toys.	Tangible
Maha is sitting in class, the teacher is not paying attention to her nor given anything to do	Maha starts rocking, scripting, and hand-flapping at her disk. This movement feels good to her.	Next time Maha does not have anything to do, she will do these movements	Sensory

Table 3 Examples of ABC Strategies by Behavioral Function

Function	Antecedent Strategies	Replacement Skills	Consequence Strategy
Avoid non-preferred activity eg, bath time	Create visuals for evening routine with a preferred activity eg, story time at the end of the routine. Provide a choice of taking a bath, or a shower, bubbles, or no bubbles.	Teach how to request a shower instead of a bath	Provide frequent verbal praise for appropriate behavior. Celebrate the completion of a bath activity.
Escape tooth brushing	Use visual (timer) or auditory cues eg, preferred song signals to show how long the activity will take. Use a favorite flavored toothpaste	Teach how to request a break from the current activity eg, saying stop, holding up his hand	Provide frequent verbal praise for appropriate behavior or appropriate requests for short breaks. Follow appropriate tooth brushing with favorite activity.
Attention seeking eg, in class	Place student at a desk where they are easily accessible Give students intermittent attention for positive or neutral behavior	Teach students more appropriate way to ask for attention eg, as raise hand, wait patiently to call on you.	Respond quickly if a student asks appropriately. Give frequent attention for positive behavior. Appraise/award star of the week for persistent positive behavior

Figure 2 Flowchart of Functional Behavioral Assessment (FBA) and Behavioral Intervention Plan (BIP).