Support Strategies for Support Strategies for Challenging BehaviorsChallenging Behaviors

Benjamin R. Thomas, M.A., BCBABenjamin R. Thomas, M.A., BCBA

BehaviorBehavior

• Behavior is anything people:Behavior is anything people:

Do Do

or or

SaySay

BehaviorBehavior

• Behavior is:Behavior is:

– Verbal:Verbal: communicates with communicates with another personanother person

– Nonverbal:Nonverbal: interacts with interacts with environment onlyenvironment only

Appropriate BehaviorsAppropriate Behaviors

• Communication (asking for Communication (asking for wants/needs)wants/needs)

• Play and leisure skillsPlay and leisure skills

• Social behaviors with family and Social behaviors with family and friendsfriends

• Following directions/listeningFollowing directions/listening

• Etc.Etc.

ChallengingChallenging Behaviors Behaviors

• Looking away, non-responding, non-Looking away, non-responding, non-compliancecompliance

• Self-stimulatory (rocking, mouthing objects, Self-stimulatory (rocking, mouthing objects, etc.)etc.)

• Falling to the floor, running from adultsFalling to the floor, running from adults

• Climbing on tables, counters, bookcases, etc.Climbing on tables, counters, bookcases, etc.

• Screaming, yelling, crying, loud noises, etc.Screaming, yelling, crying, loud noises, etc.

• Hitting, biting, kicking othersHitting, biting, kicking others

• Self-injurious behaviorsSelf-injurious behaviors

• Refusal to eatRefusal to eat

Applied Behavior Analysis (ABA)Applied Behavior Analysis (ABA)

• The three-term contingency The three-term contingency (ABC analysis)(ABC analysis)

AntecedentAntecedent BehaviorBehavior ConsequenceConsequence Child wants juiceChild wants juice Says “Juice” Says “Juice” Parent gives child Parent gives child

juice juice

AntecedentAntecedent BehaviorBehavior ConsequenceConsequence Child doesn’t want Child doesn’t want Runs from adults Runs from adults Delays taking a bath Delays taking a bath

to take a bathto take a bath and gets chased and gets chased

What Causes Behavior?What Causes Behavior?

1.1. Recognize the Recognize the cuescues for the behavior for the behavior (antecedent)(antecedent)– Where and when a behavior is likely to occurWhere and when a behavior is likely to occur

2.2. Recognize the events that follow a behavior Recognize the events that follow a behavior (consequence)(consequence)

– What happens immediately after a behavior occurs? If the What happens immediately after a behavior occurs? If the behavior persists, the consequence is REINFORCING the behavior.behavior persists, the consequence is REINFORCING the behavior.

Escape BehaviorsEscape Behaviors• Why won’t your child do it?Why won’t your child do it?

• Too hardToo hard• Uncomfortable sensory inputUncomfortable sensory input• No reason to do it (nothing in it for him/her)No reason to do it (nothing in it for him/her)

• PreventionPrevention– Start small- introduce a little bit at a timeStart small- introduce a little bit at a time– Change the task- reduce uncomfortable input Change the task- reduce uncomfortable input

(ex. Gloves for water, headphones)(ex. Gloves for water, headphones)• Appropriate behaviorAppropriate behavior

– Teach to say “No,” ask for a “Break,” or a way to Teach to say “No,” ask for a “Break,” or a way to make it go awaymake it go away

• StrengthenStrengthen– Offer incentive for compliance- access to Offer incentive for compliance- access to

preferred item/activity preferred item/activity – Honor appropriate requests to terminate Honor appropriate requests to terminate

situationsituation

Behaviors that Get ThingsBehaviors that Get Things• What does your child want?What does your child want?• PreventionPrevention

– Have items/activities available at all times or regularly at Have items/activities available at all times or regularly at scheduled timesscheduled times

– Arrange home so child does not pass by preferred things as Arrange home so child does not pass by preferred things as s/he is transitioning out the doors/he is transitioning out the door

– Timed access/sharing/scheduled accessTimed access/sharing/scheduled access• Appropriate behaviorAppropriate behavior

– Teach to ask nicely for what s/he wants (i.e., “juice” to get Teach to ask nicely for what s/he wants (i.e., “juice” to get juice when thirsty)juice when thirsty)

– Teach waiting, accepting “no”/ “not right now”Teach waiting, accepting “no”/ “not right now”• StrengthenStrengthen

– Honor all appropriate requests for thingsHonor all appropriate requests for things– Ignore challenging behaviors (inappropriate requests) that get Ignore challenging behaviors (inappropriate requests) that get

thingsthings

Behaviors that Get AttentionBehaviors that Get Attention

• How does s/he want you to pay attention?How does s/he want you to pay attention?• PreventionPrevention

– Pay attention regularly/on a schedule- use a timer to Pay attention regularly/on a schedule- use a timer to rememberremember

– Enrich environment with other fun things to do so you Enrich environment with other fun things to do so you are not the only source of fun during specific timesare not the only source of fun during specific times

