V Preventing and Addressing Challenging Behavior in Children with Autism Glen Dunlap and Phil Strain...

vPreventing and Addressing Challenging Behavior in

Children with Autism

Preventing and Addressing Challenging Behavior in

Children with Autism

Glen Dunlap and Phil StrainPresented at the 2009 OSEP Early

Childhood Conference

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v

www.challengingbehavior.org

Purpose of PresentationPurpose of Presentation

Describe issues related to problem behaviors and ASD

Present a multi-tiered model of prevention

Discuss implications for practice

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AgendaAgenda

Introduction

Autism and Challenging BehaviorChanging Perspectives

A Model of Prevention

Implications, Directions and Conclusions

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4 Main Messages4 Main Messages

The best way to address challenging behaviors of children with autism is with a multi-tiered (hierarchical) framework of prevention and intervention

A sensible and effective (evidence-based) approach to intervention is positive behavior support

Families are essential elements of children’s lives, and are deeply affected by challenging behaviors and by interventions*

A vital challenge is to help systems (e.g., schools) establish responses to ASD, and challenging behavior, that are: (a) fully incorporated into the system, (b) effective, and (c) sustainable 5

Autism Spectrum Disorder(s)

Autism Spectrum Disorder(s)

A diverse syndrome involving problems with the development of communication and social relatedness… as well as restricted interests and perseverative and stereotypical patterns of behavior

ASD encompasses a great range of abilities and disabilities

For instance, some children with ASD have very serious risks for challenging behavior; others have relatively mild risks

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Challenging BehaviorsChallenging Behaviors

Destructive BehaviorsAggression; SIB; Property Destruction

Disruptive BehaviorsLong tantrums; Loud, Repetitive Noises; Running, etc.

Irritating & Interfering Behaviors“self-stim;” repetitive and perseverative speech or actions, etc.

Social WithdrawalLack of responsivity and initiations

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Importance of Challenging Behaviors

Importance of Challenging Behaviors

Barrier to Inclusion, Community Participation, and Social Opportunities

Most Significant Impediment to Education Present Physical & Emotional Risk for Individual

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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It is important to appreciate that challenging behaviors seriously detract from:

• all aspects of social/emotional/intellectual development

• opportunities and quality of life of children• quality of life of the children’s family

members….

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vSome Changing Perspectives on

Autism and Challenging Behaviors

Some Changing Perspectives on

Autism and Challenging Behaviors

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Early (1st Generation) Perspectives

Early (1st Generation) Perspectives

• 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 Effects1st 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 (2nd Generation) Perspectives

Changing (2nd Generation) Perspectives

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 socially-adaptive 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)

Changing Perspectives (continued)

Intervention involves PREVENTING problem behaviors from developing or occurring by:I. Arranging the environment so that

challenging behaviors are unnecessary (and desired behaviors are encouraged), and

II. Teaching skills needed to navigate and control the social environment

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3rd Generation Challenges3rd Generation Challenges

Developing Strategies for Incorporating Effective Prevention Practices into the Systems that Affect our Service Delivery

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Multi-tiered Prevention Frameworks

Multi-tiered Prevention Frameworks

Increasingly common (e.g., community health; school-wide PBS)

Basic framework has 3 levels:1) Universal strategies (primary prevention)--- for

everybody; low intensity prevention practices

2) Targeted strategies (secondary prevention) --- for particularly high risk groups; higher intensity

3) Indicated strategies (tertiary prevention/ intervention)--- for individuals already affected by problem; usually intensive and individualized strategies

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Preventing Challenging Behavior for Children with

ASD


ASD

LEVEL 3:Individualized

Intensive Interventions

LEVEL 2:Building social and communicative

competencies inconsistent with challenging behavior

LEVEL 1:Building positive relationships, supportive

environments, and healthy physiologies

Prevention – Universal (Level 1)

Prevention – Universal (Level 1)

Positive RelationshipsNurturing, caring, secure

Enhances influence of adult caregiver

Physical and Emotional HealthPhysical health and nutrition

Social-emotional well beingSafe, responsive, “friendly” and stimulating environment

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Prevention – Level 1 Practices

Prevention – Level 1 Practices

Adult-child interactionsPositive attention

Organized environmentStructure, routine, schedule

A comprehensible environment

InstructionUseful communicationSocial skillsClear, consistent behavioral expectations

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ASD


ASD







Level 2 Prevention Practices

Level 2 Prevention Practices

Differences from Level 1 PracticesIntensity of Intervention

Planfulness of Intervention

Intensity of Data Collection

Intensity of Family Involvement

For children at risk for challenging behavior:

