BEHAVIOR REDUCTION PLAN - Carbone Clinic...Behavior Reduction Plan Sabrina’s Behavior Reduction Plan will include using MO manipulations to decrease the value of the reinforcers

Dr. Vincent J. Carbone, Director 614 Corporate Way,

Board Certified Behavior Analyst-Doctoral Valley Cottage, NY 10989 Certificate # 1-00-0232 Vincent J. Carbone, Ed.D., BCBA, LLC Phone: 845-267-0920

Fax: 845-267-0921

Kristin Albert, M. Ed., Assistant Director www.carboneclinic.com Board Certified Behavior Analyst Certificate #1-08-4241

Jaimie Weinlein, MAT, Supervisor of Education & Therapy

BEHAVIOR REDUCTION PLAN

Sabrina: Sabrina

Date of Birth:

Age: 9 years, 3 months

Disability: Autism

Parents/Guardian:

Clinic Start Date: 07/16/2013

Reported By: Lisa Reynolds, M.Ed., BCBA; Kristin Zulkeski, B.S., BCaBA; Julien Mollereau

Approved by: Jaimie Weinlein, MAT; Kristin Albert, M.Ed., BCBA

Date of Report: 07/26/2013

Brief Description of Assessment Methods

During a 4-session assessment period from July 16, 2013 to July 19, 2013, sequence analysis

(antecedent-behavior-consequence; ABC) data were recorded on the frequency and cumulative

duration of problematic behaviors emitted by Sabrina that interfered with instruction. The

following clinic-wide definitions of episode and cumulative duration were used when recording

data on problem behaviors:

An episode of problem behavior begins with the emission of a response that is a member

of any of the topographical response classes defined below and ends when there is a

break of at least 3 seconds during which no additional responses that are members of any

of the topographical response classes defined below are emitted. Any response, which is

a member of any of the topographical response classes defined below, emitted following

an inter-response time greater than 3 seconds shall constitute the beginning of a new

episode of problem behavior.

The cumulative duration is the amount of time (i.e., seconds and/or minutes) during

which episodes of problem behavior are emitted within a session. The duration of each

episode of problem behavior is measured from the beginning to the end of that episode in

accordance with the above definition. Therefore, the shortest duration for any episode of

problem behavior will be 3 seconds. The durations of individual episodes are added

together to calculate the cumulative duration for a session.

Across the 4-session assessment period, Sabrina emitted a cumulative total of 72 episodes of

problem behavior, lasting for a cumulative duration of 43 minutes and 0 seconds. This averaged

out to 18 episodes per session, lasting for an average cumulative duration of 10 minutes and 45

2

seconds per session. Episodes of problem behavior included the topographies listed below. Of

the 72 total episodes of problem behavior, 10 occurred when Sabrina was interrupted or

transitioned from a reinforcing activity, 7 occurred when Sabrina was denied access to a

reinforcer (told “no”), 16 occurred when there was a motivating operation (MO) that was strong

but Sabrina manded inappropriately, 10 occurred when Sabrina was presented with demands

during discrete trial instruction (DTI), 11 occurred when Sabrina was presented with demands

during activities, 5 occurred when automatic reinforcement was high in value, 13 occurred when

the MO was unclear (i.e., “Out of the Blue”), and 0 occurred when another MO was in effect.

Based on these data, the following behaviors have been topographically defined and targeted for

reduction:

Biting (B): Opening the mouth and placing an item or any body part (often the part of her palm

between her thumb and wrist) between her teeth and closing her jaw so that teeth close around

body part or item.

Bolting (BT): Leaving or attempting to leave (walking or running) an activity or setting in

which she is engaged or has been instructed to stay.

Crying (C): The production of tears. Often accompanied by whining (emitting vocal wailing

sounds or high pitched, non-functional noises consisting of intelligible or unintelligible speech

sounds/words) and/or the emission of vocalizations at an excessively loud and socially

unacceptable volume.

Flopping (F): When not instructed to do so, any sudden drop to the ground, or attempt to do so,

that occurs while sitting or standing.

Grabbing (G): Any extension of the hand or arm in the direction of an object or person

accompanied by wrapping or attempting to wrap her fingers around that object or person. May,

but does not have to, be accompanied by squeezing of the object or person.

Physical Resistance (P): When physically prompted, using or attempting to use any part of her

body to push against the instructor in the opposite direction of the prompt that lasts more than 3

seconds.

