Dr. Jennifer Foster Psychologist, Coordinator of Mental Health Programs Perth Amboy Public Schools.
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Transcript of Dr. Jennifer Foster Psychologist, Coordinator of Mental Health Programs Perth Amboy Public Schools.
Dr. Jennifer FosterPsychologist, Coordinator of Mental Health
ProgramsPerth Amboy Public Schools
AgendaBrief Overview of Disruptive Behavior
DisordersOppositional Defiant DisordersConduct Disorders (Early & Late Onset)Disruptive Behavior Disorders (NOS)
ABC’s of BehaviorFunctions of BehaviorManagement of Acute and Chronic
Behavioral ProblemsCPI 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 disordersOppositional Defiant DisorderConduct 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 CriteriaMust have 4 of 8 symptoms occurring
frequentlyLoses temperArgues with adultsActively defies or refuses to comply with
adult’s requests or rulesDeliberately annoys peopleBlames others for own mistakes or misbehaviorTouchy and easily annoyed by othersAngry and resentfulSpiteful of vindictive
ODD Signs & SymptomsStubborn and noncompliantContentious and argumentativeQuick to shift blameHighly DefensiveSee demands as unreasonablePassive aggressive/systematically ignore othersRefusal to negotiateDeliberate annoyance of othersThreatens/intimidates othersVerbally aggressivePresent with low self-concept or inflated self-
esteem
Oppositional Defiant DisorderAverage 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, anxiety80%+ with ODD have comorbid ADHD65% 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 normsAggression toward people and animalsDestruction of propertyDeceitfulness or theftSerious violations of rules
Criteria for CD (Cont.)At least 3 of the 15 items, present for 12
monthsOf which one symptom in the past 6 months
Significant impairment in social, academic, or occupational functioning
Differences in age of onsetEarly Childhood Onset—onset of at least one
criterion characteristic of CD prior to age 10 Outcomes are poor, ingrained behavior is highly
resistantAdolescence Onset—absence of any criteria
characteristic prior to the age of 10 More resilient b/c they developed better coping
skills at earlier age
Signs & Symptoms of CDAggressive behavior that harms or threatens
other people or animals (i.e., physical altercations, intimidation, bullying)
Destructive behavior that damages or destroys property
Manipulation via lying, deceitTheftTruancy or other serious violations of rulesEarly tobacco, alcohol, and substance use and
abusePrecocious sexual activityShow little remorse for their actions, empathy, or
concern for the thought or feelings of othersRead hostile intent in the actions of others,
reactiveFake 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 BehaviorAntecedent
Behavior
Consequence
The Dance of BehaviorAntecedent 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 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.
Child stands up Teacher continues with activity
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 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
Teacher tells child that he can keep the orange block on the floor next to him, but he has to use the blue block
Child puts the orange block by his side on the floor and takes the blue block
Teacher begins song with children
Functional AnalysisDetermining 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 behaviorCan be environmentalCan be “internal” environmental effects
Must “listen” or observe behavior to determine causes!
Primary Functions of BehaviorEscape/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 activitybehavior often occurs when something has been denied
or taken away -- it is not person or event specificAttention (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 BehaviorBehaviors may result from a combination of functionEscape and sensory are often related to
circumstances that are stressful or boringAttention 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. What are the setting events (i.e., conditions
that alter the probability of a behavior occurring
2. What are the antecedents of the challenging behavior (i.e., specific events that precede a behavior)?
3. What are the consequences for the challenging behavior, which may reinforce it?
4. What does the student gain?5. 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.
Setting event Antecedent Response Consequence
Misses 12:30medication
Teachersmake
multipletask demands
Semantha makesnegative self-statements &
writes profanelanguage
Teacher sendsSamantha to
office for beingdisrespectful
What function?Avoid difficult tasks
Setting event Antecedent Response Consequence
Caesar isteased severaltimes about his
hair by his friends before
class
His teacherstares at his hair in class
Caesar askshis teacher what she’sstaring at
His teachersends him to
in-school detention
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 in-school detention. What function?
Escape adult &peer attention
Setting event Antecedent Response Consequence
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.
New student Studentapproaches &
speaks inEnglish
Cleo turns away
Other student walks
away
What function?Escape peer attention
Setting event Antecedent Response Consequence
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.
None Teacher askswhat capitolcity of countryis
Napoleongive correctanswer
Teacher givesverbal praise & time to workwith a friend
What function?Access peer &adult attention
Setting event Antecedent Response Consequence
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.”
?? Look at him.“What’s up!”
“Who yalookin’ at?”“Ya wantSome?” “Yatalkin’ to me?
Kids shakeheads & call him “weirdo”
What function?Access peer attention
Describing the Problem Behavior?1. Note the type of problem behavior2. Note where the problem behavior
occurs3. Note when the problem behavior
occurs4. Note characteristics of the setting
and events related to the problem behavior
5. Note situations or personal events that might induce the behavior
include actions of others that increase or trigger the behavior.
6. Note the consequences associated with the problem behavior.
7. Once this is understood, you can test a hypothesis
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Developing/Testing a HypothesisDevelop a hypothesis based on the
information gatheredTest 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 statementWhen he misses breakfast & peers tease
him about his walk, Caesar calls them names & hits them. Teasing stops.
Setting Events TriggeringAntecedents
MaintainingConsequences
ProblemBehavior
Hypothesis Statement
Missesbreakfast.
Teasedby peers.
Name calling &Hits.
Teasingstops.
Function
Escape negative social contact
Function
Escape aversive social contact
Once you have a have a hypothesis, you can experiment with interventions
The Conflict Cycle
Crisis Development Model (CPI, 2005)
Crisis Development/Behavior Levels
Staff Attitudes/Approaches
AnxietyDefensiveActing Out-Person
Tension Reduction
SupportiveDirectiveNon-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 ApproachesMaintain sufficient personal spaceAwareness of non-verbal cues from body
languageIt’s not what you say, but how you say itSet LimitsEmpathetic Listening
When Responding…Do Don’t
Remain CalmIsolate the SituationEnforce LimitsListenBe aware of Non-Verbal
cuesBe consistent
OverreactGet into power strugglesMake false promisesFake attentionBe threateningUse jargon—tends to
confuse and frustrate
Effective EnvironmentsProblem behaviors are irrelevant
Aversive events are removedAccess to positive events are more common
Problem behaviors are inefficientAppropriate behavioral alternatives availableAppropriate behavioral alternatives are taught
Problem behaviors are ineffectiveProblem behaviors are not rewarded
District Behavioral Referral ProcessSpeak to your student’s Child Study Team Case Manager
and/or 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 conductedA meeting will be coordinated with the consultant/crisis
counselor and/or case manager, and teacherRecommendations 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 InformationDr. Jennifer FosterPsychologist, Coordinator of Mental Health
ProgramsOffice: Department of Special
Services/Administration BuildingEmail: [email protected] (best way to
contact)Phone: 732-376-6200 Ext. 30234Fax: 732-826-4932