vIntervention for Young Children’s

Challenging Behaviors

Intervention for Young Children’s

Challenging Behaviors

Challenging BehaviorsChallenging Behaviors

Destructive BehaviorsAggression; SIB; Property Destruction

Disruptive BehaviorsLong tantrums; Loud, Repetitive Noises; Running, etc.

Irritating & Interfering Behaviors“self-stim;” repetitive and perseverative speech or actions, etc.

Social WithdrawalLack of responsivity and initiations

2

Importance of Challenging Behaviors

Importance of Challenging Behaviors

Barrier to Inclusion, Community Participation, and Social Opportunities

Most Significant Impediment to Social-emotional Development and Education

Present Physical & Emotional Risk (and reduction of quality of life!) for Child and for Families, Teachers, Other Professionals, Peers and Friends---------------

Need to Prevent/Resolve Challenging Behaviors as Early and as Thoroughly as Possible

3

Some Changing Perspectives on

Autism and Challenging Behaviors

Some Changing Perspectives on

Autism and Challenging Behaviors

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Early Perspectives (1960s ---)

Early Perspectives (1960s ---)

• Challenging Behaviors are “part of autism”• Not “diagnostic”, but “characteristic”

• Intervention = contingency management• Largely reactive

• Reinforcement (DRO) for desired behavior (or absence of problem behavior)

• Time out, extinction, or punishment for problem behavior

5

1st Generation Effects1st Generation Effects

Often, short-term beneficial effects

But usually without maintenance or generalization

Occasionally ineffective, leading to escalating intensity of rewards and negative consequences

6

Changing Perspectives (mid 1980s ---)

Changing Perspectives (mid 1980s ---)

I. Challenging behaviors are not “part of autism”

II. Challenging behaviors: (1) are maladaptive ways of responding to inadequacies in the environment, (2) occur due to lack of socially-adaptive skills for controlling environment

III. Children with autism are at high risk for developing challenging behaviors due to difficulties with learning, communication, and perception

7

Changing Perspectives (continued)

Changing Perspectives (continued)

Intervention involves PREVENTING problem behaviors from developing or occurring by:I. Arranging the environment so that

challenging behaviors are unnecessary (and desired behaviors are encouraged), and

II. Teaching skills needed to navigate and control the social environment

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Positive Behavior Support

Positive Behavior Support

Level 3 procedures for children with serious challenging behavior

9

Positive Behavior SupportPositive Behavior Support

An approach for resolving challenging behaviors that is based on person-centered values, empirical data and a multi-disciplinary scientific orientation

A pragmatic, data-based problem-solving approach for enhancing development and improving quality of life in natural, everyday contexts

A preventative approach emphasizing teaching and environmental redesign 10

PBS – ComponentsPBS – Components

1. Team-building, Goal SettingPerson-Centered Planning

2. Functional Assessment of Challenging Behavior

3. Individualized Behavior Support Plan

4. Implementation

5. Evaluation11

Core Elements of a Behavior Support Plan

Core Elements of a Behavior Support Plan

(Linked to Assessment Information)Prevention Strategies – Arrangements of

antecedent environmentTeaching Strategies – Building skills to teach

throughout the day to replace the challenging behavior

Reinforcers – Providing effective reinforcement schedules (note --- this is the contingency management component)

-----------------

+ Evaluation strategies 12

EvaluationEvaluation

All support plans should have some form of evaluation, so team knows if plan (or parts of a plan) is working as intended

Evaluation can focus on desired outcomes AND on extent to which elements of plan are being implemented

Evaluation should NOT be complicated or effortful, but it should be valid…and valued

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vPrevent-Teach-

ReinforcePrevent-Teach-

Reinforce

A Standardized and Individualized Model

For Challenging Behaviors

Purpose of P-T-RPurpose of P-T-R

To provide a standardized, easy-to-use model with which to apply research-based, behavioral strategies for addressing serious problem behaviors.

For all students with serious problem behaviors --- special education, general education.

