Transcript Behavior presentation - Perth Amboy Public Schools

Dr. Jennifer Foster
Psychologist, Coordinator of Mental Health Programs
Perth Amboy Public Schools
Agenda
 Brief Overview of Disruptive Behavior Disorders
 Oppositional Defiant Disorders
 Conduct Disorders (Early & Late Onset)
 Disruptive Behavior Disorders (NOS)
 ABC’s of Behavior
 Functions of Behavior
 Management of Acute and Chronic Behavioral
Problems
 CPI Crisis Development Model
 District Referral Process
What is a Disruptive Behavior
Disorder?
 Attention-Deficit Disorders and Disruptive Behavior
Disorders are the two categories considered under
“Disruptive Behavior Disorder”
 Disruptive Behavior Disorders are broken down into to
3 major categories of mental health disorders
 Oppositional Defiant Disorder
 Conduct Disorder (Early & Late Onset)
 Disruptive Behavior Disorder (NOS)
Oppositional Defiant Disorder
(ODD) Diagnostic Criteria
 A persistent pattern of defiant, angry, antagonistic,
hostile, irritable, or vindictive behavior
 Most often directed toward authority figures
 Pattern of behavior must be present for 6 months
 Extremely difficult to manage due to
confrontational nature
 Behavior must be causing significant problems, in
school and in relationships with family and friends
ODD Diagnostic Criteria
 Must have 4 of 8 symptoms occurring frequently
 Loses temper
 Argues with adults
 Actively defies or refuses to comply with adult’s requests
or rules
 Deliberately annoys people
 Blames others for own mistakes or misbehavior
 Touchy and easily annoyed by others
 Angry and resentful
 Spiteful of vindictive
ODD Signs & Symptoms
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Stubborn and noncompliant
Contentious and argumentative
Quick to shift blame
Highly Defensive
See demands as unreasonable
Passive aggressive/systematically ignore others
Refusal to negotiate
Deliberate annoyance of others
Threatens/intimidates others
Verbally aggressive
Present with low self-concept or inflated self-esteem
Oppositional Defiant Disorder
 Average age of onset is 6 years old, symptoms
can be seen in children as early as 3 years old
 Symptoms usually manifests by 8 years old,
with most children diagnosed during
preadolesence
 Early onset of ODD is more likely to persist
and lead to subsequent development of CD
 More prevalent in males than females prior to puberty,
but evens out in adolescence
 Comorbid with:
 CD, learning disabilities, ADHD, depression,
anxiety
 80%+ with ODD have comorbid ADHD
 65% with ADHD have comorbid ODD
Criteria for Conduct Disorder (CD)
 A repetitive and persistent pattern of behavior that
involves violation of age appropriate social norms and
the rights of others
 Four categories of aggressive behaviors and violations
of rules and age appropriate norms
 Aggression toward people and animals
 Destruction of property
 Deceitfulness or theft
 Serious violations of rules
Criteria for CD (Cont.)
 At least 3 of the 15 items, present for 12 months
 Of which one symptom in the past 6 months
 Significant impairment in social, academic, or
occupational functioning
 Differences in age of onset
 Early Childhood Onset—onset of at least one criterion
characteristic of CD prior to age 10
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Outcomes are poor, ingrained behavior is highly resistant
 Adolescence Onset—absence of any criteria
characteristic prior to the age of 10
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More resilient b/c they developed better coping skills at
earlier age
Signs & Symptoms of CD
 Aggressive behavior that harms or threatens other
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people or animals (i.e., physical altercations,
intimidation, bullying)
Destructive behavior that damages or destroys
property
Manipulation via lying, deceit
Theft
Truancy or other serious violations of rules
Early tobacco, alcohol, and substance use and abuse
Precocious sexual activity
Show little remorse for their actions, empathy, or
concern for the thought or feelings of others
Read hostile intent in the actions of others, reactive
Fake feelings to get lesser consequence, seek to blame
others
Disruptive Behavior Disorder
Not Otherwise Specified
(DBD NOS)
This category of DBD was created for children
who demonstrate similar behaviors as children
with ODD or CD but do not display the same
frequency /severity and only met one or two of
the behavior criteria for this disorder.
Like ODD and CD, this disorder causes
significant impairment in the child’s life.
ABC’s of Behavior
Antecedent
Behavior
Consequence
The Dance of Behavior
Antecedent
Behavior
Consequence
Teacher giving lesson
Child raises hand
Teacher continues with lesson
Teacher continues with lesson
Child calls out
Teacher asks child to quiet down
Teacher asks child to quiet down
Child keeps talking
Teacher moves onto another
activity, singing and dancing, and
asks the class to stand up
Teacher moves onto another
activity, singing and dancing, and
asks the class to stand up
Child refuses to stand up
Teacher asks child to stand up
Teacher asks child to stand up
Child refuses and remains seated
on the floor
Teacher walks over to child and
tries to physically pick him up
Teacher walks over to child and
tries to physically pick him up
Child becomes weightless as
teacher tries to lift him
Teacher whispers, “Either I can pick
you up like mommies pick up their
little babies or you can stand up on
your own,” in his ear.