Shoes Off (SO): Any instance in which shoes are removed from feet, when not instructed to do

so, either by using her hands or using the other foot to push the shoe off of the opposite foot.

This is only considered a problem behavior if Sabrina does not comply with “keep your shoes

on” or “put your shoes back on” within 3 seconds of instruction to do so.

Whining (W): Any time Sabrina emits vocal wailing sounds or high pitched, non-functional

noises consisting of intelligible or unintelligible speech sounds/words that are not accompanied

by tears.

3

Problem Behavior Summary Data Sheet

Across Antecedents

Date

07/16 07/17 07/18 07/19 Cumulative

Total

Interruption/

Transition

3 1 4 2 10

Told “No”/

Denied Access

1 2 2 2 7

MO Strong but

Mands

Inappropriately

3 10 2 1 16

Demand during

DTI

2 1 0 7 10

Demand during

Activities

9 2 0 0 11

Automatic

Reinforcement is

High in Value

1 1 2 1 5

MO Unclear/Out

of the Blue 1 10 0 2 13

Other

0 0 0 0 0

Total frequency

20 27 10 15 72

Total duration

6:05 19:15 3:57 13:43 43:00

4

Tentative Functional Analysis and Possible Treatments

Antecedent /

Frequency

Behaviors

Tentative Analysis

of Function

Possible

Treatment

Data Collection

Interruption/

Transition

10

BT, C, F, G, P, W Socially-mediated

positive and negative

reinforcement

Interruption/

Transition Protocol

Total frequency and

cumulative duration of

episodes of problem

behavior per session by

antecedent

Told No/

Denied Access

(7)

BT, C, F, W, SO,

G

Socially-mediated

positive

reinforcement

Told No Protocol

Total frequency and


episodes of problem


antecedent

MO Strong but

Mands

Inappropriately

(16)

BT, G, P, W, C Socially-mediated

positive

reinforcement

Count and Mand

Protocol

Total frequency and


episodes of problem


antecedent

Demand during

DTI (10)

B, C, W, P Socially-mediated

negative

reinforcement

Demand During

Discrete Trial

Instruction Protocol

Total frequency and


episodes of problem


antecedent

Demand during

Activities (11)

C, W, F, SO, B,

BT, P

Socially-mediated

negative

reinforcement

Demand During

Activities Protocol

Total frequency and


episodes of problem


antecedent

Automatic

reinforcement is

high in value

(5)

B, P Automatic positive

reinforcement

Response Blocking Total frequency and


episodes of problem


antecedent

MO

Unclear/Out of

the Blue (13)

B, BT, C, F, G, P,

SO, W

Socially-mediated

positive and negative

reinforcement

Out of the Blue

Protocol

Total frequency and


episodes of problem


antecedent

5

Functional Definitions of Problem Behavior

Sequence analysis data recorded on Sabrina’s problem behavior suggest that the problem

behaviors listed above are multiply-controlled.

The antecedent conditions that evoked problem behavior included: when interrupted from a

preferred item or activity and/or transitioned to another item or activity, when Sabrina was told

“no” or denied access to a reinforcing item or activity, when an MO was strong by Sabrina

manded inappropriately, when demands were presented during DTI, when demands were

presented during activities, when automatic reinforcement was high in value, and when the

specific MO was unclear (i.e., out of the blue).

These data suggest that there may be a functional relationship between the responses and a

history of access to socially-mediated positive reinforcement (SMPR), socially mediated

negative reinforcement (SMNR), and automatic positive reinforcement (APR).

Interruption/Transition Antecedent: When Sabrina is interrupted from a preferred

activity and transitioned to a less preferred item or activity, she will engage in any of the

problem behaviors listed above because in the past these behaviors have been reinforced

by the removal of the demand to transition (SMNR) and the maintenance of access to the

preferred item or activity (SMPR).

Told “No”/Denied Access Antecedent: When Sabrina is told “no” or denied access to a

preferred item or activity, she will engage in any of the problem behaviors listed above

because in the past these behaviors have been reinforced by the presentation of

reinforcing stimuli (SMPR) in an effort by others to stop the problem behavior.

MO Strong but Mands Inappropriately Antecedent: When there is a strong MO for a

specific reinforcer, Sabrina will mand inappropriately by engaging in any of the problem

behaviors listed above to gain access to that item instead of appropriately manding for the

item because in the past these problem behaviors may have been reinforced by receiving

access to the desired item (SMPR).

