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Creating a Roadmap to Success
Best Practice Interventions for Challenging Behavior at Home and School
Jane Barbin, PhD, BCBA-D, [email protected]
Why do kids misbehave (or behave) – strongly related to what is reinforced!
Inappropriate behavior serves a purpose
Environmental events influence behavior (antecedents / consequences)
Overview
Overview
Functional assessment seeks to answer the question “Why does he/she do that?”
Looking at~ what antecedents occasion behavior what consequences maintain behavior
Interventions based on the function of the behavior have been shown to be more effective and less likely to involve punishment.
The goal is to replace the function of the inappropriate behavior.
Behaviors that look identical can be maintained by totally different functions (for different reasons)
Overview
Why important to address? Caregivers (e.g., parents/educators) can effect
significant change in the natural environment
They interfere with skill acquisition
Stigmatizing to individual
They reduce available opportunities (e.g., vocational, recreational) and limit generalization
Harmful
Interfering Behaviors
Topography (Form) –
Ritualistic / perseverative behavior (stereotypy) Tantrums (yelling, dropping, profanity) Aggression Disruption (grabbing /breaking items) Self-Injurious Behavior (SIB) Noncooperation Wandering
Interfering BehaviorsFunction (Reason) -
Escape / Avoid
Attention (divided attention)
Access to Preferred Items / Activities
Automatic (behavior reinforces itself)
Other (i.e., conditioned fears, control function)
Developmental Stages
Behavioral challenges (and opportunities!) present at various stages, affecting behavior (Terrible 2s, adolescents, new siblings, sibling with special needs).
Normal part of child’s challenging their environment.
How this is handled by parent and other adults can be critical!
What is Functional Assessment?· A continuum of assessment procedures from
indirect methods to experimental methods
· Includes several techniques to identify the reason the behavior is occurring. Consider maintaining factors and motivating operations (e.g., illness, academic deficits establish escape).
Methods
A. Informant Assessment (indirect) – questionnaires, rating scales, interviews. Nothing manipulated. Use multiple informants!
Motivation Assessment Schedule (Durand & Crimmins, 1988),
Questions About Behavioral Function (Matson & Vollmer, 1995)
Functional Analysis Screening Tool (Florida Ctr. on Self-Injury, 2002)
School questionnaires may not have established psychometric properties.
Methods
B. Descriptive Assessment (direct) –
Antecedent-Behavior-Consequence (ABC) assessment (structured ABC)
Scatter plot
More reliable than above but still anecdotal. Observe for correlation between antecedents/consequences and behavior.
Nothing manipulated; hard to get reliable and valid results
Methods
C. Functional Analysis ~ used < 17% of time
Direct observation / Experimental ~most difficult & most accurate
Variables manipulated systematically (tests cause-effect)
Student put in specific conditions and information gathered on problem behavior
Five conditions alternated in 5 or 10 minute sessions ~ analog and natural setting
Difficult for low rate behaviors, time consuming, advanced training needed
Functional Analysis Conditions
Attention - attention given to targeted behavior (“That’s too loud.”, “ Don’t throw things.”). All else ignored. If behavior occurs to gain attention, should see increase.
Tangible - access to preferred items/activities given for targeted behaviors. No other attention. If behavior occurs to gain access to these, should see increase.
Functional Analysis Conditions - cont.
Demand - demands are presented every 30 sec. Escape from task given for 30 sec. if behavior occurs (“Ok, you don’t have to do it.”). If behavior sensitive to escape, should see increase.
Alone - evaluating automatic / intrinsic reinforcement. No social consequences for behaviors
Toy Play - control condition. Noncontingent attention + preferred items are provided. Targeted behaviors ignored and redirected.
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Functional Analysis -Self-Injurious Behavior
Attention
What Technique is Best?
1997 IDEA amendments mandate FA, no guidelines
Reliability & validity of method; always conduct interview (e.g., operational definitions, idiosyncratic variables)
Educational setting requires efficient FA, minimal training & accommodation to schedule demands
Behavior analysis field provides structured observations, brief functional analysis, better rating scales, structured interview: Functional Analysis Interview (O’Neill et al., 1997)
Behavior Intervention Programming
Conduct functional assessment
Select function-based treatment
Explore acceptability and ability of caregivers to implement (OBTAIN INFORMED CONSENT)
Provide adequate training and monitoring
A Helpful Place to Start -
What constitutes the behavior (OPERATIONAL DEFINITIONS) for consistency across adults?
Reinforce “good” behavior quickly and often. Don’t only look for poor behavior.
More Ideas to Start ~
Catch the child being good!
Be careful not to accidentally reinforce maladaptive behavior.
Caregivers must agree on goals and commit to a plan. You are a model for your child.
More Ideas to Start -
Provide clear direction ~ avoid repeating close proximity use child’s name get eye contact use firm, neutral voice provide clear and simple language
Why is this difficult to do? Adults may feel:
Guilty about setting limits Encumbered by spouse Low energy Difficulty confronting child and/or being the bad guy (e.g.,
hearing “I hate you.”) Hopeless / lack skills
Other interfering situations- marital problems, financial concerns. Work toward correcting what is hindering your BEST actions!