Teacher continues with activity
Child stands up
Teacher whispers, “Either I can pick
you up like mommies pick up their
little babies or you can stand up on
your own,” in his ear.
Teacher continues with activity
Child is cooperating and enjoying
himself
The song and dance ends and
teacher says, “okay, now we are
going to sing the color song”
Antecedent
Behavior
Consequence
The song and dance ends and
teacher says, “okay, now we are
going to sing the color song”
Child calls out “I win, I win, I win”
Teacher asks children to sit down
on the floor
Teacher asks children to sit down
on the floor
Child sits down
Teacher passes out colored blocks
Teacher passes out colored blocks
Child calls out “I want orange, I
want orange”
Teacher gives the child an Orange
block
Teacher gives the child an Orange
block
Child is happy and shows his
blocks to his friend
Teacher realizes that the color
orange is not in the song and asks
the child for the block back
Teacher realizes that the color
orange is not in the song and asks
the child for the block back
Child puts block behind his back
and says “no”
Teacher tries to grab the block out
of child’s hand
Teacher tries to grab the block out
of child’s hand
Child holds on to the block tight
and tries to pull it away from the
teacher
Teacher tells child there is no
orange in the song, and tries to
give him a blue block instead
Teacher tells child there is no
orange in the song, and tries to
give him a blue block instead
Child refuses to give her the orange Teacher tells child that he can keep
block
the orange block on the floor next
to him, but he has to use the blue
block
Child puts the orange block by his
Teacher begins song with children
side on the floor and takes the blue
block
Teacher tells child that he can keep
the orange block on the floor next
to him, but he has to use the blue
block
Functional Analysis
 Determining the function of the behavior
 The process of gathering information to determine the
relations between variables, particularly functional relations
 Looking to answer the question “What is the function of
the behavior?”
 A functional relationship exists when a cause and effect
relationship between variables has been experimentally
established
 Trying to find what contingencies maintain the behavior
 Can be environmental
 Can be “internal” environmental effects
 Must “listen” or observe behavior to determine causes!
Primary Functions of Behavior
 Escape/Avoidance:
 from person, task, environment, etc.
 behavior usually occurs in response to specific person, event or
requests to perform activity.
 Tangible:
 desire for a specific item or activity
 behavior often occurs when something has been denied or taken
away -- it is not person or event specific
 Attention (positive or negative):
 desire for attention from peers, adults, can include “power”
 behaviors usually occurs when specific individuals are present -may be all the time if the desire is for attention from peers -- it is
person specific -- not event or location.
 Sensory:
 the behavior feels good or meets a sensory need.
 behaviors occur anytime, anywhere--not person, event or location
specific but may occur more often when under stress
Functions of Behavior
 Behaviors may result from a combination of function
 Escape and sensory are often related to circumstances that
are stressful or boring
 Attention and escape may result from difficult/boring
curricular demands and not much attention
 Tangible in combination with any of the others may be a
result of boredom.
 Combinations of 2 or more functions require a careful look
at curricular requirements, basic classroom management,
and availability of noncontingent reinforcement.
Questions To Be Answered. . .
1.
2.
3.
4.
5.
What are the setting events (i.e., conditions that alter
the probability of a behavior occurring
What are the antecedents of the challenging
behavior (i.e., specific events that precede a
behavior)?
What are the consequences for the challenging
behavior, which may reinforce it?
What does the student gain?
What does the student avoid?
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When Samantha misses her 12:30 medication &
teachers present multiple task demands, she
makes negative self-statements & writes profane
language on her assignments. Teaching staff
typically send her to the office with a discipline
referral for being disrespectful.
What
function?
Avoid
difficult
tasks
Setting event
Misses 12:30
medication
Antecedent
Response
Consequence
Teachers
make
multiple
task demands
Semantha makes
negative selfstatements &
writes profane
language
Teacher sends
Samantha to
office for being
disrespectful
Caesar has dyed his hair three colors & is teased
several times by his friends before class. When
he enters the class, his teacher stares at his hair.
Caesar immediately says “what are you staring
at?” His teacher immediately sends him to inschool detention.
Escape adult &
What
peer function?
attention
Setting event
Caesar is
teased several
times about his
hair by his
friends before
class
Antecedent
Response
Consequence
His teacher
stares at his
hair in class
Caesar asks
his teacher
what she’s
staring at
His teacher
sends him to
in-school
detention
Cleo is new to the 6th grade, & English is her
second language. When another student
approaches & says something to her in
English, Cleo turns away. The other student
walks away. This happens several times
during the day.
