Evidence Based Practices to Reduce Challenging Behavior

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Evidence-Based Practices to Reduce Challenging

Behavior

Lise Fox, Ph.D.University of South Florida

Evidence-Based Practices to Reduce Challenging

Behavior

Lise Fox, Ph.D.University of South Florida

Session DiscussionSession Discussion

Critical importance for developing systems to support teacher implementation of evidence-based practices

Adoption of a promotion, prevention, intervention model

Identifying evidence-based practices for early educators

National Centers - ResourcesNational Centers - Resources

Center on the Social and Emotional Foundations for Early LearningCenter on the Social and Emotional Foundations for Early Learning(CSEFEL) (CSEFEL)

www.vanderbilt.edu/csefel

Technical Assistance Center on Social Emotional Intervention (TACSEI)Technical Assistance Center on Social Emotional Intervention (TACSEI)

www.challengingbehavior.org

Key MessagesKey Messages

High quality caregiving + high quality environments ≠ No challenging behavior

Addressing challenging behavior = Promoting the development of social competence

We have evidence-based practices; but we need practitioners and systems to implement those practices with fidelity

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An estimated 9 to 13% of American children An estimated 9 to 13% of American children and adolescents between ages nine to 17 and adolescents between ages nine to 17 have serious diagnosable emotional or have serious diagnosable emotional or behavioral health disorders resulting in behavioral health disorders resulting in substantial to extreme impairment.substantial to extreme impairment.(Friedman, 2002) (Friedman, 2002)

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o More than half of students with More than half of students with SED drop out of grades 9-12, the SED drop out of grades 9-12, the highest rate for all disability highest rate for all disability categories. categories. (U.S. Department of Education, (U.S. Department of Education, 2002; 2006)2002; 2006)

o At 2 years post high school, At 2 years post high school, 58% of youth have been arrested 58% of youth have been arrested at least once and 42% are on at least once and 42% are on probation or parole. (NLTS2, probation or parole. (NLTS2, 2005).2005).

o Students with ED reported use Students with ED reported use of alcohol (54%), illegal drug use of alcohol (54%), illegal drug use (36%), marijuana use (33%), and (36%), marijuana use (33%), and smoking (53%) at rates higher smoking (53%) at rates higher than all other disability categories than all other disability categories (NLTS2, 2008)(NLTS2, 2008)

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Over 15% of all students with disabilities (6-21) are taking psychotropic medications (USDOE, 2005)

About 1/3 of all adolescent students with disabilities have been suspended or expelled (USDOE, 2005)

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Campbell (1995) estimated that approximately 10-15% Campbell (1995) estimated that approximately 10-15% of all typically developing preschool children have of all typically developing preschool children have chronic mild to moderate levels of chronic mild to moderate levels of behavior problems.behavior problems.

Children who are poor are much more likely to develop Children who are poor are much more likely to develop behavior problems with prevalence rates that approach behavior problems with prevalence rates that approach 30% (Qi & Kaiser, 2003).30% (Qi & Kaiser, 2003).

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Children who are identified as hard to Children who are identified as hard to manage at ages 3 and 4 have a high manage at ages 3 and 4 have a high probability (50:50) of continuing to have probability (50:50) of continuing to have difficulties into adolescence (Campbell & difficulties into adolescence (Campbell & Ewing, 1990; Campbell, 1997; Egeland et al., Ewing, 1990; Campbell, 1997; Egeland et al., 1990).1990).

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Early Predictors

•Temperamental Difficulties

•Early Aggression

•Language Difficulties

•Noncompliance

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Family Factors

•Maternal Depression

•Harsh Parenting

•Stressful Family Life Events

•Low Social Support

•Family Instability

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Depression Hurts

• D• Children of mothers who were depressed in their infancy are more likely to be delayed

• Children of depressed mothers are at increased risk for behavior problems, depression, and mood disorders in adolescence

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The correlation between The correlation between preschool-age aggression preschool-age aggression and aggression at age 10 and aggression at age 10 is higher than that for IQ.is higher than that for IQ. (Kazdin, 1995)(Kazdin, 1995)

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Early appearing Early appearing aggressive behaviors are aggressive behaviors are

the best predictor of the best predictor of juvenile gang juvenile gang membership membership and violence.and violence.