There is a whole body of research supporting effectiveness of these procedures so be encouraged!
Understandably, the work is hard and more than you may have bargained for!
BIP Interventions
A. Extinction
Discontinuing reinforcement for previously reinforced behavior
Used only if there is good control over reinforcement
Can entail ignoring the behavior, response interruption or working through (depending on function)
Might see an Extinction Burst. Ensure that is it safe to use extinction before starting (not always essential to see behavior change).
BIP InterventionsB. Antecedent Modifications
give choice reduced demands (difficulty, amount of work) provide more attention reduce verbal prompts or environmental noise non-contingent reinforcement enriched environment (e.g., provide music/edibles/
choice) “Sensory-Work-Reward” schedules My Way- Your Way plan
BIP Interventions
C. Reinforcement-based Procedures
Teach Functionally Equivalent Alternative Behavior: Teach child to request attention, break or item, teach waiting, provide other forms of communication
Use Differential Reinforcement Procedures: DRO (Other) DRA (Alternative) DRI (Incompatible) DRL (Low rates)
More on teaching alternatives…
Look for replacements
where you can and respond
differently to each behavior
in the child!
Grabbing from others Sharing
Whining Talking in neutral tone
Hitting Requesting a break
Tantrums Asking for help
Targeted for Targeted for
Decrease Increase
Premack Principle (‘Grandma’s Rule’)
Require lower probability behavior (unpleasant tasks) contingent on higher probability ones (pleasant ones) - “Do chores, then watch television.”
Creates natural motivation
Be fair when implementing. Consistency helps child predict routines
Behavioral Contracts
Parent – Child Contract
I, Joey_, agree to: _do homework after school for 30 min.
before dinner Monday, Tues, Wed, and Thursday.
Mom and dad, agree to: give me 75 cents allowance for each day it is completed.
Date Contract begins: March 10, 2015Date Contract ends: End of Quarter 3 (then discuss) Agreed by: ________________ ________________ Parent(s) Child
Reinforcer Options
Playing ball
Visual /spinning or blinking toys
Play date with favorite friend
Activation/sound toys
Book
Break from work
Computer game
Prize box
Homework pass
Ice cream
Special outing/meal with parent
Singing
CD/iPodTime playing Wii
Certain video, iPad
Clapping
Game with parent
Trip to favorite store
Points that convert to allowance
Yo-yo
Smiles
Stay up late
Picking dinner location/Order pizza
High 5s
Verbal praise “good job”
Trip to park
BIP Interventions
D. Punishment-based Procedures
These should not be utilized as a first plan of action (less intrusive procedures must have been tried!)
Punishment has been associated with negative side-effects (e.g., punishment induced aggression, lack of generalization to other settings)
Support Rooms: look for lost opportunity to learn adaptive skills, restrictive procedures?
Time-Out What is it?
How is it misapplied? (takes too long, location not boring, discussion during and after with child, threats)
When should it be used? (think “attention/tangible” function; ‘time out’ an item; planned ignoring)
How used? (one min. per age, exit criteria, timer)
(Excerpt from SOS! Help for Parents book)
Interventions Based on Function
Escape Demand fading, request break/help, scheduled breaks, 3-
step guided compliance /follow-through, reinforce compliance, outline task list
Attention / Tangible Teach to request attention or item (low effort), give scheduled
attention/ item, reinforce absence of behavior, social reinforcers, planned ignoring, use of time out
Automatic Modify antecedents, blocking, provide alternative (competing)
stimulation, reinforce nonoccurrence (is it automatic?)
Escape Related Ideas
Escape Related Ideas
Escape Related Ideas
Outings/Trips
Have a preset plan – reduce what is stigmatizing
Anticipate snags
Get other adults on board
Transport your plan if one is working – adjust accordingly
Supports Outside of Home
Procedures can be difficult to carry out in community (library, grocery store, museums, vacation)
Prepare (preview online/ call in advance) Involve personnel Give staff/adults specific direction on ways
to help Reinforce support
My CHILD has AUTISM.
I am implementing a procedure that was recommended by Behavioral Directions,
LLC. For more information you may contact
(703) 855-4032.
My child’s behavior may be disturbing to you. My child is not spoiled or misbehaving.
MY CHILD HAS AUTISM.
Over 2 million children are affected with Autism in the US today. CDC reports 1 in 68
children have Autism.
Families need your help and compassion.
Thank you for your support and being a friend to someone with Autism.
(Please see other side for more information.)
Camp Cheat SheetSam has successfully used a Level Plan at home. There are 3 levels
(3=best privileges)
If he stays on Level 3 at camp, he can earn “electronic time” during whole group (mid-day) for 15 minutes and again after he is dismissed to his parent.
He drops to Level 2 if he breaks any of the following rules: (1) Do your part/ Follow Directions, (2) Kind words, and (3) Keep property safe. See specific definitions for rules. If the Level 2 occurred before whole group, he skips the mid-day “electronic time”.
If he breaks the rule “Keep people safe”, he will drop to Level 1 (no electronic access or dismissal privilege) for a 24 hour period. Inform parent.
