Transcript Positive Behavior Support in the Home

“Why Does My Child Do That? Understanding Challenging
Behavior”
Presented by
Lupe Castañeda, MS, BCBA
Pediatric Rehabilitation and Behavioral Services
Board Certified Behavior Analyst
January 24, 2013
What is problem behavior?

In the educational environment, behaviors are considered problematic if they
 consistently interfere with the child’s or other children’s education
 restrict the child from participating in general education activities, and
 endanger the child, other students or adults
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Home and community, behaviors might be considered problematic if they
 (a) interfere with the family’s desire to participate in community or extended
family activities,
 (b) endanger the child, siblings or other family members,
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Most problem behavior is believed to be learned (operant) Problem behavior often
serves a purpose/function or a combination of functions for the individual
engaging in the behavior
Problem Behaviors Reported in Individuals with
Autism/Asperger’s
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Meltdowns for no “apparent reason”
Non-compliance
Lack of production (e.g. incomplete assignments)
Lack of motivation
Slow pace
Inattentiveness
Inapropriate comments to peers/adults
Aggression towards others
Property destruction
Difficulty with transitions
Talking out in class
Dominating conversations
Difficulty with changes in routines/schedules
Self-injury
Talk about hurting self or others
Excessive self-stimulation
Why is Problem Behavior so
Prevalent in Autism?
 Not a byproduct of autism, but rather many are learned due to
ineffective means to get needs met
 Difficulty with communication
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Some language, but not as efficient as problem behavior
 Social deficits
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Difficulty interacting w/peers seeking attention
Difficulty knowing how to initiate, maintain, end or avoid social interactions
 Restricted interests
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Insistence on sameness
Viewing the world through laser beam rather than flashlight
Functional Assessment
Functional Behavior Assessment
 Assists in identifying variables influencing
behaviors
 Function can be determined by
 direct observation,
 interviews with the child or those who know him/her
well
 functional analysis
Possible Functions
 Obtain Desired Events
 Obtain Internal Stimulation
(Automatic Positive)
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Visual stimulation
Endorphin release
 Obtain Attention (Social
Positive)
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Smiles, Hugs, Frowns
 Obtain Activities or Objects
(Access to
Tangibles/activities)
 Escape/Avoid Undesirable
Events
 Escape/Avoid Internal
Stimulation (Automatic
Negative)
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Sinus pain, itching, hunger
 Escape/Avoid Attention
(Social negative)
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Smiles, hugs, frowns,
correction
 Escape/Avoid Tasks and
Activities
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Hard tasks, change in
routine, unpredictability
Determining the Function of
Problem Behavior
 Setting
 Does the behavior occur in specific settings?
 Does the behavior occur in all settings?
 Setting Event
 Was the child sick?
 Was the child hungry?
 Did the child have an argument with someone earlier in the day?
 Antecedent
 Was the child given an instruction to do something?
 Was the child alone or being ignored at the time of the behavior(s)?
 Did the child want something that was not available at the time?
Determining the Function of
Problem Behavior
 Behavior
 What did the behavior look like? Be specific. Use
words like hit, screamed, kicked rather than aggressive,
angry, upset or frustrated.
 Was it one or more behaviors?
 Consequences
 Was the child reprimanded?
Attention as a Function of
Problem Behavior
 Quality of attention?
 Any attention?
 Peer attention?
 Adult attention?
 Undivided attention
 High intensity attention?
 Physical attention?
 Certain person’s attention?
 Duration of attention and between instances of attention
Escape or Avoidance as a
Function of Problem Behavior
 What is individual escaping?
 Demand too challenging?
 Task too boring?
 Demand centered around non-preferred activities?
 Demand associated with certain type of stimulation?
 Social demand?
 Specific to certain person?
 Demand too long?
Access to Desirable Object,
Activity, Food
 What activities or items does the individual get?
 Does behavior occur when time to give up item?
 Does behavior occur when he/she needs to wait
for item?
 Does behavior occurs when it’s time to share?
 Does behavior occurs when he/she needs to take
turns
Automatic Reinforcement as
Function
 What is sensation individual is seeking?
 Is behavior related to medical condition?
