“Why Does My Child Do That? Understanding Challenging Behavior” Presented by Lupe Castañeda,...
Transcript of “Why Does My Child Do That? Understanding Challenging Behavior” Presented by Lupe Castañeda,...
“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
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,
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
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 Some language, but not as efficient as problem behavior
Social deficits Difficulty interacting w/peers seeking attention Difficulty knowing how to initiate, maintain, end or avoid social
interactions
Restricted interests 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) Visual stimulation Endorphin release
Obtain Attention (Social Positive) Smiles, Hugs, Frowns
Obtain Activities or Objects (Access to Tangibles/activities)
Escape/Avoid Undesirable Events Escape/Avoid Internal
Stimulation (Automatic Negative) Sinus pain, itching, hunger
Escape/Avoid Attention (Social negative) Smiles, hugs, frowns,
correction Escape/Avoid Tasks and
Activities 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-Behavior-Consequence) Analysis Form
Setting/ Activity/
Setting Events
Grocery store
Event Prior to Behavior
Parent told child to put
candy back on shelf
Behavior
Child screams, cries that he wants
the candy
Consequence
Parent lets the child have the candy to stop
him from crying
Home Sibling playing video
game
Hits, kicks, and bites sibling
Sibling gives the video
game to child
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 Date Tar Behv:123
Location Tar Behv:
Notes:
Activity
Pos. Reinf. Pos. Reinf. Neg. Reinf. Auto. Reinf.
Antecedent (attention) (materials) (escape) (sensory)
Ignored by staff
Leisure materia denied
other request denied
given inst. Prompt to w ork
provoked by peer
None (doing nothing)
ConsequenceAttention, response block
redirected to another area
leisure material given
w ork requirement termin
staff w alked aw ay
staff did nothing
TOTAL
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 attention-getting 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 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
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
May need slower pace for some individuals 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
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. 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!
Hurt
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. or or
5.
12.
6.
13.
7.
My Rewards
Follow the rules and get 10 minutes of my choice:
Rules
Prevention Strategies
Motivate compliance and cooperation by (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 (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, “Mo
m” 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)
Follow schedule
Participate in routine
Self-management
Request help
Teach delay of reinforcement
Request attention
Choice
Ask for a hug
Ask for a turn
Ask for item
RESPONSES TO PROBLEM BEHAVIOR: Obtain (e.g., attention, object, activity)
Redirect/cue to use appropriate “new replacement skill”
Cue with appropriate prevention strategy
State “exactly” what is expected
Offer choices
Use “wait-time”
Praise/reinforce when replacement skill is performed
Respond in a way that does NOT maintain problem behavior Minimize attention while responding to severe behavior Ignore minor behavior (“Planned ignoring”)
Prevention Strategies: Escape (e.g., activity, demands, social interaction)
Modify task length,
Modify expectations
Modify materials
Modify instructions,
Modify response mode
Break task down
Provide choice
Modify seating arrangements
Reduce distractions
Provide activity schedule
Select reinforcer prior to activity
Incorporate child’s interest
Use timer
Self-management system
Provide peer supports
Add manipulatives
Provide visual supports
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
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)
Request break
Set work goals
Request help
Follow schedule
Participate in routine
Choice
Self-management
Say “No”
Say “All done”
Identify and express feelings
Use supports to follow rules
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
Redirect/cue to use appropriate “new replacement skill” and then allow escape
Cue with appropriate prevention strategy
State “exactly” what is expected
Offer alternatives
Use “wait-time”
Praise/reinforce when replacement skill is performed
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 Analysis (2nd 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 Non-aversive 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/