Demand during DTI or Demand during Activities Antecedents: When Sabrina is

presented with demands during ITT or during activities, she will engage in any of the

problem behaviors listed above because in the past these behaviors may have been

reinforced by removal or delay of the demand (SMNR).

Automatic Reinforcement is High in Value Antecedent: When Sabrina is in a

reinforcer-deprived environment, she may engage in stereotypic/self-stimulatory behavior

because in the past this behavior has been reinforced by the feeling/sensation produced

simply by engaging in the behavior (APR).

MO Unclear/Out of the Blue Antecedent: When Sabrina is motivated for some type of

a change to be made within the current environment (e.g., attention, a generally enriched

environment) but the specific MO is unclear, she will engage in any of the problem

behaviors listed above because in the past these behaviors may have been reinforced by

the presentation of reinforcing stimuli (SMPR) in an effort by others to stop this

seemingly “out of the blue” problem behavior.

6

Behavior Reduction Plan

Sabrina’s Behavior Reduction Plan will include using MO manipulations to decrease the value of

the reinforcers associated with each antecedent that evokes problem behavior (thereby

decreasing the likelihood that problem behavior will be emitted), differential reinforcement to

increase alternative/appropriate replacement behaviors (DRA), and extinction (EXT) to reduce

the frequency of problem behavior. The following treatment protocols, specific to each

antecedent that evoked problem behavior during the assessment period, will be implemented:

1. Interruption/Transition Protocol: Treatment for Interruption/Transition Antecedent (Page

7)

2. Told “no”/Denied Access Protocol: Treatment for Told “no”/denied access antecedent

(Page 9)

3. Count and Mand Protocol: Treatment for MO Strong but Mands Inappropriately

Antecedent (Page 11)

4. Demand during DTI Protocol: Treatment for Demand during DTI Antecedent (Page 14)

5. Demand during Activities Protocol: Treatment for Demand during Activities Antecedent

(Page 17)

6. Out of the Blue Protocol: Treatment for MO Unclear/Out of the Blue Antecedent (Page

19)

7. Topography-specific Treatments (Page 21)

a. Response Blocking for Biting

b. Walk With Me Protocol

7

1. Interruption/Transition Protocol: Treatment for Interruption/Transition Antecedent

The purpose of this protocol is to teach Sabrina to transition from a reinforcing activity to

another activity without engaging in problem behavior as a replacement for problem behavior

that is maintained by a history of SMNR (having the demand to transition removed) and

SMPR (maintaining access to the reinforcing activity). Set up many transition opportunities

per day for Sabrina to learn this skill.

Offer a

“Promise”

HOWEVER, IF SABRINA EMITS PROBLEM BEHAVIOR

(Bolting, crying, whining, physical resistance, grabbing, flopping)

NO YES

If teacher/Parent

REMOVES DEMAND

&

SABRINA

MAINTAINS

ACTIVITY

Problem Behavior KEEPS

Happening

If teacher/Parent

REMOVES “PROMISE”

&

REMOVES ACTIVITY

&

MAINTAINS DEMAND

&

After Transition and

Several Responses

without Problem

Behavior----Reinforces

Problem Behavior STOPS

Happening

&

Sabrina Transitions Easily

Prevention:

MO

manipulation Consequence:

EXT + DRA

SABRINA’S ACTIVITY

INTERRUPTED

(Asked to Leave One

Activity and Directed to

Another Activity)

8

MO Manipulations

o Approach Sabrina while holding out a “promise” (i.e., a highly preferred item)

so it is clearly visible to Sabrina.

o Present a demand to transition away from the current activity or reinforcer by

asking Sabrina to physically leave the area in which the activity was taking

place or by asking her to give you the reinforcer she currently has access to.

o Initially offer the “promise” during every transition. But, over time, thin the

schedule of reinforcement by offering a “promise” only intermittently, and

eventually not at all.

DRA

o If Sabrina complies (with prompting if necessary) and does not engage in any

problem behavior, deliver the “promise” as a reinforcer immediately and

continue with the transition.

o It may be necessary to provide additional reinforcers throughout the transition

depending on the effort and number of demands required to complete the

transition (see Walk with Me Protocol on p. 21 of this document).

o Once you have successfully transitioned to the next activity, deliver

reinforcers as appropriate to maintain Sabrina’s responding.

o Over time, fade prompts to increase independence during transitions and thin

the schedule of reinforcement so as to intermittently reinforce appropriate

transition behaviors.