Parent training classes

Social-emotional teaching curricula21

Building Functional Competencies

Building Functional Competencies

Interventions focused on teaching and building appropriate engagementIntervention supports for enhancing motivation

e.g., Pivotal Response Training

Group strategies (classroom models) with direct focus on teaching and motivating social interaction

e.g., LEAP; Project DATA; Walden22

“Active” Engagement Is Key“Active” Engagement Is Key

Rethinking Story Time and the “Dead Person”


Rethinking Circle and the “Dead Person”


Rotations and Novelty• Centers• Toys• Materials

“Active” Engagement Is Key

“Active” Engagement Is Key

Books as the GlueThe Three Little Pigs go to:

Art Activity

Circle

Free Play

Transitions

Reinforcer Assessment Is The Pivotal Assessment

Reinforcer Assessment Is The Pivotal Assessment

Developmental assessment and wasted time and money

Conducting Reinforcement AssessmentsCaregiver interview

Observation as a check

Paired comparisons

Choosing from the hierarchy

Repeated assessments

Keeping To A Routine Is Insufficient Routine For

Many


Many

Routine = Redundancy Routine = Restricted Stimuli Routines within Routines (Circle Example)

Circle Time RoutineCircle Time Routine

Opening Song1. Child passes out

prop

2. Sing song

3. Child collects prop


Calendar1. Clap out month

2. Sing Days of the Week song

3. Count to today with motor movement

4. Review the pattern


Child Choice Song1. Child chooses song

from 3-4 options

2. Props, Materials and/or Motor Movement are utilized with every song.


Center Choices1. Adult holds up

name cards

2. Children come up and choose a Center

3. Children go off to play


Many


Many

Routines should help provide answers to these key questions.

1. What am I doing now?

2. Where am I in the Routine?

3. How do I know when I’m finished?

4. What comes next?


ASD


ASD







Level 3 Practices - Intensive Individualized InterventionsLevel 3 Practices - Intensive Individualized Interventions

Are used for children with persistent and severe challenging behavior

Are used when children do not respond to preventive practices, child guidance procedures (e.g., redirection), or social-emotional teaching strategies

Children with multiple, severe risk factorsIntellectual-Communicative Disability (e.g., autism)

Exposure to substances, violence, depression, poverty, etc., etc. 35

vPositive Behavior Support

Positive Behavior Support

Level 3 procedures for children with serious challenging behavior

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Level 3 - Positive Behavior Support

Level 3 - 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 37

PBS – ComponentsPBS – Components

1. Team-building, Goal SettingPerson-Centered Planning

2. Functional Assessment of Challenging Behavior

3. Individualized Behavior Support Plan

4. Implementation

5. Evaluation38

Core Elements of a Behavior Support Plan Level 3 - PBS

Core Elements of a Behavior Support Plan Level 3 - PBS

(Linked to Assessment Information)Prevention Strategies – Arrangements of

antecedent environmentTeaching 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 39

EvaluationEvaluation

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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v

Summary and

Conclusions

Summary and

Conclusions

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Closing MessagesClosing Messages

Preventing and resolving challenging behaviors is extremely important….

Because of the implications for the quality of life of individual and all those who are close to the individual

Because of opportunities that can be compromised if challenging behaviors persist

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Implications of the Prevention Model

Implications of the Prevention Model

Some children with ASD will respond well to high quality implementation of Level 1 (universal) procedures

Some additional children with ASD will respond well to high quality implementation of Level 2 procedures

The remaining children with ASD will require implementation of Level 3 procedures

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The proportion of children with ASD who require some Level 3 procedures may be high, but we can presume that the implementation of high quality Level 1 and 2 procedures will mitigate the intensity with which the Level 3 procedures need to be implemented.

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What We Need to DOWhat We Need to DO

Early Identification --- because autism presents so many risk factors

Provide ALL identified children/families with supports for Level 1 prevention strategies

Provide ALL child care and pre-K classrooms with supports for implementing Level 1 prevention strategies

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Need to Do (continued)Need to Do (continued)

Disseminate the rationale and logic of the multi-tiered prevention framework as well as specific procedures associated with all levels.

Conduct research to validate and refine prevention model

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What We Need To DoWhat We Need To Do

Provide for training and direct technical assistance so that all children/families have access to effective supports in designing and implementing PBS plans

In early intervention programsIn schoolsIn community agenciesFor initial implementation and for ongoing support and evaluation

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Develop, evaluate and disseminate standardized models of PBS to enable large numbers of school practitioners to implement strategies with sufficient fidelity to be effective

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V Preventing and Addressing Challenging Behavior in Children with Autism Glen Dunlap and Phil Strain...

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