• Appropriate behaviorAppropriate behavior– Teach to ask nicely (i.e., “Hug, “Pick up,” “play with Teach to ask nicely (i.e., “Hug, “Pick up,” “play with

me”)me”)– Social/play skills- receive attention from othersSocial/play skills- receive attention from others

• StrengthenStrengthen– Honor all appropriate requests for attentionHonor all appropriate requests for attention– Ignore challenging behaviors that get attentionIgnore challenging behaviors that get attention

Self-stimulatory Behaviors Self-stimulatory Behaviors • What kind of feedback/input does your child get from What kind of feedback/input does your child get from

the behavior?the behavior?• PreventionPrevention

– Enrich environment with other fun things s/he enjoysEnrich environment with other fun things s/he enjoys– Structure daily routine to minimize periods without Structure daily routine to minimize periods without

appropriate activitiesappropriate activities– Provide an acceptable place where the behavior may occurProvide an acceptable place where the behavior may occur

• Appropriate behaviorAppropriate behavior– Teach play skills, leisure skills- how to do appropriate things Teach play skills, leisure skills- how to do appropriate things

that give similar feedback (*that may also help make friends)that give similar feedback (*that may also help make friends)• StrengthenStrengthen

– Reinforce periods with absence of behaviorsReinforce periods with absence of behaviors– Provide incentive to play appropriately -(why should they do Provide incentive to play appropriately -(why should they do

something new when they already know an easy way to something new when they already know an easy way to entertain themselves?)entertain themselves?)

– Block inappropriate behaviors to the extent possible- the Block inappropriate behaviors to the extent possible- the only way to get the sensory input will be the appropriate wayonly way to get the sensory input will be the appropriate way

Ignoring Challenging Behavior: Ignoring Challenging Behavior: ExtinctionExtinction• Be prepared for an extinction burstBe prepared for an extinction burst• Eye contact is often attention (reinforcement)Eye contact is often attention (reinforcement)• Don’t show facial reactionsDon’t show facial reactions• Don’t argue, scold or talk (attention)Don’t argue, scold or talk (attention)• Don’t show anger (attention)Don’t show anger (attention)• Act absorbed in some other activity, walk awayAct absorbed in some other activity, walk away• Give your child attention shortly after the bad Give your child attention shortly after the bad

behavior stopsbehavior stops

(Mark Sundberg, Ph.D., BCBA)(Mark Sundberg, Ph.D., BCBA)

Identifying PrecursorsIdentifying Precursors• What responses precede problem behaviorWhat responses precede problem behavior

• What conditionsWhat conditions

Ex:Ex:• 0) None; 1) Glazed/vacant look (not working); 2) Scripting 0) None; 1) Glazed/vacant look (not working); 2) Scripting

about behavior incidents from earlier; 3) Tensing of the about behavior incidents from earlier; 3) Tensing of the arms and hands; arms and hands; 4) Disruptive behavior 5) Aggression4) Disruptive behavior 5) Aggression

• 0)None; 1)Tensing, shaking, facial grimace; 0)None; 1)Tensing, shaking, facial grimace; 2)Inappropriate vocalizations; 2)Inappropriate vocalizations; 3) Disruption; 4) SIB; 3) Disruption; 4) SIB;

5) Aggression to Others5) Aggression to Others

During a meltdownDuring a meltdown

• Your behavior:Your behavior:– Avoid eye contact (often a reinforcer)Avoid eye contact (often a reinforcer)– Avoid facial reactionsAvoid facial reactions– Avoid reprimands, arguing, talkingAvoid reprimands, arguing, talking

– Safe position = 45° behind child at arms Safe position = 45° behind child at arms lengthlength

Getting your child back on Getting your child back on tracktrack• Allow child to calm down before Allow child to calm down before

instructionsinstructions• Reinforce calming downReinforce calming down• Counting, BreathingCounting, Breathing• High-probability response sequenceHigh-probability response sequence

– Present a series of easy to follow Present a series of easy to follow requests for which your child has a requests for which your child has a history of compliance, followed by the history of compliance, followed by the target request.target request.

Token EconomyToken Economy• A motivation system in which tokens are A motivation system in which tokens are

delivered for desirable behaviors. The tokens delivered for desirable behaviors. The tokens are accumulated and exchanged for preferred are accumulated and exchanged for preferred items/activities/privileges (reinforcers).items/activities/privileges (reinforcers).

