What Is the Breathing Strategy?
Relaxation techniques, such as deep breathing, are important tools to teach Individuals with disabilities to manage and regulate their emotions and behaviors. Individuals with disabilities often respond best given instructions that are clear, concrete and presented visually when learning more abstract concepts. Visual supports are teaching and communication tools that provide information to a Learner to help process a message, task or expectation (Rao & Gagie, 2006). The use of visual aids with Learners with disabilities has also been found to decrease the amount of assistance needed for Learners to focus and complete tasks (Bryan & Gast, 2000; Conroy, Asmus, Sellers, & Ludwig, 2005; MacDuff, Krantz, & McClannahan, 1993).
The Breathing Strategy provides an image of a heart on the screen to promote steady breathing in and out by a Learner or group of Learners. The strategy is initiated by staff members when a Learner is demonstrating signs of anxiety, frustration, aggression or other behaviors that may warrant the use of a relaxation strategy. The Learner can be prompted to use the strategy one time or multiple times, based on individual or group needs. The strategy may also be adjusted by changing the color of the heart used and/or number of breaths.
Why Is the Breath Strategy Important?
Multiple studies have been conducted focusing on using mindfulness training with people with intellectual disabilities to help them deal with behavioral issues such as anger, aggression and sexual arousal (Singh et al. 2003, 2007a, 2011a, c). Individuals were taught meditation procedures (some including deep breathing) to help them calm their minds by focusing on the body rather than the emotionally arousing thought, situation or event. Several studies found reductions in physically and verbally aggressive behavior during the training (Singh et al. 2011a), decreased anger and aggressive events (Sing et al., 2011b) among other successes (Hwang & Kearney 2013). Interesting enough, individuals with intellectual disabilities also reported that they valued learning how to control their own feelings rather than being told to calm down by other people.
Mindfulness training can be provided in a variety of settings by a variety of staff, family members along with children with disabilities (Chapman et al. 2013). The mindfulness training needs to be accessible to individuals with intellectual disabilities to ensure that they understand and can use the concepts and techniques. Clear instructions, regular practice and concrete examples are strategies to assist in understanding. According to Tummers (2005), yoga has been shown to be an effective tool in supporting behaviors that may be due to stress or over excitement in preschool children with Down syndrome, cerebral palsy, autism, sensory integration and learning disabilities, as well as attention deficit disorder. Mullins and Christian (2001) found that progressive relaxation training was effective at increasing academic engagement and decreasing the duration of tantrum behavior in students with autism spectrum disorders immediately following the intervention.
The Breathing Strategy in Positivity provides a visual tool to better understand the concept of taking deep breaths in order to work through strong emotions. The Breathing Strategy is best used on a regular basis, and as needed in times when the Learner may be experiencing anxiety or other emotions that may require regulation.
Setting Up the Breath Strategy in Positivity
Because the Breathing Strategy is available only on demand, setup is quick, easy and occurs upon delivery. The User would simply determine:
- Who the strategy is to be delivered to
- The number of breaths
- The color of the heart
- Selecting submit to deliver the Breath Strategy
Implementing the Breathing Strategy in Positivity
Step 1: Identify the target behavior to decrease through the Breathing Strategy
Gather information about the problem behavior from parents and team members to assist the team in making a plan for using the strategy. Some questions the team may consider include:
- What specific problem behavior would you like to decrease?
- What signs/symptoms does the Learner demonstrate that would indicate he or she may need to take a deep breath? Examples may include: pacing, increased verbalizations, frustration, etc.
- Are there certain times in the day or activities that the student seems to demonstrate these signs more often?
- Does the learner know how to take a deep breath?
Step 2: Collect baseline data on the problem behavior before implementing the Breathing Strategy
The team should collect baseline data on how often the problem behavior has been occurring prior to the use of the strategy as well as what activities and situations the behavior was most likely to occur in.
Step 3: Directly teach the Learner HOW to use the Breathing Strategy
In the initial phases of intervention, it’s important to focus on teaching the Learner how to use the strategy appropriately. Choose times in the day to provide direct instruction on the strategy.
- Model how to use the Breathing Strategy initially when the Learner is calm and attentive. For example, say, “If you are feeling anxious or upset, we can take a breath to calm down.” Then state, “Let’s practice…let’s breathe.” Model breathing in and breathing out along with the heart on the screen.
- Provide immediate positive feedback and reinforcement to the Learner for taking a deep breath with the visual cue on Positivity, even if you have to prompt the Learner to do so.
This strategy should be introduced at low-stress times during initial phases of the intervention to ensure the Learner understands the concept.
Step 4: Use the strategy throughout the school day
Once the Learner has learned how to take a breath using the strategy, initiate the intervention across the day on demand. When the Learner begins to show initial signs of frustration or anxiety, initiate the use of the Breathing Strategy.
Consider using the strategy during group times to provide additional opportunities for practice in which the Learner will see other students and adults modeling the same behavior.
Step 5: Collect and analyze intervention data
How do you know if it is working? Once the Breathing Strategy has been introduced, begin to collect data to determine the success of the intervention. Positivity provides users with data, recording the event that the strategy was delivered, the time the strategy was initiated and the total count of breath strategies delivered for the defined time.
The team may also choose to document any incidents of problem behavior similar to the baseline data to determine the intervention effectiveness. The team may also collect data surrounding the level of assistance the Learner needed to engage in the strategy (e.g., independent, prompted).
If the intervention is effective, the team should continue with the current intervention. The learner should be moving towards independence in breathing and hopefully generalizing that skill to other times in the day.
If after 3-4 data points, a positive trend in the breathing behavior is not observed or the problem behavior continues to occur, the team should review the current implementation plan and ensure it is being conducted with fidelity. The team may also consider adjustments to how many breaths are given, the color of the heart as well as the timing of the strategy.
After 10 data points, a reliable trend of data should be obtained to assist the team in making significant decisions related to the intervention (Gall, M. D. & Gall, J. P., 2007). In such cases, the team may need to make more intensive changes to the current intervention and or adjust the type of intervention.
Some common questions to consider:
- Is the intervention being implemented with fidelity?
- Is the frequency of the strategy sufficient to provide enough practice for the Learner?
- Is there enough and appropriate reinforcement delivered when the Learner engages in the target behavior?
- What prompting strategies are being used?
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