Extinction

o If Sabrina engages in problem behavior when you present the demand to

transition, DO NOT ALLOW HER TO MAINTAIN ACCESS TO THE

PREFERRED ITEM OR ACTIVITY SHE WAS BEING ASKED TO GIVE

UP. Physically remove or block access to this preferred item or activity.

o ALSO, REMOVE THE “PROMISE” THAT WAS OFFERED.

o DO NOT REMOVE THE DEMAND TO TRANSITION. Maintain the

demand to transition by vocally representing the demand about every 2 – 3

seconds and using physical guidance (i.e., prompts) to obtain compliance.

o If Sabrina attempts to engage in any aggressive or self-injurious behaviors, the

instructor will use physical prompting to protect her while providing the

minimal amount of attention possible.

o Block access to all reinforcers as long as problem behavior continues.

o ONCE PROBLEM BEHAVIOR STOPS OCCURRING FOR ABOUT 3 – 5

SECONDS (i.e., 3 – 5 responses), begin delivering reinforcers so as to

reinforce appropriate transition behavior.

o If problem behavior is still occurring after completing the transition, begin

requiring responses related to the activity to which you have just transitioned

(see the Demand during DTI or Demand during Activities protocols on p. 15

or p. 17 of this document).

9

2. Told “no”/Denied Access Protocol : Treatment for Told “no”/denied access antecedent The purpose of this protocol is to reduce problem behavior that is maintained by a history of

SMPR (i.e., gaining access to denied activity or item) by offering an “alternative” and

reinforcing “accepting no” behavior. Set up many opportunities per day for Sabrina to learn

this skill.

SABRINA ASKS

FOR SOMETHING

TOLD “NO”

(or access to reinforcer is

denied in some way)

Offer an

“Alternative”


(Bolting, crying, flopping, whining, shoes off, grabbing)

NO YES

If teacher/Parent

Gives Sabrina what she

wants;

Negotiates;

Offers other items;

Attends to behavior


Happening

If teacher/Parent

Does not give Sabrina what

she wants;

Does not offer an

“alternative”

&

Removes all attention for

problem behavior

(except to protect)


Happening

&

Sabrina Accepts “No” in

Future

Prevention:

MO

manipulation

Consequence:

EXT + DRA

10

MO Manipulations o When Sabrina mands for something that you are not willing to give her,

approach her while holding out an “alternative” (i.e., a highly preferred item)

so it is clearly visible to Sabrina.

o Deny access or say no to Sabrina’s mand for a desired activity or item.

o As you deny access or say no, offer an “alternative” activity or item saying,

“But you can have this,” or, “But you can do this”.

o Initially offer the “alternative” for each instance of denying access. But, over

time, thin the schedule of reinforcement by offering an “alternative” only

intermittently, and eventually not at all.

DRA – Differential reinforcement of alternative behaviors o If Sabrina complies (with prompting if necessary) and does not engage in any

problem behavior, deliver the “alternative” as a reinforcer immediately and

continue to deny access, then continue on to the next activity.

o Once Sabrina successfully accepts “no,” deliver reinforcers as appropriate to

maintain Sabrina’s responding.

o Over time, fade prompts to increase accepting “no” and thin the schedule of

reinforcement so as to intermittently reinforce appropriate accepting “no”

behaviors.

Extinction o When Sabrina emits problem behavior following being told “no” or denied

access, do not change environment or provide any attention, items, actions,

activities, or other potential reinforcers contingent upon the problem behavior.

o If Sabrina engages in problem behavior when you say “no” or deny access to

an activity or item, DO NOT ALLOW HER TO ACCESS THE DESIRED

ITEM OR ACTIVITY FOR WHICH SHE WAS TOLD “NO.” Physically

block access to the desired item or activity. ALSO, REMOVE THE

“ALTERNATIVE” THAT WAS OFFERED.

o DO NOT GIVE ACCESS TO THE DENIED ACTIVITY OR ITEM.

Maintain “no” or continue denying access by blocking access to the activity or

item.





o ONCE PROBLEM BEHAVIOR STOPS OCCURRING FOR ABOUT 3

SECONDS, reengage with Sabrina and reinforce appropriate behaviors.

o If problem behavior continues for an extended duration and time/schedule

dictates a transition, present subsequent demands and treat accordingly using

Interruption/Transition (p. 7), Demand during DTI (p. 14), or Demand during

Activities (p. 17) protocols.

11

3. Count and Mand Protocol: Treatment for MO Strong but Mands Inappropriately

Antecedent

The purpose of this protocol is to reduce problem behavior that is maintained by a history of

SMPR (i.e., gaining access to desired items and activities) by teaching appropriate mand

topographies as replacements for the problem behavior. Conduct mand training across many

different MOs many times per day to teach these skills.