(Reid, 1993)(Reid, 1993)

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When aggressive and When aggressive and antisocial behavior has antisocial behavior has

persisted to age 9, further persisted to age 9, further intervention has a poor intervention has a poor

chance of success.chance of success. (Dodge, 1993)(Dodge, 1993)

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Young Children with Young Children with Challenging Behavior:Challenging Behavior:

•Are rejected by peersAre rejected by peers•Receive less positive Receive less positive

feedbackfeedback•Do worse in schoolDo worse in school•Are less likely to be Are less likely to be

successful in successful in kindergartenkindergarten

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Preschool children are three times more likely to be “expelled” than

children in grades K-12

(Gilliam, 2005)

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Faculty in higher education early childhood programs report that their graduates are least likely to be

prepared to work with children with persistently challenging behavior

(Hemmeter, Santos, & Ostrosky, 2004)

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Of the young children who need mental Of the young children who need mental health services, it has been estimated health services, it has been estimated that fewer than 10% receive services that fewer than 10% receive services for these difficulties. for these difficulties.

(Kataoka, Zhang, & Wells, 2002) (Kataoka, Zhang, & Wells, 2002)

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There are evidence-based practices that are effective in changing this developmental trajectory…the problem is not what to do, but rests in ensuring access to intervention and support (Kazdin & Whitley, 2006)

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The Pyramid ModelThe Pyramid Model

Pyramid ModelPyramid Model

UniversalPromotion

SecondaryPrevention

TertiaryIntervention

Nurturing and Responsive Relationships

Nurturing and Responsive Relationships

Foundation of the pyramidEssential to healthy social developmentIncludes relationships with children, families

and team members

RelationshipsRelationships

High Quality EnvironmentsHigh Quality Environments

Inclusive early care and education environments

Comprehensive system of curriculum, assessment, and program evaluation

Environmental design, instructional materials, scheduling, child guidance, and teacher interactions that meet high quality practices as described by NAEYC and DEC

Reviewing Rules

Transitions

Circle Time – Universal DesignCircle Time – Universal Design

Adult Support

From: www.headstartinclusion.org

Circle Time – Universal DesignCircle Time – Universal DesignPeer Support

From: www.headstartinclusion.org

Circle Time – Universal DesignCircle Time – Universal Design

Child Preference

Special Equipment

From: www.headstartinclusion.org

Circle Time – Universal DesignCircle Time – Universal Design

Environmental Support

From: www.headstartinclusion.org

Circle Time Circle Time Special Equipment

Circle Time Circle TimeChild Preference

From: www.headstartinclusion.org

Circle TimeCircle Time

Invisible Support

From: www.headstartinclusion.org

Circle TimeCircle Time

Simplify the Activity

From: www.headstartinclusion.org

Targeted Social Emotional Supports

Targeted Social Emotional Supports

Self-regulation, expressing and understanding emotions, problem solving, developing social relationships

Explicit instructionIncreased opportunities

for instruction, practice, feedback

Family partnershipsProgress monitoring and

data-based decision-making

Friendship Skills

• Gives suggestions (play organizers)

• Shares toys and other materials

• Takes turns (reciprocity) • Is helpful• Gives compliments• Understands how and

when to give an apology• Begins to empathize

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On Monday When

it Rained

Glad MonsterSad Monster

Hands Are Not for Hitting

Book Nookswww.vanderbilt.edu/csefel

Book Nookswww.vanderbilt.edu/csefel

Feeling Wheel & Feeling Dice

Feeling Wheel & Feeling Dice

Turtle Technique

Recognize Recognize

that you that you

feel angry.feel angry.

““Think” Think”

Stop.Stop.

Go into shell. Go into shell. Take 3 Take 3 deep deep breaths breaths and think and think calm, calm, coping coping thoughts.thoughts.

Come out of Come out of shell shell when when

calm and calm and think of a think of a solution.solution.

Would it be safe?Would it be fair?How would everyone feel?