Assessment Tools
 Functional Assessment Screening Tool (FAST)
 Motivation Assessment Tool (MAS)
 Direct Observation (A-B-C Analysis, Structured A-B-C
Checklist)
 Functional Analysis (experimental manipulation of
consequences)
ABC (Antecedent-BehaviorConsequence) Analysis Form
Setting/
Event Prior to
Activity/
Behavior
Setting Events
Grocery store
Home
Behavior
Consequence
Parent told
Child
child to put
screams, cries
candy back on that he wants
shelf
the candy
Parent lets the
child have the
candy to stop
him from
crying
Sibling
playing video
game
Sibling gives
the video
game to child
Hits, kicks,
and bites
sibling
STUDENT:
TARGET BEHAVIOR:
Date/Time 30 1:00 1:30 2:00 2:30 3:00 3:30 4:00 4:30 5:00 5:30 6:00 6:30 7:00 7:30 8:00 8:30 9:00 9:30 10
Frequency Data
Tar Behv:
Behavior
1
2
3
Date
Tar Behv:
Location
Tar Behv:
Notes:
Activity
Antecedent
Ignored by staff
Leisure materia denied
other request denied
given inst. Prompt to w ork
provoked by peer
None (doing nothing)
Consequence
Attention, response block
redirected to another area
leisure material given
w ork requirement termin
staff w alked aw ay
staff did nothing
TOTAL
Pos. Reinf.
Pos. Reinf.
Neg. Reinf.
Auto. Reinf.
(attention)
(materials)
(escape)
(sensory)
Function-Based Intervention
 Linked to the function of problem behavior as
identified by the functional behavior assessment
 Based on the basic principles of behavioral science
 Plan make behavior problems “irrelevant,
ineffective and inefficient.”
 General Rule: Must teach a replacement behavior for
every behavior to decrease
Make Behaviors “Irrelevant”
 The child no longer needs to engage in problem
behavior to meet his wants or needs
 Example: A child engages in attention-getting
behavior while his mother prepares dinner. The
intervention may include asking the child to help set
the table while his mother cooks. The attentiongetting behavior may decrease because his mother is
providing attention while he helps her. This makes
the problem behavior “irrelevant.”
Make Behaviors
“Ineffective”
 Problem behaviors no longer enable the child to
achieve the function of the behavior.
 Example: A child who tantrums when he wants a
snack before dinner is told by his parents that he has
lost snack for the remainder of the day and he will
have the opportunity for snack the following day.
The problem behavior becomes “ineffective” at
getting snack before dinner.
Make Behaviors “Inefficient”
 Appropriate/desired behaviors should be made more
efficient than problem behaviors.
 Example: A child tantrums to avoid doing chores,
which results in a delay or avoiding the chores about
50% of the time. His tantrums are effective, but
require much physical effort. When he is taught to say
“break” or “I’m finished now,” his problem
behaviors diminish to near zero levels because the
“appropriate” behaviors result in immediate
termination of the undesired activity.
Prevention Strategies
 Alterations to the environment that make challenging behavior
irrelevant
 Why try to prevent or avoid situations that may trigger problem
behavior?
 Reduces child’s or family’s stress
 Allows time to teach appropriate replacement behaviors
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Replacement behaviors should be taught at other times
 Social Stories (see example)
 Short story written from individual’s perspective
 Describes situation appropriate responses to difficult/new
situations
 Provides rationale for why the individual should do or say
in a social situation
Prevention Strategies (Making
Behaviors Irrelevant)
 Usually involves making changing physical setting of environment
 Enriching environment
 Providing individual with more information or adaptive strategies
 Increasing predictability
 Providing choices
 Won’t resolve challenging behaviors, but may reduce individuals
need to use challenging behavior while learning appropriate skills
Prevention Strategies
 Priming (video modeling, roleplay, or social scripts)
 Often used to teach appropriate social/play skills
 Can be used with Social Stories to prepare for
difficult/new situation
 Visual schedules/task lists (written, photographic, symbols,
combination)
 Increases predictability (see example)
 Clarifies expectations for common routines, activities,
or skills within the home and community (see example)
 Rule Cards (see example)
 Power Cards
 Rule cards using favorite cartoon characters, sports
idols, etc. to communicate rules
Prevention Strategies
 Transitions
 Visual schedules
 Warn (e.g. verbally, timer, etc.)
 Allow closure (e.g. complete computer game or finish watching
television show)
 Morning routine
 Prepare as much as possible night before
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Lay out clothes
Organize school supplies, etc. near door
Provide incremental alarms for awakening (e.g. 10-minute alarm, 5 min, 1
min, etc.)