Intended for pre-K through high school, however the bulk of research has been conducted in grades K-8

PTR ModelPTR Model

Research-based PracticesAssessment and Intervention

Team-driven decision-makingSteps are scripted as much as possibleEach step ends with self-evaluation

(checklist)Selection of interventions is menu-drivenEntire process is manualized

The PTR ModelThe PTR Model

5-Step ProcessDeveloping a Team

Establishing clear goals (short and long term)

Functional Assessment

Designing and Implementing a Behavior Intervention Plan

Evaluation (ongoing) and Revision (as necessary)

Step 1: TeamingStep 1: Teaming

Purpose: Establish group involved with developing and implementing intervention

Members: Teacher(s), Para-educator(s), School professionals, Family members, etc.

3-8 individualsAt least one person (e.g., administrator) who can

deliver resources and develop/interpret policiesAt least one person knowledgeable in behavioral

theory and principles and experienced in FA and BIP

Step 2: Goal Setting and Data Collection

Step 2: Goal Setting and Data Collection

Purpose: (1) to establish clear long and short-term objectives; (2) to establish a unified vision for desired outcomes; (3) establish feasible strategies for valid data collection

Kinds of goals: (1) Reducing specified problem behaviors; (2) Develop academic competencies; (3) Improve social competencies, problem solving, and interpersonal relations/interactions

Data CollectionData Collection

Data instrument(s) decided by team

Recommendations are often for Behavior Rating Scales –

Usually 5-point scales with specific anchors indicating frequencies, durations, and/or intensities of problem behavior

Step 3: Functional Assessment

Step 3: Functional Assessment

Purpose: Identify function(s) and antecedent variables influencing target behavior(s)

Strategy: (1) Detailed, structured questionnaires for each team member focused on antecedent variables, functions, and maintaining consequences. (2) Team meeting to produce consensus.

Outcomes: Hypothesis statement(s) with each component specified.

Step 4: Intervention Design and Implementation

Step 4: Intervention Design and Implementation

Purpose: To build a Behavior Intervention Plan (BIP) based on FA information

Features:(1) BIP must include at least one strategy from each

of the 3 components: Prevent, Teach, Reinforce

(2) Menus of research-based strategies for each component; forms and templates to build plan

(3) Selection of strategies is made by team, based on FA and on team’s ability/resources to implement

Examples of “Prevent” Strategies

Examples of “Prevent” Strategies

Increase “comprehensibility” of environment --- picture schedules, transition objects, lists

Choice making Add stimuli associated with desirable

(prosocial) behavior Remove stimuli associated with

challenging behaviors

“Teach” - Replacement Skills

“Teach” - Replacement Skills

Can be in any form (e.g., words, gestures, pictures) that is effective

Should be appropriate to developmental level (but more efficient than the challenging behavior!), and consistent with overall plan for language development

Use natural teaching opportunities throughout day

Functional Communication Training

Functional Communication Training

Determine function of the behavior within a routine

Select a functionally equivalent communicative behavior to replace

Prompt the child to use the replacement behavior

Reinforce the use of the replacement behavior

“Reinforce”“Reinforce”

Be sure reinforcers are strong (and as natural as possible) for desired behavior

Be sure reinforcers do not follow challenging behavior

May need reinforcer assessment to determine what is really effective

EvaluationEvaluation

Purpose: (1) Measure effects of intervention on problem behaviors and academic/social behaviors; (2) Measure fidelity of implementation

Features: Simple (easy-to-use) instruments --- behavior rating scales; checklists; etc.

Research on PTRResearch on PTR

Randomized Control Group EvaluationIncluding students with ASDIovannone et al. 2009, Journal of Emotional and Behavioral

Disorders

Case Study (A-B) AnalysesBehavior rating scale (BRS) dataDirect observation dataDunlap et al., 2010, Journal of Positive Behavior Interventions

Multiple Baseline Across Participants (with ASD) Design

Strain et al., in preparation

Teacher’s Ratings of Mike’s Behavior

Teacher’s Ratings of Mike’s Behavior

Disruptive Behavior

Engagement

Task Completion

1

2

3

4

5

Disruptive Behavior

1

2

3

4

5

Engagement

5 10 15 20 25 34 39 44 491

2

3

4

5

Independent Task Completion

Baseline PTR intervention

Sessions

Teacher’s ratings of Jose’s Behavior

Teacher’s ratings of Jose’s Behavior

Following Directions

Appropriate Interactions

Off Task Behavior

1

2

3

4

5

Following Directions

1

2

3

4

5

Times to Interact

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 231

2

3

4

5

Off Task

Baseline PTR Intervention

Sessions

Ali (Iovannone et al., unpublished)

Ali (Iovannone et al., unpublished)

6 years oldAutism; nonverbal; significant intellectual

disabilitySelf-contained Spec Ed classroomBIP..