SABRINA

“WANTS”

SOMETHING (MO)

Teach Mands

Frequently

HOWEVER, IF SABRINA ASKS WITH PROBLEM

BEHAVIOR

(Bolting, grabbing, whining, crying, physical resistance)

NO YES

If teacher/Parent

Gives Sabrina

What she wants;

Asks what she wants;

Searches for what

Sabrina wants


Happening

If teacher/Parent

Immediately withdraws

attention

(except to protect)

Uses count procedure

Until 5-10 Seconds of

No Problem Behavior

+

Prompts and Reinforces

Appropriate Mand


Happening

&

Sabrina Mands Appropriately

Prevention:

MO

manipulation

Consequence:

EXT + DRA

12

MO Manipulations

o Have a wide variety of reinforcers readily available.

o Begin by delivering reinforcers “for free” (i.e., without placing any demands)

to build motivation.

o Frequently contrive opportunities to conduct mand training so as to teach

Sabrina to appropriately vocally mand across a variety of motivational

categories, settings, stimuli, and instructors.

DRA

o Use prompting and prompt fading as appropriate to teach Sabrina new vocal

mand topographies. If the mand topography matches the MO, regardless of

the quality of her articulation provide MO specific reinforcement for Sabrina’s

initial vocal mand. Contrive another trial and vocally prompt Sabrina

immediately after delivering the reinforcer in order to shape the

quality/articulation of Sabrina’s vocal mand. Provide reinforcement for each

vocal approximation. Differentially reinforce and provide larger amounts of

the specific reinforcer as vocal mand topography improves. Once Sabrina has

improved her vocal mand with instructor-provided echoic prompts, run an

item only trial. In other words, if Sabrina’s vocal mand improvement is

maintained with the item only, differentially reinforcer with a larger amount

of the reinforcer.

o Differentially reinforce appropriate mand responses. In other words, deliver

larger amounts of the reinforcer when Sabrina independently emits vocal

mands and deliver smaller amounts of the reinforcer when Sabrina emits vocal

mands following echoic prompts.

Extinction

o When Sabrina declares motivation for a reinforcer that you are willing to

deliver but she mands using problem behavior, run the COUNT AND MAND

PROCEDURE as described below.

o Tell Sabrina, “No (problem behavior),” and begin counting aloud and showing

the passage of time by using your fingers. You will say, “No (problem

behavior), one, two, three…” as you hold up your fingers. Use a slow count to

10 initially. If Sabrina counts, ignore her counting and maintain your pace of

counting.

o If you complete the count and Sabrina has not engaged in another form of

problem behavior, vocally prompt the appropriate vocal mand topography. As

soon as Sabrina imitates the vocal mand, deliver a small amount of the

reinforcer.

o HOWEVER, if at all during the count interval, Sabrina engages in any form of

problem behavior (see topographies above) restart your count. For example,

“No (problem behavior), one, two, no (problem behavior), one, two, three, no

(problem behavior), one, two, etc.).” Continue this process until Sabrina has

stopped engaging in all forms of problem behavior for the entire interval (i.e.,

to the count of 10) and you can therefore prompt the appropriate vocal mand

and deliver the reinforcer.

o If you repeat the count for many trials without reaching 10, then discontinue

by merely withdrawing the reinforcer without comment AND THE

OPPORTUNITY TO COUNT AND MAND IS NO LONGER AVAILBLE

TO SABRINA. If she moves away from you, ensure her safety, but do not

follow her. If and when she returns to you with continued problem behavior

13

and a clear motivation for a particular reinforcer, restart the count and mand

procedure. If he/she does not return to you and time dictates that it is

necessary to move on to a new activity, then merely carry on and the

opportunity to count and mand is no longer available.




14

4. Demand during DTI Protocol: Treatment for Demand during DTI Antecedent The purpose of this protocol is to abolish the reflexive conditioned motivating operation

(CMO-R), thereby abolishing (decreasing) the value of escape as a reinforcer and abating

(decreasing) problem behavior during DTI, which was maintained by a history of SMNR

(i.e., escape). DTI will comprise 30% of the time during Sabrina’s sessions.