Avoid excessive negotiation or discussion with Sam on level drops /behavior.
Sam should participate in the same system for earned items/activities related to
points as other campers. If he has a level drop at camp, only his 15 min extra electronic access is lost.
Creating a “Positive” Environment Have fun with your child. Communicate "I love you" often. Have structure and routines. Participate in family traditions and rituals. Be a good listener. Request feedback from your child and take turns talking. Work on developing patience. Build your child's self-esteem. Help your child solve problems with peers.
(Adapted from Forehand & Long, 2002)
Potential Pitfalls: Reciprocal escalation can occur when parents become
aggressive toward their child because the child behaved aggressively.
This can worsen an already poor situation.
Complementary escalation occurs when parents give in to the demands of a child. Rather than respond appropriately to aggression, it is ignored to avoid conflict.
Usually the more a parent caves in to the child's demands, the more demands the child will make.
(Omer, 2001)
Data Collection- why?
Data Collection
For behaviors targeted for decrease or increase include:
Rate/frequency Duration Intensity Latency Percentage of whole or partial intervals Percentage of opportunities
#1 Michelle: Difficulty Waiting in Community
12 year old diagnosed with autism, ID and severe behavior disorder
Inpatient treatment for assessment and treatment of challenging behaviors
Difficulty waiting impeded outings (e.g., waiting in line or for food, waiting in doctor’s office, waiting at signal in car)
Functional Analysis -SIB, aggression, and heel dropping were sensitive to escape
Michelle’s Community Waiting Plan
Reinforce steps to target response + escape extinction + competing items + wait card
Locations chosen in conjunction with needs of family (e.g., frequent errands, shopping needs)
First increased variety of known locations; then wait interval /unknown locations
Steps taken to minimize stigmatizing nature of program
Waiting Program Steps
4 initial locations of importance (Target, CVS, Toys R Us, Michael’s)
Began with 30 sec. waiting period across stores (not at front or for unpredictable times)
Moved up time interval (to 4 minutes), Built in trying on clothing, checking out, returns
Pretested each step and randomized locations for each data point (% correct opportunities). Data indicated acquisition of all steps.
#2 Karey: Aggression, Disruption & Refusal
16 year old diagnosed with autism
Demonstrated challenging behavior at home and school
Attention, escape and access to tangibles maintained behavior
Karey’s Behavior Plan: Reinforcing Low Rates of Behavior (DRL) + Planned Ignoring + 3 Step Guided Compliance
Day comprised of 1 hour intervals; 10 tokens initially available / interval
Run by both parents across day
Lost a token for each occurrence of targeted behavior. Remaining tokens exchanged for preferred items/activities. 2-3 “cash in” times /day.
Family cued to increase attention (contingent and noncontingent)
Behavior Reduction Program -Aggression
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Karey
Baseline DRL 10/hr + 3 Step Guided Compl
DRL 9/hr
DRL 9/hr + 3 Step GC + Loses next Sr (agg/dis)
DRL 7/hr
DRL 6/hr
DRL 9/hr + 3 Step GC + Loses next Sr + DRA (attention) + 30 min T/O/Restitution
DRL 5/hr
Tokens Remaining Per Interval - DRL
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DRL9/hr
DRL7/hr
DRL6/hr
DRL5/hr
Observe and gather data on behaviors of concern
Functional assessment process to identify functional reinforcers/ setting events
Develop function-based plan
Seek informed consent
Train relevant individuals – Implement!
Evaluate effectiveness with objective data collection
Make needed adjustments
Process - Behavior Intervention Programming
Challenges
Difficulty demonstrating methodological control (analyzing/controlling human behavior in applied settings)
Confounding /other variables in environment (e.g., medication changes, parent away)
Maintaining high integrity programs (protocol drift)
Limits to data-based decision making
Crisis Intervention vs. Behavior Intervention Plan
Crisis: Procedures to provide for safety of child and others in environment. Having a plan and training adults reduces risk.
If crisis methods are used, a BIP should be developed.
Procedures work hand in hand
Other Considerations
Component analyses can isolate effective treatment elements (extinction, reinforcement). Do you need to do all of the parts?
Explain Rationale / Reinforce Caregiver Compliance
Consider teaching appropriate skills as well as reducing targeted behaviors for child
Plan early for successful integration and transitions
References
Cambridge Center for Behavioral Sciences (see Parenting under “Behavioral Solutions” for great information and resources) www.behavior.org.
Cannon, L. et al. (2011). Unstuck and on target!: An executive function curriculum to improve flexibility for ASD. Baltimore, MD: Brookes.
Clark, Lynn & Robb, J. (2005). SOS Help for Parents, 3rd Ed. Bowling Green: Parents Press.
References cont.Forehand, R. & Long, N. (2002). Parenting the strong-willed
child. New York: McGraw-Hill.
Latham, G. (1994). The Power of Positive Parenting. North Logan, UT: P & T Ink. (www.parentingprescriptions.com)
Omer, H. (2001). Helping parents deal with children's acute disciplinary problems without escalation: The principle of nonviolent resistance. Family Processes, 40(1), 53-66.
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