13 Elements That Influence Behavior (and what should be in a good IEP) Michael J. Weiss, Ph.D. Applied Developmental Analysis (ADA) Therapy, LLC Fairfield.

13 Elements That Influence Behavior (and what should be in a good IEP)

Michael J. Weiss, Ph.D.

Applied Developmental Analysis (ADA) Therapy, LLC

Fairfield University

([email protected])

Levels of Emotional Regulation

A Developmental system for thinking about self-regulation and adult supports

Four levels of adult responsiveness to child’s levels of emotional regulation

• Level 1: Proactive growth factors– Need for meaningful education, therapy & relationships– Need to "push the envelop of growth" in emotional regulation

• Level 2: Read Emotions & Acknowledge Distress (READ)

– Need for recognition, acknowledgement and communication related to a person's distress, disagreement or other forms of refusal

– Need to return to proactive growth factors through communication, collaboration & compromise

• Level 3: Adult insistence on participation– Interaction partners need to both recognize the difference between a

request/choice and a "requirement”– If the activity is a "requirement” – adult must “compel” participation– Need to move past point of conflict and through the activity

• Level 4: Reactive strategies to extreme distress & actions– Need to keep everyone safe– Need to create calm & return to proactive growth factors

Level 1: proactive factors & strategies that influence children’s growth & behavior

1. Definitions & Data2. Medical team evaluation3. Relationships and finding my child’s (and my) voice 4. Communication5. Sensory & movement issues6. Multimodal channels of information7. Intensity, diversity, generalization8. Assume competence: offering a wide academic window9. Inclusion in the world10. Make plans do-able11. Understand your belief-systems12. Dynamic behavior (“parenting”) plan13. Medical management

Level 1.1: Definitions & data: be evidence based

• Have you defined the behaviors, educational and therapeutic targets of concern?

• Factually note: what, where, when, who

• What happened before and after events– Indicate “antecedents” and “consequences” or

environmental factors

• Record frequency and duration of events?

But, beware of “data-ists”• You know… racist, sexist, dataist….

• The “big data lie” – “there is no data…”– Beware of statements like, “the literature indicates…”– “no data” is interpreted to mean “no truth”– Concerning most therapies, what should be said is that

“it hasn’t been appropriately studied yet”

• Assessing issues in clinical settings is time consuming, costly, hard-to-control & contrary to providing services “right now”– That doesn’t mean intuition should be ignored– Nor, does it mean that we should NOT collect

information

“An absence of evidence is not evidence of absence (Dr. Carl Sagan) ”

Level 1.2: Medical team evaluations

Pervasiveness of medical issues that follow our kids, i.e., Neurological, Gastrointestinal anomalies– See Tim Buie in Bauman & Kemper (2004) Neurobiology

of Autism

• Who is the total team that is sharing information– Neurologist, Geneticist, Endocrinologist, ENT, Urologist,

Immunologist, Orthopedist, GI, Dentist, & more….

• Psychopharmocology generally, put in place non-medical interventions of behavioral development first – use of medications should routinely “go last”

Level 1.3: Recognizing the PERSON: Finding your child’s “voice”

• What does your child like to do? What do they gravitate toward?

• Consider the who, what, where, when of actions in terms of “why”– go beyond the facts and make guesses about motives and desires about

what is motivating a child’s behavior– Yet, recognize the fallibility of guessing!

• Enlist your child on his/her terms– Join in (Floor time/Relationship Development Intervention)

• Offer age-appropriate options, choices & autonomy

• Create therapeutic opportunities for self-expression– Have you asked the child/student/patient “why” they do what they do or how

they feel about what is going on?

Level 1.4: Communication• Communication occurs ALL DAY

− Not “two times 30-minutes”− Should NOT require a Speech & Language Pathologist − Training staff & family is the life blood of all-day communication

• Total Communication systems− Verbal behavior programs− Gestures & Sign− Picture-symbol-systems − Augmentative and Alternative Communication (AAC)− Schedules, aided Language boards & use of “visuals”− MUSIC− Teaching THE ALPHABET!!

• Have you given the child a means of saying what they might like to say?

−“None of the above”−“More string to ‘stim’ with please” −“Drop dead you jack-ass”

Level 1.4: CommunicationUsing music & reading to access speech & language

Level 1.4: Communication• Discussions of feelings, thoughts, desires

– Social-affective-emotional vocabulary

• Social curricula with instruction in pragmatics– “Social grammar:” turn-taking, reading cues, etc.– Learn how to anticipate what others’ are saying– Learn how to interpret others’ feelings about what they are saying– Use commercially available curricula as instructional/therapeutic guide

• Age-typical partners: don’t let your child’s only communication partners be adults and other children with developmental concerns

• Rehearsal of social communication– Social stories– Social scripts– Video models and video self-monitoring

Social script rehearsal for “Maine”

conversations Pam: Do you ever go skiing in the mountains?Megan: Yes, I go skiing in the mountains.Pam: What else can you do in the mountains?Megan: I can go sledding. I can go hiking up a

mountain path.Pam: What else?Megan: I can climb rocks.Pam: What do mountains look like?Megan: Mountains are tall.