INSTRUCTIONAL

DEMAND IS PRESENTED

Abolish CMO-R


(Biting, crying, whining, physical resistance)

NO YES

If teacher/Parent

REMOVES OR

DELAYS DEMAND

OR

REMINDS SABRINA

OF REINFORCERS


Happening

If teacher/Parent

MAINTAINS DEMAND

(EXT)

&

REQUIRES SEVERAL

APPROPRIATE

RESPONSES

&

THEN REINFORCES


Happening

&

Sabrina Complies with

Instructional Demands

Consequence:

EXT + DRA

Prevention:

MO

manipulation

15

MO Manipulations (Antecedent Curricular Revisions)

1. Use competing positive reinforcers (pairing): Pair the instructional

environment with the delivery of highly valued, positive reinforcers.

2. Mix and vary tasks: Present instructional demands in which the stimuli

and response requirements vary from trial to trial. The use of mixed

verbal behavior (MVB) cards (index and picture cards) will assist the

teacher in ensuring there is a mix of skills being presented.

3. Use errorless teaching: Ensure high levels of correct responding through

the use of errorless teaching (0-second prompt delay) and error correction

procedures. During the errorless teaching procedure, the instructor will

prompt, transfer, present distracters, and probe.

- Prompt: present the discriminative stimulus (SD; i.e., instruction)

and, using a zero second time delay, prompt the correct response

by using the least intrusive/most effective prompt necessary.

- Transfer: present the SD and prompt the correct response using a

faded prompt and/or a 2-second constant time delay.

- Distracters: present one to four known MVB skills.

- Probe: present the SD and further fade prompts or allow for an

independent response.

4. Intersperse easy and difficult demands: Present easy tasks which result

in correct responding and are correlated with a higher density of

reinforcement along with relatively more difficult tasks. About 80% of

tasks presented should be easy (previously mastered skills) versus 20% of

tasks presented being relatively more difficult (current acquisition skills).

5. Fade in the number of demands: At every intensive teaching session

begin by presenting a low frequency of demands before delivering

reinforcers and fade in greater and greater response ratio requirements.

6. Fade in the effort and difficulty of tasks: Begin by presenting easy tasks

that are of a relatively low response effort and fade into more difficult

tasks. This should also be done at each intensive teaching session.

7. Pace instruction properly: The pace of instruction should be relatively

fast, using an inter-trial interval of about 1 – 2 seconds. Once you have

removed reinforcement, begin presenting tasks immediately. Once

Sabrina has responded, only 1 – 2 seconds should pass before the next

demand is placed or reinforcement is delivered.

(See an article regarding this topic that was recently published by Dr. Carbone

and colleagues:

Carbone, V. J., Morgenstern, B., Zecchin-Tirri, G., Kolberg, L. (2010).

The role of the reflexive-conditioned motivating operation (CMO-R)

during discrete trial instruction of children with autism. Focus on Autism

and Other Developmental Disabilities, 25, 110-124.

DRA

o Delays in the receipt of reinforcers have been demonstrated to be related to

higher levels of problem behavior. Therefore, reinforcers will be immediately

delivered for all desirable or on-task behaviors, such as complying with

demands, following directions, keeping hands folded, appropriate manding,

and correct responding.

o Specific items, activities, and actions that have functioned as reinforcers (e.g.,

edibles, Elmo videos, tickles) during the assessment period will be used to

16

differentially reinforce appropriate behaviors (e.g., sitting with hands folded,

correctly responding to instructional demands).

o Based on the assessment period, it was determined that during DTI

reinforcement will be delivered according to a variable ratio schedule of 10

(VR 10), which means that the reinforcer is delivered after approximately 10

responses.

Extinction

o When Sabrina engages in any of the problem behaviors defined above, the

instructor will withhold reinforcement by implementing escape extinction,

thereby not allowing her to escape the instructional demand.

o In other words, the instructor will maintain the instructional demand by

representing the demand in a neutral voice about every 2 – 3 seconds and

using prompts (e.g., vocal, physical) if necessary, to obtain compliance.

o The instructor will not deliver verbal praise or any other reinforcers while

implementing escape extinction.


RESPONSES, the instructor will return to using a natural tone of voice,

frequently delivering verbal praise, and delivering other reinforcers according

to Sabrina’s previously established schedule of reinforcement (i.e., VR 10) so

as to reinforce compliance during DTI.




17

5. Demand during Activities Protocol: Treatment for Demand during Activities

Antecedent

The purpose of this protocol is to decrease problem behavior that occurs during the

completion of daily activities (e.g., those that are a part of natural environment teaching

(NET)) due to a history of SMNR (i.e., escape). NET will comprise 70% of the time during

Sabrina’s session.