Prevention Strategies
 Mealtimes
 For picky eaters, introduce 1 food at a time and 1 bite at a time
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May need slower pace for some individuals
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Tolerating new foods on table, plate, smelling food, touching food with fingers,
touching food to lips, placing food in mouth, and then swallowing.
Research indicates may take at least 2 weeks to consistently accept new food
 Keep mealtime consistent
 May need weekly menu or meal schedule
 Serve individual’s food with the rest of family
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Make clear expectations to eat with family at table
Some may need frequent breaks away from table
Prevention Strategies
 After school routine
 May need down time to “decompress”
 Others may need time to “burn” excess energy (e.g. physical
activity)
 Bedtime
 Provide advance warning of upcoming bedtime
 Establish consistent routines
 Allow to engage in quiet activities prior to bedtime (e.g. reading, etc.)
 Family outings
 Social Stories
 Gradually acclimate to new activities
Prevention Strategies
 Change situation to reduce need for individual to
engage in behavior
 Remedy physiological ailments
 If overstimulated, overwhelmed in a situation
 Allow individual to take/request frequent breaks from the situation
 Gradually introduce exposure to similar situations over time
 Warn of upcoming event
 Inform individual that preferred/positive activity will follow
Keep My Cool!
I’m a teenager who will be looking for job this summer.
I’ve worked as a carry-out/sacker at a grocery store before. That’s one of
my favorite jobs.
When I’m working, I sometimes get asked to do a lot of things as part of my
job.
Sometimes I like what I’m asked to do and sometimes I don’t really want to
do what I’ve been asked. Sometimes I may have to talk to customers when I
don’t feel like talking to them.
These things are all part of keeping a job.
These things may make me angry.
It’s okay to get angry, but I have to try to Keep My Cool.
When I’m angry, I can make some choices to help Keep My Cool. Some
good choices I can make are:
1. Take a deep breath and let it out without saying anything
2. Walk to a quiet spot for a few minutes when given my trigger word.
When I’m mad, it is not okay to hurt another person.
Hurt
When I’m mad, it is not okay to cuss at them.
When I’m mad, I will try to make some good choices to help me stay calm
and Keep My Cool.
Keeping My Cool can help me Keep my Job!
Bus Rules
When you’re on the bus
Buckle Up!
Bus Rules
When you’re on the bus
Buckle Up!
Grant’s School Schedule
1.
8.
2.
9.
3.
10.
4.
11.
5.
or
12.
6.
13.
7.
My Rewards
Follow the rules and get 10 minutes of my choice:
Rules
or
Prevention Strategies
 Motivate compliance and cooperation by
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(a) allowing the child to make choices,
(b) give positive praise for compliance,
(c) use high-probability requests
 Pre-correct behaviors (before the problem behavior occurs) by
reminding the child
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(a) how to ask for attention,
(b) what behaviors are expected at a relative’s home,
(c) how to share a favorite toy with a sibling.
 Use safety signals to inform the child that an activity is near
completion
Replacement Behaviors
 Require less effort
 Easily understood by others
 Results in the same “rewards” as the problem behaviors
 Ex. Attention is provided immediately when the child says,
“Mom” rather than hitting the mother or throwing an object
Factors Affecting Replacement
Behaviors
 How frequently behavior is reinforced
 How quickly behavior is reinforced
 How much effort is required
Teaching Replacement Skills
 Select skills to teach
 Consistency and repetition
 Skills taught throughout day when not engaging in challenging
behavior
 Identify opportunities in daily routines
Prevention Strategies: Obtain (e.g.,
attention, object, activity)
 Provide more frequent
attention/reinforcement
 Activity schedule
 Contingency for activity
completion
 Schedule time with adult
or peer
 Scheduled access to
desired object/event
 Choice of activity,
material, and/or partner
 Use timer, alarm to delay
reinforcement
REPLACEMENT SKILLS: Obtain
(e.g., attention, object, activity)
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Follow schedule
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Participate in routine
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Self-management
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Request help
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Teach delay of reinforcement
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Request attention
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Choice
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Ask for a hug
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Ask for a turn
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Ask for item
RESPONSES TO PROBLEM BEHAVIOR: Obtain
(e.g., attention, object, activity)
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Redirect/cue to use appropriate “new replacement skill”
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Cue with appropriate prevention strategy
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State “exactly” what is expected