Problem Solving Steps

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Step 2

The Solution KitThe Solution Kit

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Secondary – Skill Instruction

Secondary – Skill Instruction

Identify target skill

Identify learning opportunities and seek to maximize the number of learning trials

Select procedure for teaching

e.g., least to most, most to least, incidental teaching procedure, peer support, modeling, visual prompts

Track child progress

Individualized Intensive Interventions

Individualized Intensive Interventions

Comprehensive interventions

Assessment-based

Skill-building

Partnerships with families

Progress monitoring and data-based decision-making

Positive Behavior SupportPositive Behavior Support

Convene a team

Conduct functional assessment

Identify hypotheses

Develop behavior support plan for all relevant environments

4 years oldOnly childFirst preschool experience Strengths – very smart, loves books, engages well

with adultsChallenging Behaviors - Aggression, Verbal

threats, Destroys other children’s products, Damages toys intentionallySignificant risk of Preschool Expulsion

About TimAbout Tim

Before PBS

Team of individuals who know him best – teacher, parents, paraprofessional, assistant directorBehavior consultant guided the processFocused on understanding the purpose of Tim’s challenging behavior - importance of gathering informationDeveloped a comprehensive plan that includes:

Strategies for preventing his challenging behaviorNew skillsAdult responses

Classroom team and family implement and monitor plan outcomes

Develop PlanDevelop Plan

HypothesesHypotheses

Tim engaged in challenging behavior to:

initiate social interactions

enter into play

get access to particular toys

get teacher or peer attention

Behavior Support PlanBehavior Support Plan

Prevention StrategiesSocial story to describe behaviors that were expected during center play and outdoor activitiesReview of social story prior to center timePriming to remember skills to useVisual prompt to remember skills to use

I Can Be a SUPER FRIEND!I Can Be a SUPER FRIEND!

Created for Tim by Lisa Grant & Rochelle Lentini2002

I like talking and playing with my friends

at school.

My Friends get sad or mad when I hit, kick, use mean words, or take toys.

Sometimes, I want to play with what my friends are playing with.

When I play, I sometimes feel like taking toys, using mean words, or hitting and kicking.

If I want to join in play, I need to join nicely or ask to play with my friends’ toys.

I can say, “Can I play with that toy?” or “Can I play with you?”.

Can I play with you?

I can join my friends and play nicely. I can take turns.

I can go with the flow. I can stop, think, and do.

I CAN BE A SUPER FRIENDI CAN BE A SUPER FRIEND

I can join my friends and play nicely. ________

I can take turns nicely. ________

I can go with the flow. ________

I can stop, think, and do. ________

DATE: ___________

Tim’s Plan (cont.)Tim’s Plan (cont.)

Instructional StrategiesSocial skills instruction of each new skill (role play

and story review)Self-management system for new skills

Tim’s Plan (cont.)Tim’s Plan (cont.)

New ResponsesAttention to child who was assaultedPrevent access to toy or activityReview with Tim after incident has been

resolved

Tim – with PBSTim – with PBS

“If a child doesn’t know how to read, we teach.”

“If a child doesn’t know how to swim, we teach.”

“If a child doesn’t know how to multiply, we teach.”

“If a child doesn’t know how to drive, we teach.”

“If a child doesn’t know how to behave, we…… teach?… punish?”

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Pyramid ModelPyramid Model

UniversalPromotion

SecondaryPrevention

TertiaryIntervention

Evidence-Based Practices that

Promote the Social Emotional

Development of All Children

Assess your teachingAssess your teaching

How skilled are you at….Developing strong teaming relationships?Developing parent partnerships?Creating classroom environments that support the

active engagement of all children?Teaching social emotional skills intentionally to all

children?Teaching social emotional skills with sufficient

intensity to individual children who are at-risk of challenging behavior?

Assess your ProgramAssess your Program

Does your program…

Have a system for screening children for social emotional delays?

Ensure that children at-risk of challenging behavior receive intentional instruction and support that leads to outcomes?

Use data to make decisions about how to support children effectively?

Assess your programAssess your program

Does your program…Have a system for ensuring that children

with persistent challenging behaviors receive intensive, individualized support?

Offer teachers individualized professional development (training and coaching) to provide evidence-based approaches?

National Centers - ResourcesNational Centers - Resources

Center on the Social and Emotional Foundations for Early LearningCenter on the Social and Emotional Foundations for Early Learning(CSEFEL) (CSEFEL)

www.vanderbilt.edu/csefel

Technical Assistance Center on Social Emotional Intervention (TACSEI)Technical Assistance Center on Social Emotional Intervention (TACSEI)

www.challengingbehavior.org