DEMAND PRESENTED

DURING ACTIVITY

(e.g.,

“Stay with Me,”

“Play with These Toys”)

Abolish CMO-R


(Crying, whining, flopping, physical resistance, shoes off, biting,

bolting)

NO YES

If teacher/Parent

REMOVES OR

DELAYS DEMAND

OR

REMINDS SABRINA

OF REINFORCERS


Happening

If teacher/Parent

MAINTAINS DEMAND

(EXT)

&

THEN

REINFORCE AFTER

SEVERAL

APPROPRIATE

RESPONSES


Happening

&


Demands during Activities

Prevention:

MO

manipulation

Consequence:

EXT + DRA

18

MO Manipulations

o During NET, pair non-preferred items/activities with previously established

reinforcers so as to build the motivation for these items/activities. Deliver

preferred items “for free” (i.e., without placing any demands) at high rates

(i.e., several times per minute).

o Initially stay with activities, especially non-preferred activities, for short

periods of time. As these non-preferred activities become conditioned

reinforcers, gradually increase the amount of time Sabrina is required to stay

with them.

DRA

o After a period of pairing, fade in the number and difficulty of demands.

Mands should be the first responses required prior to mixing and varying

across the other verbal operants.

o Use prompt and prompt fading procedures so as to errorlessly teach skills,

thereby decreasing the response effort ensuring frequent opportunities to

reinforce appropriate responses.

o Specific responses to be reinforced include mands, playing with toys

according to their function, social interactions with adults or other students,

using language (e.g., tacts, intraverbals) during NET activities, and

completing personal care/self-help routines.

o Begin with a dense schedule of reinforcement during NET and thin this

schedule as appropriate based upon Sabrina’s motivation and the response

effort required.

Extinction

o When Sabrina engages in any of the problem behaviors defined above, the

instructor will withhold reinforcement by implementing escape extinction,

thereby not allowing her to escape the activity-based demand.

o In other words, the instructor will maintain the activity-based demand by

representing the demand in a neutral voice about every 2 – 3 seconds and

using prompts (e.g., vocal, physical), if necessary, to obtain compliance.

o The instructor will not deliver verbal praise or any other reinforcers while

implementing escape extinction.


RESPONSES, the instructor will return to using a natural tone of voice,

frequently delivering verbal praise, and delivering other reinforcers as

appropriate given Sabrina’s motivation and the response effort required within

that activity.

o Subsequently, the instructor will require a period of compliant responding

without additional problem behavior prior to transitioning to another activity.

During this time the instructor will make adjustments to his/her behavior (e.g.,

quicker pace of instruction, denser schedule of reinforcement, using a wider

variety of and/or more valuable reinforcers) so as to increase Sabrina’s

motivation to participate in the activity and decrease the likelihood of

additional escape-maintained problem behavior.




19

6. Out of the Blue Protocol: Treatment for MO Unclear/Out of the Blue Antecedent

The purpose of this protocol is to teach Sabrina to appropriately mand for a generalized rich

environment as a replacement for problem behavior that has previously been maintained by

obtaining access to a variety of reinforcing stimuli (i.e., SMPR). This type of problem

behavior may occur seemingly without reason, and may therefore be mistakenly thought to

be a sensory or medical issue.

“OUT OF THE BLUE”

(No obvious environmental

stimulus (no demand, not

told no, etc.) and it is not

medical problem)

Teach Manding

Frequently

NO YES

If teacher/Parent

Asks what she wants;

Searches for what

Sabrina may want;

Talks to Sabrina to

discover reason for

behavior


Happening

If teacher/Parent

Immediately withdraws

attention

(except to protect)

&

Blocks access to

reinforcers

&

Waits for 3-5 seconds of

NO problem behavior

BEFORE attending to

Sabrina and reinforcing

appropriate change in

behavior


Happening

&


Demands during Activities

Consequence:

EXT + DRA

Prevention:

MO

manipulation

HOWEVER IF SABRINA EMITS PROBLEM BEHAVIOR

(Biting, bolting, crying, flopping, grabbing, physical resistance,

shoes off, whining)

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MO Manipulations

o Have a wide variety of reinforcers readily available.

o Begin by delivering reinforcers “for free” (i.e., without placing any demands)

to build motivation.

o Frequently contrive opportunities to conduct mand training so as to teach

Sabrina to appropriately vocally mand across a variety of motivational

categories and settings.