– Sticker chartsSticker charts– Points systemPoints system– Penny board/token boardPenny board/token board– AllowanceAllowance– PaycheckPaycheck

Token economy Token economy componentscomponents

• Appropriate behaviors to strengthenAppropriate behaviors to strengthen

• What to use for tokensWhat to use for tokens

• What the tokens will be exchanged What the tokens will be exchanged for (reinforcers)for (reinforcers)

• Schedule for token deliverySchedule for token delivery

• Rate/time/place to exchange tokensRate/time/place to exchange tokens

• Response cost/fine for inappropriateResponse cost/fine for inappropriate

Token Economy (cont)Token Economy (cont)

• Selecting Reinforcers (consequences Selecting Reinforcers (consequences that increase appropriate behaviors)that increase appropriate behaviors)

• Preference assessmentsPreference assessments– ObservationObservation– InterviewInterview– AssessmentAssessment– Asking? Low correspondenceAsking? Low correspondence

Activity RAISDActivity RAISD

Token economy (cont)Token economy (cont)

• Make bed: 1ptMake bed: 1pt• Brush teeth: 1ptBrush teeth: 1pt• Homework: 3ptsHomework: 3pts• Eat dinner at the table: 1ptEat dinner at the table: 1pt• Play with brother nicely: 4ptsPlay with brother nicely: 4pts

Store:Store:Go to Baskin Robbins: 15ptsGo to Baskin Robbins: 15ptsXbox: 10pts, Bike ride w/dad: 8 pts, TV: 8pts, Xbox: 10pts, Bike ride w/dad: 8 pts, TV: 8pts,

SchedulesSchedules

• Clear expectations of events Clear expectations of events

• Tie into token economyTie into token economy

• Scheduled access to preferred Scheduled access to preferred items/activitiesitems/activities

After School RoutineAfter School Routine

• Hang up jacketHang up jacket• Unpack/hang up bagUnpack/hang up bag• BathroomBathroom• SnackSnack• Choose something to do (choice board)Choose something to do (choice board)• *(activity schedule book)*(activity schedule book)• Outside play Outside play • Set tableSet table• DinnerDinner

Self-monitoring: Self-monitoring: promoting independencepromoting independence

Self-monitoring (cont)Self-monitoring (cont)

• Hang up jacket Hang up jacket □□• Unpack/hang up bag Unpack/hang up bag □□• Choose something to do Choose something to do □□• activity schedule book activity schedule book □□• Set table Set table □□• Dinner at table Dinner at table □□

Total ___/Total ___/6__6__

Difficulty with TransitionsDifficulty with Transitions

• TransitionsTransitions– Allow child to transition with a preferred Allow child to transition with a preferred

item- fade to after transitionitem- fade to after transition– Incorporate reinforcement/tokens for Incorporate reinforcement/tokens for

successful transitionssuccessful transitions– Warnings prior to transitionsWarnings prior to transitions– Visual timers for activitiesVisual timers for activities– Daily scheduleDaily schedule

Change in routine/scheduleChange in routine/schedule

• Anticipate and prepare your childAnticipate and prepare your child

• Social stories (Carol Gray)Social stories (Carol Gray)

• Change in routine cardChange in routine card•w/social storyw/social story

•Add to daily schedule (see it many times)Add to daily schedule (see it many times)

•Reinforce tolerance of change/new activityReinforce tolerance of change/new activity

Change in Routine Card

Notice: ____ will be changed on _____

Because_________________________

The new activity is _________________

Trip to the Doctor’s Office

Sit in the waiting room.

Go into the exam room.

Sit on the table.

Dr. Jay will look in my ear.

Dr. Jay will look in my mouth.

Say “AHH.”

Go to Baskin-Robbins for ice cream!

Patrick’s Fire Drill Storywritten just for Patrick

Fire Drills tell people when to go outside in case there is a fire.

We have fire drills two times a month in school.

Most of the time these are just for practice. There isn’t a fire.

The alarm goes off and everyone lines up.We walk outside together and wait until it is time to go in.

Sometimes the fire alarm scares me. It’s very loud.

There are some things I can do when the alarm goes off to make it less scary.

When the fire alarm goes off, I can do these things:1. Put my headphones on.

They will make the alarm quieter.

2. Ask to hold someone’s hand.

3. Tell myself, “It will be over soon.”

I will still line-up with my class and walk out of the building

I will wait outside until the alarm sops and we can go inside.

Once the alarm ends it’s over!

I can go back inside and go back to my school work.

Fire drills are loud, but when I use my headphones and ask someone to hold my hand, it will be okay.

Waiting and Accepting “NO”Waiting and Accepting “NO”

• Activities to keep occupied, activity Activities to keep occupied, activity schedulesschedules

• Teach counting to wait/delay (for Teach counting to wait/delay (for interruptions)interruptions)

• Visual timersVisual timers

• Scheduled access (build into daily schedule)Scheduled access (build into daily schedule)

• Reinforce accepting “No” with access to Reinforce accepting “No” with access to something else preferred. ***Have these something else preferred. ***Have these items with you at all times when travelingitems with you at all times when traveling

22ndnd Place aka “LOSING” Place aka “LOSING”• LosingLosing

– Reinforce “sportsmanship”Reinforce “sportsmanship”– Points for playing games (gym class)Points for playing games (gym class)

•1 pt for winning1 pt for winning

•2 pts for losing and not getting mad (meltdown)2 pts for losing and not getting mad (meltdown)

•0 pts for getting upset0 pts for getting upset

•Points exchanged for preferred items, privileges, etcPoints exchanged for preferred items, privileges, etc

– 2 games: making friends and actual game 2 games: making friends and actual game

(Jed Baker, 2008)(Jed Baker, 2008)