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Offer choices
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Use “wait-time”
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Praise/reinforce when replacement skill is performed
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Respond in a way that does NOT maintain problem behavior
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Minimize attention while responding to severe behavior
Ignore minor behavior (“Planned ignoring”)
Prevention Strategies: Escape (e.g., activity,
demands, social interaction)
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Modify task length,
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Provide activity schedule
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Modify expectations
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Select reinforcer prior to activity
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Modify materials
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Incorporate child’s interest
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Modify instructions,
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Use timer
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Modify response mode
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Self-management system
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Break task down
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Provide peer supports
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Provide choice
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Add manipulatives
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Modify seating arrangements
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Provide visual supports
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Reduce distractions
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Follow least preferred with most preferred
Add Predictability to the Demand
 Prepare for upcoming demand
 Verbal warning of upcoming demand
 Visual schedule
 Increase clarity of task
 Review expectations/requirements of demand
Eliminate Signal for Escape or
Avoidance
 Complete task in new setting
 Change task materials
 Change wording of task
 Change people involved with task
Increasing Compliance
 High probability instruction sequence
 Behavioral momentum
 Begin with several instructions that are consistently followed
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Issue instruction(s)
Reinforce (praise, thanks)
Issue difficult instruction
Reinforce if child complied
 Interspersing simple and complex tasks
 May begin with easy task (behavioral momentum)
 Follow with more complex task
 Reinforcement procedures (token system)
REPLACEMENT SKILLS: Escape (e.g.,
activity, demands, social interaction)
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Request break
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Set work goals
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Request help
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Follow schedule
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Participate in routine
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Choice
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Self-management
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Say “No”
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Say “All done”
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Identify and express feelings
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Use supports to follow rules
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Anticipate transitions
Consequence Based Strategies for
Escape/Avoidance
 Differential Reinforcement
 DRA (alternative)
 DRO (omission/other)
 DRI (incompatible)
 Extinction
 Punishment
RESPONSES TO PROBLEM BEHAVIOR: Escape
(e.g. demands, activity, social interactions
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Redirect/cue to use appropriate
“new replacement skill” and
then allow escape
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Offer alternatives
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Use “wait-time”
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Cue with appropriate prevention
strategy
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Praise/reinforce when replacement
skill is performed
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State “exactly” what is expected
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Respond in a way that does NOT
maintain problem behavior
Stereotypy
 Noninjurious behavior that involves repetitious and invariant
movement of one or more body parts that serves no apparent
social function and a high time allocation (Lewis &
Baumeister, 1982).
 Literature review (Rapp & Vollmer, 2005) concluded that
stereotypy often maintained by automatic positive
reinforcement
 Stereotypy persisted in absence of social consequences
 Noncontingent access to preferred objects was correlated with
reductions in stereotypy
 Sensory extinction produced temporary reductions in stereotypy
 Contingent access to stereotypy functioned as reinforcer for other
behavior
 Restricted access (deprivation) produced increases in time
allocation to stereotypy
Noncontingent access to matched
stimulation
 Continuous access to preferred, matched
stimulation decreased stereotypy and other
automatically reinforced behaviors