DRA

o Use prompting and prompt fading as appropriate to teach Sabrina new vocal

mand topographies. (See the Count and Mand Protocol on p. 11 of this

document for detailed teaching procedures.)

o Differentially reinforce appropriate mand responses. In other words, deliver

larger amounts of the reinforcer when Sabrina independently emits vocal

mands and deliver smaller amounts of the reinforcer when Sabrina emits vocal

mands following echoic prompts.

EXT

o When problem behavior occurs, the instructor will immediately block access

to all suspected reinforcers, including attention by not looking at or talking to

Sabrina.

o Otherwise, the instructor will not change anything about the environment. In

other words, the instructor will not remove potentially aversive stimuli from

the environment.




o The instructor will continue to block access to all suspected reinforcers until

Sabrina ceases engaging in problem behavior for a period of 3-5 seconds.

o After this period of time passes without Sabrina engaging in problem

behavior, the instructor will reengage with Sabrina and return to reinforcing

appropriate responding according to previously described schedules of

reinforcement.

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7. Topography-specific Treatments

a) Response Blocking for Biting

o When Sabrina engages in biting (self), the instructor will physically block the

behavior from occurring and will simultaneously redirect Sabrina to engage in

whatever appropriate behavior should be occurring at that time.

o If this behavior is evoked by one of the antecedents listed above, the instructor

will also implement the antecedent-specific protocol.

b) Walk with Me Protocol

The purpose of this protocol is to teach Sabrina to walk in close proximity to the

instructor when transitioning from one activity to another activity without bolting,

walking ahead, holding onto the instructor, or touching the walls or other objects. Set

up many contrived opportunities to practice each day. Start by completing transitions

with short distances, provide many prompts, and reinforce. Increase distance for

transitions and decrease prompts/reinforcers as appropriate.

MO Manipulations

o Before transitioning/walking, offer Sabrina a “promise” (i.e., a highly

preferred edible) and ensure that it is clearly visible to Sabrina.

o Present a vocal SD similar to, “Walk with me.”

DRA

o If Sabrina complies by walking in close proximity to the instructor (with

prompts if necessary) during the transition, deliver the “promise” as

reinforcement every 3-5 seconds.

o Once you have successfully transitioned to the next activity, deliver

reinforcers as appropriate to maintain Sabrina’s responding.

o Over time, fade prompts to increase independence during transitions and thin

the schedule of reinforcement so as to intermittently reinforce appropriate

walking and transitioning behaviors.

Extinction

o If Sabrina engages in problem behavior or walking ahead, during the

transition, DO NOT ALLOW HER TO GAIN ACCESS TO THE

“PROMISE.” If needed, physically remove or block access to this preferred

item.

o ALSO, INDICATE REINFORCEMENT IS NO LONGER AVAILABLE, BY

REMOVING THE “PROMISE.”

o DO NOT REMOVE THE DEMAND TO WALK WITH ME. Maintain the

demand by representing the demand about every 2 – 3 seconds and using

physical guidance (i.e., prompts) to obtain compliance.


o Once you have completed the transition, if problem behavior is still occurring

begin requiring responses related to the activity to which you have just

transitioned.

o ONCE PROBLEM BEHAVIOR STOPS OCCURRING FOR ABOUT 3 – 5

SECONDS (i.e., 3 – 5 responses), begin delivering reinforcers so as to

reinforce appropriate behavior (e.g., walking next to the instructor in the

absence of problem behavior, completing the activity in the absence of

problem behavior).

o If Sabrina bolts (i.e., leaves or attempts to leave) during the transition, return

to the location where the bolt began, then continue the transition from there.

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Data

Sequence analysis (ABC data) per episode of problem behavior

Duration data per episode of problem behavior, cumulative duration per session

Summary data by antecedent, total frequency, and cumulative duration.

Graphing

Total Frequency and Cumulative Duration of Episodes of Problem Behavior per 2.5-hour

Session

Total Frequency of Problem Behavior by Antecedent per 2.5-hour Session for:

o Interruption/Transition

o Told “No”/Denied Access

o MO Strong but Mands Inappropriately

o Demand during ITT

o Demand during Activities

o Automatic Reinforcement is High in Value

o MO Unclear/Out of the Blue.

Criteria for Success

10 consecutive sessions without problem behavior

Documents

BEHAVIOR REDUCTION PLAN - Carbone Clinic...Behavior Reduction Plan Sabrina’s Behavior Reduction Plan will include using MO manipulations to decrease the value of the reinforcers