Mountain peaks are pointed.Sometimes snow is on the mountain peak, even in the

summer.Pam: When there is a lot of snow in the driveway

what do you need to do?Megan: I need to shovel the snow to clear the way.

Level 1.5: Sensory & Movement realities

• Recognizing autism (and a wide host of other developmental disorders) as a “sensory-movement disorder”

• Consider what types of therapies influence movement regulation in others’ that share the diagnosis of ASD

• Consider other forms of movement disorders (i.e., issues related to cerebellum or basal ganglia; Parkinson’s; stroke patients, etc.) and what therapies help these individuals

The Neurobiology of Movement Disorders & Autism (Bauman, 2008; Bauman & Kemper, 2005; Courchesne & Allen,

1997; Hollander, et al., 2005)

• The embryological early anomalies to effect development:

– Brainstem/Inferior Olive • Cranial nerve development• Somatosensory information

– Cerebellum • Regulates all movement• Regulates sensory processes• Motor, language & cognitive planning, sequencing, timing &

organization

– Basal Ganglia• Enlarged aspects (right caudate/total putamen volume)

correlates with uncontrolled or perseverative movement

Correlations among aberrant movement patterns in:

• Speech

• Ballistic/Aberrant & repetitive movements

• Throwing

• Grasp/hand use

• Lip Closure

• Gait

• Hopping & jumping

• Reaching/Crossing midline

• Kneeling & standing

• Disassociation of movement of different body parts

• Difficulties in core strength, idiosyncratic weakness and/or hypotonia

• Balance and coordination dysregulation

• Cerebellum and Basal Ganglia regulation?

What might they have in common?

Autism is a movement disorder!

Level 1.5: Sensory & Movement realities

• Recognizing environmental “contributions” (“noise” in any sensory modality)

• Again, therapies are ALL DAY

• “Sensory Diets”: managing arousal cycles

• Oral-motor programming and daily carry-over

• Real movement opportunities – Movement/expressive therapies (music/dance/art)– Break-a-sweat exercise– Use “incidental” exercise: sitting on a stool– Organize when movement is and is not encouraged

Level 1.6 Considering multimodal channels of information

• Which modalities of taking in information goes with the least distress (seeing, hearing, touching??)

• How to systematically combine modalities:– Play with modalities one at a time– Systematically add, subtract, mix modalities– Use behavior as an index of too many or too few?

• Most common “good combination?”– Use visual information more – Talk at children less– Incorporation of touch that suits the child

Level 1.7: Understanding Intensity, diversity & generalization strategies

• Intensity means: – hundreds of repetitions daily to further responsiveness– long periods of time dedicated– “early intervention” for 3-hours/week exemplifies “non-intensity”

• Diversity of experiences effects attention – Moderate novelty in activities associated with alerting– Redundancy is associated with inattention (i.e., habituation)

• Teach with intensity and diversity promotes generalization – systematically put in long hours with several differing:

– Ways of presenting materials– People– Locations– Orders of activities– Repetition of activities through the day (rather than all at once)

Intensity-diversity-generalization of exposure to curricula

(1) Communication systems are an all day requirement(2) Assistive technologies are omnipresent (verbal

behavior; aided language boards; software; communication devices; picture-symbol systems)

(3) Expansion into the “personal world” of interest-reality themes

(4) Expansion into the social world (social scripts; social stories; functionality in the real world)

(5) Table-top activities in support of real-world activities (how instruction traverses different methodologies)

(6) Taught through diverse medium/methods (i.e., learning to read music)

(7) Taught in a generalized manner; learned for generalize application

Level 1.8: Assuming competence: offering the dignity of age-appropriate curricula

• The “retardation” or the “not ready yet” assumptions– Performance is a measure of competence? Ask a person

diagnosed with Cerebral Palsy if they agree

– Work at the child’s “developmental level?” Which is….? Fallacy of IQ or Developmental Quotients as global indicators

– Discussions that the child can hear (but, shouldn’t) “stick of furniture” phenomenon

– Assuming high level of performance is a “splinter skill” or an “odd” behavior is the death of developing person-specific abilities/skills

Level 1.8: Assuming competence: offering the dignity of age-appropriate interactions and

curriculaSo…what should be our guide?• Have a great teacher as one of our guides!