 Matched stimuli selected by examining behavior and
hypothesizing about possible sensory consequences
 Systematic stimulus preference assessments using leisure
materials with similar stimulation were conducted
 Leisure materials
 Immediately reinforcing
 Requires little effort to produce reinforcement
 May require prompts to engage in leisure item
Contingent Access to Matched Stimulation
 Stereotypy decreased when matched stimuli provide for
alternative behavior (e.g. task completion)
 Need additional treatment components to be more effective
than NCR
 Blocking or interrupting stereotypy may increase effectiveness
of DRA by shifting response allocation to matched stimulation
Removing Antecedents for
Stereotypic Behavior
 Presences of specific items may set occasion for
stereotypy or other automatically reinforced
behaviors
 Identification and removal of antecedent
influences can be effective intervention
 Some studies indicate that reducing or restricting
access to one form of stereotypy may reduce other
forms of stereotypy
 However, blocking or reducing access to certain
responses may increase stereotypy
Differential Reinforcement of
Omission/Other Behavior (DRO)
 Reinforcing any other response other than a target
behavior for a specified interval of time
 Provide reinforcement at the end of interval if target
response does not occur
 No reinforcement provided at end of interval in which
problem behavior occurs
 Minimal side effects as seen with punishment and
extinction (e.g. agitation, aggression, escape avoidance)
DRO (example)
 Target behavior: Profanity
 Interval: 1 hour
 If no instance of target behavior during hour, reinforce with star
and descriptive praise
 If target behavior is exhibited, no reinforcement provided
Differential Reinforcement of
Alternative Behavior (DRA)
 Reinforce desirable alternative (not necessarily
incompatible – DRI)
 Alternative behavior occupies time that problem
behavior normally use
 Ex. Reinforcing cooperative activities instead of arguing
with peer
 Ex. Plastic block in bucket instead of loud vocalizations
 Ex. Giving “Break” card or saying “No” instead of
disruptive behavior during task
Differential Reinforcement of
Incompatible Behaviors (DRI)
 Not possible to perform problem behavior and incompatible
behavior simultaneously
 e.g. reinforce child with deep pressure massage on back while he
is completing his assignments rather than while flapping his hands
 e.g. provide reinforcement for staying at circle time and not for
roaming classroom
DRA
 Purpose is to increase behavior that will compete with
stereotypic behavior
 Access to preferred objects and activities provided contingent
on specific forms of adaptive behavior
 May need prompts and instructions to engage in alternative
response
Important Points!
 Behavior can serve multiple functions
 Behaviors that look different can serve the same function
 Some events that occur earlier in the day or that are ongoing
(e.g. illness, hunger, stress) can effect behavior
Important Points!
 Make problem behaviors irrelevant, ineffective and inefficient
 Teach alternative behaviors to replace problem behaviors
 Praise and reinforce appropriate behaviors as often as possible
 Plan and implement emergency procedures for severe behavior
Contact Information
Lupe Castañeda, MS, BCBA
Board Certified Behavior Analyst
Executive Director
Behavior Analytic Solutions, LLC DBA
Pediatric Rehabilitation and Behavioral Services
Office: 210-858-9062
Fax: 210-566-3433
Email 1: [email protected]
Website: www.rehababa.com
References
 Cooper, J.O.,
Heron, T.E., & Heward, W.L. (2007). Applied Behavior
nd
Analysis (2 ed.). Pearson: New Jersey.
 Crone, D.A. & Horner, R.H. (2003). Building Positive Behavior
Support Systems in Schools: Functional Behavior Assessment.
Guilford Press: New York
 Glasberg, B.A. (2006). Functional Behavior Assessment for People
with Autism. Woodbine House: Bethesda, MD.
 Glasberg, B.A. (2008). STOP That Seemingly Senseless Behavior!
FBA-Based Interventions for People with Autism.
 Koegel L.K., Koegel, R.L. & Dunlap, G. (1996). Positive Behavioral
Support: Including People with Difficult Behavior in the Community.
Brookes Publishing: Baltimore, MD.
 Latham, G. I. (1994) The Power of Positive Parenting. P&T Ink:
North Logan, UT.
References
 LaVigna, G.W. & Donnellan, A.M. (1986). Alternatives to
Punishment: Solving Behavior Problems with Nonaversive Strategies. Irvington Publishers: New York.
 Lucyshyn, J.M., Dunlap, G. & Albin, R.W. (2002).
Families and Positive Behavior Support: Addressing
Problem Behavior in Family Contexts. Brookes
Publishing: Baltimore, MD.
 Luiselli, J.K. & Cameron, M.J. (1998). Antecedent
Control. Brookes Publishing: Baltimore, MD.
References
 O’Neill, R.E., Horner, R.H., Albin, R.W., Sprague, J.H., Storey, K.,
& Newton, J.S. (1997). Functional Assessment and Program
Development for Problem Behavior: A Practical Handbook.
Brookes/Cole: New York
 Texas Behavior Support Initiative
Web Sites
 Cambridge Center for Behavioral Studies

http://www.behavior.org/
 Center for Evidence Based Practice: Young Children with
Challenging Behavior
 http://challengingbehavior.fmhi.usf.edu/pbs.html
 OSEP Technical Assistance Center on Positive Behavior
Interventions and Supports
 http://pbis.org/
 Rehabilitation Research and Training Center on Positive
Behavior Support

http://rrtcpbs.fmhi.usf.edu/