Transcript Slide 1

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Intervention for Young
Children’s Challenging
Behaviors
Challenging Behaviors
Destructive Behaviors
Aggression; SIB; Property Destruction
Disruptive Behaviors
Long tantrums; Loud, Repetitive Noises; Running,
etc.
Irritating & Interfering Behaviors
“self-stim;” repetitive and perseverative speech or
actions, etc.
Social Withdrawal
Lack of responsivity and initiations
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Importance of Challenging
Behaviors
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
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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
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Some Changing
Perspectives on
Autism and
Challenging Behaviors
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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
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1st Generation Effects
Often, short-term beneficial effects
But usually without maintenance or
generalization
Occasionally ineffective, leading to
escalating intensity of rewards and
negative consequences
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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 sociallyadaptive skills for controlling environment
III. Children with autism are at high risk for
developing challenging behaviors due to
difficulties with learning, communication, and
perception
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Changing Perspectives
(continued)

Intervention involves PREVENTING
problem behaviors from developing or
occurring by:
I.
II.
Arranging the environment so that
challenging behaviors are unnecessary (and
desired behaviors are encouraged), and
Teaching skills needed to navigate and
control the social environment
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Positive Behavior
Support
Level 3 procedures for children
with serious challenging behavior
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Positive 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
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PBS – Components
1. Team-building, Goal Setting
Person-Centered Planning
2. Functional Assessment of Challenging
Behavior
3. Individualized Behavior Support Plan
4. Implementation
5. Evaluation
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Core Elements of a Behavior
Support Plan
(Linked to Assessment Information)
Prevention Strategies – Arrangements of
antecedent environment
Teaching 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
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Evaluation
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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Prevent-Teachv
Reinforce
A Standardized and
Individualized Model
For Challenging Behaviors
Purpose 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 Model
Research-based Practices
Assessment and Intervention
Team-driven decision-making
Steps are scripted as much as possible
Each step ends with self-evaluation (checklist)
Selection of interventions is menu-driven
Entire process is manualized
The PTR Model
5-Step Process
Developing 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: Teaming
Purpose: Establish group involved with
developing and implementing intervention
Members: Teacher(s), Para-educator(s),
School professionals, Family members, etc.
3-8 individuals
At least one person (e.g., administrator) who can
deliver resources and develop/interpret policies
At least one person knowledgeable in behavioral
theory and principles and experienced in FA and BIP
Step 2: Goal Setting and Data
Collection
Purpose: (1) to establish clear long and shortterm 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 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
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
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
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
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
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”
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
Evaluation
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 PTR
Randomized Control Group Evaluation
Including students with ASD
Iovannone et al. 2009, Journal of Emotional and Behavioral
Disorders
Case Study (A-B) Analyses
Behavior rating scale (BRS) data
Direct observation data
Dunlap 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
PTR intervention
Baseline
5
Disruptive Behavior
4
3
2
Disruptive Behavior
1
5
Engagement
4
3
2
Engagement
1
5
Task Completion
4
3
2
Independent Task Completion
1
5
10
15
20
25
Sessions
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39
44
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Teacher’s ratings of Jose’s
Behavior
Baseline
PTR Intervention
5
Following Directions
4
Following Directions
3
2
1
5
Appropriate
Interactions
4
3
Times to Interact
2
1
5
Off Task
4
Off Task Behavior
3
2
1
1
2
3
4
5
6
7
8
9 10
11 12 13 14 15 16 17 18 19 20 21 22 23
Sessions
Ali (Iovannone et al., unpublished)
6 years old
Autism; nonverbal; significant intellectual
disability
Self-contained Spec Ed classroom
BIP..
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 Disruptive behavior
Baseline
Intervention
20
Frequency Disruption
15
10
5
0
Ali’s Engagement - Duration
Baseline
100
90
80
70
60
50
40
30
20
10
0
Duration E
Multiple Baseline Analysis Participants
3 students with ASD; Josh, Alex, Jasmine
Kindergarten; Grade 2; Grade 4
Cognitive functioning = Typical to mild delay
All had verbal language, but often not used
effectively
Majority of time in general education classes
All had frequent problem behaviors, and were
identified as students with most serious
problems in their classes
property destruction; disruptive behavior, outbursts,
crying, some aggression
Procedures
Baseline (services as usual)
PTR = Independent Variable
Teaming, goal setting, data collection (BRS)
PTR (Functional) Assessment
Individualized Behavior Intervention Plans
Data for study obtained from video recordings
15 minute sessions in regular classroom context
10-second time samples
% of samples with occurrence of behavior
Dependent Variables
Problem Behavior
Engagement
Behavior Intervention Plans
JOSH
P = explicit expectations on card
T = instruction on expectations; self-management
R = self-recruited SR+; praise for following
expectations; “tokens” with stickers/treasures as back
ups
ALEX
P = written schedules
T = self-management (using lists for independent
responding)
R = sea shells + time to examine his sea shells
BIPs (continued)
JASMINE
explicit expectations/instructions for social
interaction
instruction on social interactions; problem
solving; and self-monitoring (journal)
“CIA (caught in the act)” credits
Problem Behavior (% Intervals)
Josh
Alex
Jasmine
Engagement (% Intervals)
Josh
Alex
Jasmine
Working with Families
Issues and Considerations
Related to Families and
Young Children with Serious Challenging
Behaviors
Family-Professional
Relationships
Considerations Related to Functional Assessment
and Function-based Interventions
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Family Involvement and
Outcomes
Strong, functional families are children’s greatest resource
Goal is to help families develop knowledge (= power),
competence, confidence, and comfort in areas related to
their child’s development, education, and support
Family 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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Families
Owners of unique body of information (data) that can
be vital to comprehensive FA
Child history
Child’s ecology
Child’s preferences
Family systems --- goals, preferences, routines,
values
As intervention agents, it is essential to incorporate
input
Contextual fit; commitment
Families as unique and individualized systems
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MAIN MESSAGES
When working with families (and children in family
contexts), it is crucial to:
Establish rapport and trust
Include 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)
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 Plan
Assistance with comprehending the
environment
Picture schedules
Social Stories
Clear instructions and expectations
Careful teaching of skills in routines
Assistance with communication and selfcontrol
Etc..
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END