• Do use a tracking device (i.e., Activities of Basic Learning & Language Scales (ABLLS)) or other measurable data systems

• Avoid “linear programming” and “mastery criteria” as only mechanism of change

• Select a developmentally “wide window” of activities concurrently

• Vary extent of supports v. level of independence as a function of task complexity, i.e., high-level activity with “errorless” supports

• Select activities that lend themselves to age appropriate modifications

– What is an age-appropriate version of the child’s obsessions or preoccupations?

Level 1.8: Assuming competence: offering the dignity of age-appropriate curricula

Academic computer software offering a “wide window” of intellectual opportunity (without the “social distractions”)

• Simple Sentence Structure• EER: Plurals• EER: Prepositions• First Categories• Adjectives & Opposites• Words & Concepts I, II & III• Concentrate! I• Follow Directions: 1 & 2

Level Commands• Micro-LADS programs (i.e.,

Prepositions & Pronouns)• Sentence Master 1, 2, & 3• Number Maze

• Dollars and Cents• Picture Sentence Key 1• Picture Sentence Key 2• Pix Writer• Clicker 5• First Keys to Literacy• All My Words• Write: Out Loud• Simon Sounds It Out 2• Visual Voice• Typing Quick and Easy• Black Beauty

Software companies that you should know about

• Don Johnston

• Laureate Learning Systems

• Crick Software

Level 1.9: “Inclusion” in the world

• Real relationships: friends, loved ones and being a legitimate member of our community

– Modeling and “regression toward the mean”

• Organizing and generalizing our day-to-day conduct – don’t avoid going out

• Catch-22 irony: why aren’t our kids included? Usually related to complicated behavior. Why is behavior complicated? Partly because we aren’t included in the world.

– Going out IS HARD TO DO!– Promoting behavior in the world? Don’t want to “make a

scene”

Level 1.10: Make plans Do-able

• Figuring out how much you can realistically do• “Prep time” for all involved• REAL training and consultation of teaching staff

and family (not “15-minutes per week consult”)• Team meeting opportunities• Formalizing fun time together• Formalizing fun time apart• Getting a babysitter• In-home services • Insistence on sufficient staffing

Connecticut “Bill 301” – Family Insurance coverage for ASD’s

• Coverage for behavior services, OT, PT, Speech/Language (home programs)

• Must be a diagnosis of ASD’s

• Age and amount ($) of coverage– 2 to 9: $50,000/year– 9 to 13: $35,000/year– 13 to 15: $25,000/year

Level 1.11: Beliefs about childrearing and my child

• Wanting change is not mutually exclusive with accepting people for who they are

• People diagnosed with a developmental difference are still children, adolescents, adults

– Interact with each individual according to both developmental status and chronological age

– Yet, at no point across development is harming yourself or others acceptable behavior

• Beliefs about competence translates into levels of expectations– Expectations establish comfort zone for what we will insist of our

children– Young man in Westport, CT diagnosed with Asperger’s who drives

himself to University

• “I (teacher/parent/therapist) am entitled to respect and deference from my child/student/client, just as I owe them respect and deference”

Level 1.12: A flexible & dynamic behavior (“parenting”) plan

• Predicated on concepts from the study of social development (i.e., children benefit from “authoritative” parenting), not from animal models of learning

– Children do well in a climate combining unconditional love & support, with high standards & expectations

• Understanding basic principals of Operant Theory is extremely useful in understanding how you are parenting/teaching a child

– Know the definition of (i) positive reinforcement; (ii) negative reinforcement; (iii) punishment; & (iv) extinction

• Principal focus of contingencies should revolve around “self-determination” (or the restrictions there of)

– “Naturally occurring” consequences of doing what you want if you are comporting yourself appropriately… or not.

Level 1.13: Data-driven medical management

• Going in “the right order”: points 1 through 12 above go first whenever possible

– Obvious medical exceptions i.e., seizure activity, medical illness, disease, conditions, etc. (see point #2))

• Find a physician who: (i) you like!; (ii) returns your phone calls; (iii) is data driven; (iv) who asks about the educational/therapeutic programs; (v) is willing to try a diverse set of approaches

• Back to point #1: define what you are doing and collect data– Be able to define what you are treating– If medical treatment isn’t working… CHANGE OR STOP!!