P: curricular modifications; small task steps; choice making; etc.

T: Request attention; Request break; Delay of SR+

R: Music as reinforcer; 30s intervals

Ali’s Disruptive Behavior - Frequency

Ali’s Disruptive Behavior - Frequency

Sessions

0

5

10

15

20Frequency Disruption

Ali Disruptive behavior

Baseline Intervention

Ali’s Engagement - Duration

Ali’s Engagement - Duration

Baseline

0

10

20

30

40

50

60

70

80

90

100

Sessions

Duration Engagement

Multiple Baseline Analysis - Participants

Multiple Baseline Analysis - Participants

3 students with ASD; Josh, Alex, JasmineKindergarten; Grade 2; Grade 4Cognitive functioning = Typical to mild delayAll had verbal language, but often not used

effectivelyMajority of time in general education classesAll had frequent problem behaviors, and were

identified as students with most serious problems in their classes

property destruction; disruptive behavior, outbursts, crying, some aggression

ProceduresProcedures

Baseline (services as usual)PTR = Independent Variable

Teaming, goal setting, data collection (BRS)PTR (Functional) AssessmentIndividualized Behavior Intervention Plans

Data for study obtained from video recordings15 minute sessions in regular classroom context10-second time samples% of samples with occurrence of behavior

Dependent VariablesProblem BehaviorEngagement

Behavior Intervention PlansBehavior Intervention Plans

JOSHP = explicit expectations on cardT = instruction on expectations; self-managementR = self-recruited SR+; praise for following expectations;

“tokens” with stickers/treasures as back ups

ALEXP = written schedulesT = self-management (using lists for independent

responding)R = sea shells + time to examine his sea shells

BIPs (continued)BIPs (continued)

JASMINEexplicit expectations/instructions for social

interaction

instruction on social interactions; problem solving; and self-monitoring (journal)

“CIA (caught in the act)” credits

Problem Behavior (% Intervals)

Problem Behavior (% Intervals)

Josh

Alex

Jasmine

Engagement (% Intervals)Engagement (% Intervals)

Josh

Alex

Jasmine

Working with FamiliesWorking with Families

Issues and ConsiderationsRelated to Families and

Young Children with Serious Challenging Behaviors

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Family-Professional Relationships

Family-Professional Relationships

Considerations Related to Functional Assessment and Function-based Interventions

43

Family Involvement and Outcomes

Family Involvement and Outcomes

Strong, functional families are children’s greatest resourceGoal is to help families develop knowledge (= power),

competence, confidence, and comfort in areas related to their child’s development, education, and supportFamily support comes in many different forms and flavors

---Information, friendship, referrals, respite, training, counseling, helping, understanding, etc., etc.

But a vital support for all families is providing knowledge and practical tools needed to help their child

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FamiliesFamilies

Owners of unique body of information (data) that can be vital to comprehensive FA

Child historyChild’s ecologyChild’s preferencesFamily systems --- goals, preferences, routines, values

As intervention agents, it is essential to incorporate inputContextual fit; commitment

Families as unique and individualized systems

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MAIN MESSAGESMAIN MESSAGES

When working with families (and children in family contexts), it is crucial to:

Establish rapport and trustInclude key family members in all processes of assessment and intervention

Behavior analysts are the experts in behavioral theory and practices; Family members are experts in most everything else

Family choice is the main determinant of what goes into a behavior intervention plan

Respect it!

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ISP(Fox & Dunlap)

ISP(Fox & Dunlap)

Individualized Support Program (Early Intervention – Positive Behavior Support)

A family-centered model designed to:

Help families build skills in PBS, and confidence in problem solving

Help children gain competencies (e.g., communication) to promote optimal development

Help children reduce problem behaviors

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Brendan’s Support PlanBrendan’s Support Plan

Assistance with comprehending the environment

Picture schedules

Social Stories

Clear instructions and expectations

Careful teaching of skills in routines

Assistance with communication and self-control

Etc..

ENDEND