Whatpeer
function?
Escape
attention
Setting event
Antecedent
New student
Student
approaches &
speaks in
English
Response
Cleo turns
away
Consequence
Other
student walks
away
When his teacher asks him what the capitol
city of a country is, Napoleon gives the
correct answers. His teacher praises his
correct answer, & tells him he may work by
himself or a friend on the rest of the
assignment.
Access peer &
adultfunction?
attention
What
Setting event
Antecedent
Response
None
Teacher asks
what capitol
city of country
is
Napoleon
give correct
answer
Consequence
Teacher gives
verbal praise
& time to work
with a friend
As Manny is walking, other kids look at him
& say “what’s up?” He looks back and says:
“Who ya lookin’ at?!” “Ya want some of this?!”
“Ya talkin’ to me?!” Kids shake their heads &
call him “weirdo.”
Access
peer attention
What function?
Setting event
??
Antecedent
Response
Look at him.
“What’s up!”
“Who ya
lookin’ at?”
“Ya want
Some?” “Ya
talkin’ to me?
Consequence
Kids shake
heads &
call him
“weirdo”
Describing the Problem Behavior?
1.
2.
3.
4.
5.
Note the type of problem behavior
Note where the problem behavior occurs
Note when the problem behavior occurs
Note characteristics of the setting and
events related to the problem behavior
Note situations or personal events that
might induce the behavior
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6.
7.
include actions of others that increase or trigger
the behavior.
Note the consequences associated with
the problem behavior.
Once this is understood, you can test a
hypothesis
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Developing/Testing a Hypothesis
 Develop a hypothesis based on the information
gathered
 Test the Hypothesis—Experimentally evaluating
precisely whether the antecedents and consequences
that may control behavior, actually do.
 Testing the hypothesis is important because important
information may have been overlooked during data
collection
 Intended to reveal what is likely to be an effective
intervention before moving to the intervention stage
Example of hypothesis statement
 When he misses breakfast & peers tease him about
his walk, Caesar calls them names & hits them.
Teasing stops.
Hypothesis Statement
Setting Events
Triggering
Antecedents
Problem
Behavior
Misses
breakfast.
Teased
by peers.
Name
calling &
Hits.
Maintaining
Consequences
Teasing
stops.
Function
Function
Once you have a have a hypothesis, you
can experiment with interventions
Escape negative
Escape
social contact
aversive social
contact
The Conflict Cycle
Crisis Development Model (CPI, 2005)
Crisis Development/Behavior
Levels
 Anxiety
 Defensive
 Acting Out-Person
 Tension Reduction
Staff Attitudes/Approaches
 Supportive
 Directive
 Non-Violent Physical Crisis
Intervention (last resort)
 Therapeutic Rapport
INTEGRATED EXPERIENCE: The concept that
behaviors and attitudes of staff impact the behaviors and
attitudes of those in their care
Proactive Approaches
 Maintain sufficient personal space
 Awareness of non-verbal cues from body language
 It’s not what you say, but how you say it
 Set Limits
 Empathetic Listening
When Responding…
Do
Don’t
 Remain Calm
 Overreact
 Isolate the Situation
 Get into power struggles
 Enforce Limits
 Make false promises
 Listen
 Fake attention
 Be aware of Non-Verbal cues
 Be threatening
 Be consistent
 Use jargon—tends to confuse
and frustrate
Effective Environments
 Problem behaviors are irrelevant
 Aversive events are removed
 Access to positive events are more common
 Problem behaviors are inefficient
 Appropriate behavioral alternatives available
 Appropriate behavioral alternatives are taught
 Problem behaviors are ineffective
 Problem behaviors are not rewarded
District Behavioral Referral Process
 Speak to your student’s Child Study Team Case Manager and/or
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Crisis Counselor to determine if a referral is warranted.
Children diagnosed with Autism are an automatic referral.
If the student sees a Crisis Counselor, the referral is submitted by
the student’s Crisis Counselor
If there is no Crisis Counselor assigned, then the case manager
should complete the form
Once submitted & reviewed, a behavioral consultant will be
assigned to the case and contact the Crisis Counselor/Case
Manager
Initial observations will be conducted
A meeting will be coordinated with the consultant/crisis
counselor and/or case manager, and teacher
Recommendations will be made. This may or may not include
the decision to conduct a functional behavioral assessment and
develop a behavior plan.
Case follow-up will continue throughout the process.
Questions??
Contact Information
Dr. Jennifer Foster
Psychologist, Coordinator of Mental Health Programs
Office: Department of Special Services/Administration
Building
Email: [email protected] (best way to contact)
Phone: 732-376-6200 Ext. 30234
Fax: 732-826-4932