• Identify “blind evaluators” in the data collection process

Level 1: proactive factors & strategies that influence PEACE

1. Definitions & Data2. Medical team evaluation3. Relationships and finding my child’s (and my) voice 4. Communication5. Sensory & movement issues6. Multimodal channels of information7. Intensity, diversity, generalization8. Assume competence: offering a wide academic window9. Inclusion in the world10. Make plans do-able11. Understand your belief-systems12. Dynamic behavior (“parenting”) plan13. Medical management

Video: Tate in the Grocery Store

Use of positive consequences to insist the child’s participation

1. Autonomy (doing as they please)2. Attention (eye contact, body posture,

proximity, being silly, etc.)– Verbalizing toward child (i.e., yelling at them,

praise, singing a song to them, etc.) is highly reinforcing!

3. Any desired objects (i.e., favorite toys)4. Any desired activity (trips, games, places,

etc.)5. Token systems and “markers” of impending

rewards

Use of negative consequences (“penalties”) to insist on the child’s participation

1. Ignoring minor or low priority actions2. Verbal redirection3. Physical redirection (blocking & proximity

management)4. Removal of rewards/autonomy (all forms of “time-

out” or “response cost”)5. Physical escorts, hand-over-hand requirement

(“over-correction”)6. Restitution (righting the environment)7. Restrictive-location time-out (bedroom/high chair)8. Physical restraint (using appropriate training

protocols such as “Prevention & Management of Aggressive Behavior” (PMAB))

The “positive behavioral supports” are those…

• … done proactively (and sometimes reactively);

• … non-contingently;• … regulated with the willingness or choosing

of the child.

“Positive behavioral supports” are not…

• … anything that involves a contingency!Cardinal rule of Operant Condition: create a state of “want or desire” by

depriving the person of the putative reinforcer.Only give access to reinforcer when it has been “earned.”This type of contingent “relationship” (between child and gate keeper of

the rules) is – by definition – a form of “power assertion” (and not very fun if you are on the low end of the relationship).

TIMING!!!!!!!!!!!!!!!!Timing of response to appropriate behavior

• Frequency and predictability in giving rewards

• Only ask the child to give you a behavior that is in their repertoire

• "Fading" and "thinning" of rewards

TIMING!!!!!!!!!!!!!!!!Timing of response to inappropriate behavior

• Immediacy and certainty: be “startling”– Startle is very compelling– Use this to convey “important messages”– Use this to “insist” that you be attended to

• The importance of brevity and frequency– Adult responses are moments in duration

(duration of a startle) – Adult responds as often as possible to behavior

TALKING!!!!!!!!!!!!!!!!Verbal exchange around inappropriate behavior?

• Say Nothing!!! Act first, then talk!

• Talk AFTER the fact of a “penalty”, or during calm periods.

• Vocal tones and facial expressions carry "the message": actively modulate your affect

Level 1.4: Communication• Discussions of feelings, thoughts, desires

– Social-affective-emotional vocabulary

• Social curricula with instruction in pragmatics– “Social grammar:” turn-taking, reading cues, etc.– Learn how to anticipate what others’ are saying– Learn how to interpret others’ feelings about what they are saying– Use commercially available curricula as instructional/therapeutic guide

• Age-typical partners: don’t let your child’s only communication partners be adults and other children with developmental concerns

• Rehearsal of social communication– Social stories– Social scripts– Video models and video self-monitoring

PROXIMITY!!!!!!!!!!!!!!!!Where are you standing in relation to behavior?

• Be close enough to physically intervene if it is needed– talking (complaining, directing, repeating) from a

distance is often reinforcing inappropriate behavior

– paying attention to the child, yet too far away to physically intervene

• The "riskier" the situation, the closer you should be standing

• Practice giving your child some space– Set up routines in which you can come and go

Insisting of our children?INTERNAL CONSISTENCY

• Are you "credible"?

• Are you following your sense of right?

• Say what you mean, mean what you say, do what you say you are going to do!

Insisting of our children?Decisive Parenting/Teaching

• Do you have a plan that allows you the luxury of being confident in what you are expecting?

• Once you have developed the plan, let it “play out” even if what you are finding is that the plan is wrong

• Defining words: conclusive, definitive, determined, final, definite, positive, resolute.

• Antonyms: inconclusive, hesitant• Being decisive is NOT INCONSISTENT

with warmth and sensitivity

Insisting of our children?Decisive Parenting/Teaching

• Easier to read from the child’s point of view– offers more clear-cut cues compared to subtle variations

in response

• More consistent and predictable– allows the child to anticipate what is going to happen and

accommodate change in actions before the fact of a behavior

• Decisive people who are warm and caring are more:– desirable to the children– Are “attended to”– relied upon as a source of information

The results of challenging our children’s challenging behavior?

• Their options of being out in the world grow exponentially

• Your child’s intellect will be challenged & promoted

• Your child’s autonomy and voice will be preserved and promoted

• We convey a sensitivity to life’s difficulties, yet convey a message of mutual fun, love, respect & participation